Avaliação do custo real da utilização dos Equipamentos de Proteção Individual durante a pandemia da Covid-19 na perspectiva de um hospital público terciário.
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2022-09-30
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Universidade Estadual Paulista (Unesp)
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Introdução: a pandemia ocasionada pelo novo coronavírus (SARS-CoV-2), causador da doença desencadeada pelo coronavírus (Covid-19), tem impactado o trabalho dos profissionais da saúde, os quais têm enfrentado os árduos atendimentos aos pacientes acometidos além do combate à propagação desse vírus. Os equipamentos de proteção individual (EPIs) são empregados para reduzir o risco de contaminação por fatores e/ou objetos infectados por germes, e são essenciais para a proteção tanto do profissional de saúde como do paciente. No cenário atual dessa pandemia, é notório o crescente uso desses EPIs por todos os serviços de saúde. Objetivo: realizar uma avaliação do custo real dos EPIs utilizados pelos profissionais de saúde no contexto da pandemia da Covid-19 na perspectiva de um hospital público terciário. Metodologia: trata-se de um estudo de identificação de custos em saúde, no qual utilizou-se a metodologia de microcusteio e a identificação dos componentes de custo deu-se de baixo para cima. A perspectiva foi a do pagador, do Hospital de Clínicas da Faculdade de Medicina de Botucatu (HCFMB). Foram considerados dois cenários: o uso dos EPIs um ano anterior ao início da pandemia da Covid-19, e comparador foi o uso dos EPIs no ano de 2021. Foram identificados para os custos os seguintes EPIs: avental descartável, luvas de procedimento e estéreis, máscaras cirúrgicas e N95, gorro descartável e óculos de proteção. A mensuração da utilização dos EPIs deu-se a partir da rotina de serviço de cada setor estudado (enfermarias, prontos socorros, UTIs, unidades e isolamentos), do número de pacientes internados, bem como a mediana dos dias de hospitalização dos pacientes por setor de internação. A partir da quantidade de pacientes, mediana de dias de hospitalização, local de internação, quantidade de EPIs usados por paciente, custo unitário de cada EPI, foram estimados os custos com EPIs por cenário, por ano. No cenário da Covid-19 foram computadas uma máscara N95 por mês, por profissional de saúde atuante no HCFMB. Para análises das incertezas durante a pandemia foram usadas as seguintes variáveis: frequência de adesão do profissional ao uso dos EPIs, intervalo interquartil (ITQ) da mediana de dias de internação e variação do custo individual de cada EPI (2020 versus 2021). Resultados: O total de pacientes internados no ano de 2019 no HCFMB foi de 29.416, e o período mediano de internação foi de 4 (ITQ 2 a 7). Já no ano de 2021 foram hospitalizados 26.618 indivíduos, com mediana de dias de internação de 6 (ITQ: 2 a 8). Considerando uma adesão de 100% de adesão ao uso dos EPIs pelos profissionais de saúde, o custo total estimado pelo HCFMB em EPIs no anterior a pandemia da Covid-19 foi de R$ 2.976.296,80, e por paciente foi de R$ 101,18. Durante a pandemia o custo total estimado foi de R$ 5.847.742,18 e por paciente de R$ 219,69. Na análise das incertezas durante a pandemia, a variável que mais influenciou no custo total e por paciente foi o custo individual dos EPIs, comparando o preço em 2021 com o preço em 2020 (R$ 5.847.742,18 versus R$ 15.222.480,80 de custo total). Conclusão: A diferença de custos entre os anos de 2019 e 2021 foi de R$ 2.871.445,38 no custo total e de R$ 118,5 no custo por paciente. Nas análises de incertezas, o custo por EPI no início da pandemia (2020) comparado ao custo em 2021 foi o que mais influenciou na estimativa de custo total, seguido pela mediana de dias de internação.
Introduction: the pandemic caused by the new coronavirus (SARS-CoV-2), which causes the disease triggered by the coronavirus (Covid-19), has impacted the work of health professionals, who have faced the arduous care of affected patients in addition to fighting to the spread of this virus. Personal protective equipment (PPE) is used to reduce the risk of contamination by factors and/or objects infected by germs and is essential for the protection of both the health professional and the patient. In the current scenario of this pandemic, the increasing use of these PPE by all health services is notorious. Objective: to carry out an assessment of the real cost of PPE used by health professionals in the context of the Covid-19 pandemic from the perspective of a tertiary public hospital. Methodology: this is a health cost identification study, in which the micro-costing methodology was used, and the cost components were identified from bottom to top. The perspective was that of the payer, from the Hospital de Clínicas of the Faculdade de Medicina de Botucatu (HCFMB). Two scenarios were considered: the use of PPE one year prior to the start of the Covid-19 pandemic, and the comparator was the use of PPE in the year 2021. The following PPE were identified for costs: disposable apron, procedure, and sterile gloves, surgical and N95 masks, disposable cap and goggles. The measurement of the use of PPE was based on the service routine of each sector studied (wards, emergency rooms, ICUs, units, and isolation), the number of hospitalized patients, as well as the median number of days of hospitalization of patients per sector of hospitalization. Based on the number of patients, median days of hospitalization, place of admission, number of PPE used per patient, unit cost of each PPE, the costs with PPE per scenario, per year were estimated. In the Covid-19 scenario, one N95 mask per month was computed per health professional working at the HCFMB. For analysis of uncertainties during the pandemic, the following variables were used: frequency of professional adherence to the use of PPE, interquartile range (ITQ) of median days of hospitalization and variation in the individual cost of each PPE (2020 versus 2021). Results: The total number of patients admitted to the HCFMB in 2019 was 29,416, and the median length of stay was 4 (ITQ 2 to 7). In the year 2021, 26,618 individuals were hospitalized, with a median of days of hospitalization of 6 (ITQ: 2 to 8). Considering a 100% adherence to the use of PPE by health professionals, the total cost estimated by the HCFMB in PPE prior to the Covid-19 pandemic was R$ 2,976,296.80, and per patient was R$ 101.18. During the pandemic, the total estimated cost was BRL 5,847,742.18 and BRL 219.69 per patient. In the analysis of uncertainties during the pandemic, the variable that most influenced the total cost and per patient was the individual cost of PPE, comparing the price in 2021 with the price in 2020 (BRL 5,847,742.18 versus BRL 15,222,480 .80 of total cost). Conclusion: The cost difference between 2019 and 2021 was BRL 2,871,445.38 in total cost and BRL 118.51 in cost per patient. In the uncertainty analyses, the cost per PPE at the beginning of the pandemic (2020) compared to the cost in 2021 was what most influenced the total cost estimate, followed by the median of days of hospitalization.
Introduction: the pandemic caused by the new coronavirus (SARS-CoV-2), which causes the disease triggered by the coronavirus (Covid-19), has impacted the work of health professionals, who have faced the arduous care of affected patients in addition to fighting to the spread of this virus. Personal protective equipment (PPE) is used to reduce the risk of contamination by factors and/or objects infected by germs and is essential for the protection of both the health professional and the patient. In the current scenario of this pandemic, the increasing use of these PPE by all health services is notorious. Objective: to carry out an assessment of the real cost of PPE used by health professionals in the context of the Covid-19 pandemic from the perspective of a tertiary public hospital. Methodology: this is a health cost identification study, in which the micro-costing methodology was used, and the cost components were identified from bottom to top. The perspective was that of the payer, from the Hospital de Clínicas of the Faculdade de Medicina de Botucatu (HCFMB). Two scenarios were considered: the use of PPE one year prior to the start of the Covid-19 pandemic, and the comparator was the use of PPE in the year 2021. The following PPE were identified for costs: disposable apron, procedure, and sterile gloves, surgical and N95 masks, disposable cap and goggles. The measurement of the use of PPE was based on the service routine of each sector studied (wards, emergency rooms, ICUs, units, and isolation), the number of hospitalized patients, as well as the median number of days of hospitalization of patients per sector of hospitalization. Based on the number of patients, median days of hospitalization, place of admission, number of PPE used per patient, unit cost of each PPE, the costs with PPE per scenario, per year were estimated. In the Covid-19 scenario, one N95 mask per month was computed per health professional working at the HCFMB. For analysis of uncertainties during the pandemic, the following variables were used: frequency of professional adherence to the use of PPE, interquartile range (ITQ) of median days of hospitalization and variation in the individual cost of each PPE (2020 versus 2021). Results: The total number of patients admitted to the HCFMB in 2019 was 29,416, and the median length of stay was 4 (ITQ 2 to 7). In the year 2021, 26,618 individuals were hospitalized, with a median of days of hospitalization of 6 (ITQ: 2 to 8). Considering a 100% adherence to the use of PPE by health professionals, the total cost estimated by the HCFMB in PPE prior to the Covid-19 pandemic was R$ 2,976,296.80, and per patient was R$ 101.18. During the pandemic, the total estimated cost was BRL 5,847,742.18 and BRL 219.69 per patient. In the analysis of uncertainties during the pandemic, the variable that most influenced the total cost and per patient was the individual cost of PPE, comparing the price in 2021 with the price in 2020 (BRL 5,847,742.18 versus BRL 15,222,480 .80 of total cost). Conclusion: The cost difference between 2019 and 2021 was BRL 2,871,445.38 in total cost and BRL 118.51 in cost per patient. In the uncertainty analyses, the cost per PPE at the beginning of the pandemic (2020) compared to the cost in 2021 was what most influenced the total cost estimate, followed by the median of days of hospitalization.
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Avaliação do custo real, Equipamento de proteção individual, Profissionais da saúde, COVID-19 (Doença), Pandemias