Acknowledgements

The direct medical and nonmedical costs and indirect costs related to the diabetes patient increase over time, especially due to the consequences of the relative risk associated with A1c values, and consequently, to the presence of late complications [7, 36]. Thus, health services need to cope with rising costs in contrast to scarce resources [37]. This scenario becomes a challenge for the health system, considering the increase in the life expectancy of DM patients. Several studies are able to show that preventive measures have a positive benefit/cost ratio when considering the care of the diabetic individual [36, 38]. In addition, it is possible to have a 33% increase in expenses related to DM care in 2 years when glycemic levels are not at

Expenditures on DM treatment consume up to 12% of the annual health expenditure in the world [40]. It is noteworthy that medications are responsible for 48.2% of the direct costs of a diabetic patient [41]. In a study performed by Marinho et al., in a medium-complexity institution for DM patients, direct costs related to type 2 diabetes mellitus (T2DM) totaled US \$ 2,066,081 and 250,000 procedures were performed in the same period. Of this total, 36.3% was consumed by medication, 20.5% was third-party services (administrative, courses, rent, etc.) and 20.1% was spent by paying highly educated professionals in health care and management, high school educated supporting professionals and trainees involved in

In Brazil, for example, the prevalence of T2DM patients is approximately 15% and annual expenditures are approximately 3.9 billion dollars. The Public Health System (PHS) spends an average of US\$ 2108.00 per year for outpatient treatment with each diabetic patient. Of this, US\$ 1335.00 is considered a cost directly related to diabetes [41]. In a Pharmaceutical Care program for diabetic patients, Obreli-Neto et al. showed a mean reduction of 0.7% in A1c values for patients who had empowerment, along with medication treatment management (MTM) in the program. In addition, US\$ 660.80 of the total of US\$ 916.30 spent per patient on

It is noteworthy that many patients become incapacitated as a result of the severity of DM complications, which leads to an increase in indirect costs for the health system [21, 43]. The WHO estimates that the costs of loss of productivity of DM patients can exceed up to five times the direct costs of this disease [20, 36]. It is seen that empowerment of the diabetic patient improves glycemic control and, consequently, reduces the incidence of DM complications over time, which is the main aspect to reduce costs with the treatment of the disease; empowerment of the diabetic patient can be considered an efficient health technology for

Many studies have presented the theme of economic evaluation focused on the care provided by the pharmacist, such as pharmaceutical care, which uses methods such as MTM and patient empowerment [22, 44]. Pharmaceutical care in a program for the elderly with T2DM and systemic arterial hypertension followed in primary health care in a municipality in the interior of the state of São Paulo, showed that the implementation of pharmaceutical care does not add significant costs to the health service when compared to the results of the best outcomes achieved in patient care [35]. In other words, care strategies such as pharmaceutical care may

be more effective and efficient alternatives for health systems.

satisfactory levels and complications of the disease occur [39].

health care [42].

172 Diabetes and Its Complications

health systems.

DM care was saved [23, 35].

We thank the FAPESP funding agency for the scholarship support for the author Maurilio Souza Cazarim [grant number 2016/03584-1] from 07-01-2016 to 28-02-2019, URL (http://bvs. fapesp.br/en/pesquisador/673633/maurilio-de-souza-cazarim/). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Opinions, assumptions and conclusions or recommendations expressed in this chapter are the authors' responsibility and do not necessarily reflect the viewpoint of FAPESP.
