Custos de órteses, próteses e materiais especiais não contemplados no Sistema Único de Saúde (SUS) em hospital de ensino brasileiro
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Data
2017-02-07
Autores
Camargo, Telma Aparecida de [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: O uso de órteses, próteses e materiais especiais (OPME) está diretamente relacionado à evolução dos procedimentos cirúrgicos, sendo que as especialidades de ortopedia e cardiologia foram as primeiras a fazer uso dessa tecnologia. Hoje a medicina dispõe de OPME complexos, principalmente nas cirurgias endovasculares. Com a evolução tecnológica dos dispositivos médicos, acompanhada ao ganho na prestação de assistência médica, encontra-se a preocupação com a insuficiência de recursos no setor público, que adota o recurso da avaliação econômica para tomada de decisões. É evidente que nos hospitais de ensino a necessidade de investimento em tecnologia é maior do que nas demais instituições devido à complexidade dos atendimentos, a presença de médicos especialistas e atividades de ensino. Ademais, os lançamentos de dispositivos médicos geralmente não são remunerados pela tabela do Sistema Único de Saúde (SUS), sendo importante a avaliação de tecnologias em saúde (ATS) para incorporação de nova tecnologia por meio da Comissão Nacional de Incorporação de Tecnologias (CONITEC). Objetivo. Analisar os custos dos dispositivos de OPME exclusivamente relacionados ao ato cirúrgico, não incluídos na tabela SIGTAP. Método: Trata-se de um estudo descritivo retrospectivo, com análise quantitativa dos dados de uso de dispositivos não incluídos na tabela SUS de um Hospital Público Universitário, localizado no interior do Estado de São Paulo e vinculado à Secretaria de Estado da Saúde de São Paulo. Resultados: Foram identificados 11 dispositivos médicos não incluídos na tabela SUS, cujo valor unitário de aquisição variou entre R$ 178,00 e R$ 17.460,00, correspondendo a 146 (3%) do total de internações com uso de OPME. O custo total da internação/procedimento, incluindo a OPME que não consta na Tabela SUS, foi superior ao ressarcimento pelo SUS na maioria dos dispositivos estudados. Conclusão: O estudo possibilitou o mapeamento dos dispositivos utilizados nas instituições hospitalares, não ressarcidos pelo SUS, e foram identificados os custos elevados com as internações e/ou procedimentos envolvendo as OPME. Evidenciou ainda a necessidade de estudos de Avaliação de Tecnologias em Saúde dos dispositivos para tomada de decisão dos gestores. Produto: Foi elaborado parecer técnico-científico (avaliação de tecnologias em saúde) do dispositivo Kit de artroscopia de ombro para contribuir com a tomada de decisão do gestor da instituição local.
Introduction: The use of orthoses, prostheses and special materials (OPME) is directly related to the evolution of surgical procedures and orthoprdic and cardiology specialties were the first to make use of this technology. Nowadays, with the technological evolution of the medical devices, the OPME are more complex especially in endovascular surgeries. These improvements were accompanied by a better heath care quality; however, there is a concern about the limited resources of the public sector. Therefore, the use of economic evaluation for the decision-making in the area of OPME is fundamental. Teaching hospitals needs more investments in technology than other institutions due to the complexity of the procedures, the presence of medical experts and students of various degrees in addition, there is a gap between the launch of a new OPME device and the incorporation of this technology by public health system in Brasil (Sistema Único de Saúde – SUS). Therefore, is important a cost- benefit assessment of the new health technologies (ATS) in OPME before the incorporation by the National Commission for the Technologies Incorporation. . Objective: Map the devices of OPME, not included in the SUS table, limited to those related to the surgical act and calculate their costs. Method: This is a retrospective descriptive study, with quantitative analysis the data concerning the use of OPME devices not included in the SUS table of a Public University Hospital, located in the interior of the State of São Paulo and linked to the State Department of Health of São Paulo. Results: Were identified 11 medical devices not included in the SUS table, whit unit value of acquisition varied between R$ 178.00 to R $ 17.460,00, corresponding to 146 (3%) of the total admissions using OPME. The total cost of the hospitalization / procedure, including OPME not incorporated in the SUS table, was higher than the reimbursement for almost all the devices studied. Conclusion: The study shows that is possible to map the devices not reimbursed by the public health system, and identified the high costs of hospitalizations and / or procedures involving OPME. It also evidenced the need for studies of Health Technology Assessment to help decision-making of the hospital managers. Product: It was elaborated the technical-scientific opinion (health technology assessment) from the device Kit of the shoulder arthroscopy to contribute with the decision-making of the manager of the local institution.
Introduction: The use of orthoses, prostheses and special materials (OPME) is directly related to the evolution of surgical procedures and orthoprdic and cardiology specialties were the first to make use of this technology. Nowadays, with the technological evolution of the medical devices, the OPME are more complex especially in endovascular surgeries. These improvements were accompanied by a better heath care quality; however, there is a concern about the limited resources of the public sector. Therefore, the use of economic evaluation for the decision-making in the area of OPME is fundamental. Teaching hospitals needs more investments in technology than other institutions due to the complexity of the procedures, the presence of medical experts and students of various degrees in addition, there is a gap between the launch of a new OPME device and the incorporation of this technology by public health system in Brasil (Sistema Único de Saúde – SUS). Therefore, is important a cost- benefit assessment of the new health technologies (ATS) in OPME before the incorporation by the National Commission for the Technologies Incorporation. . Objective: Map the devices of OPME, not included in the SUS table, limited to those related to the surgical act and calculate their costs. Method: This is a retrospective descriptive study, with quantitative analysis the data concerning the use of OPME devices not included in the SUS table of a Public University Hospital, located in the interior of the State of São Paulo and linked to the State Department of Health of São Paulo. Results: Were identified 11 medical devices not included in the SUS table, whit unit value of acquisition varied between R$ 178.00 to R $ 17.460,00, corresponding to 146 (3%) of the total admissions using OPME. The total cost of the hospitalization / procedure, including OPME not incorporated in the SUS table, was higher than the reimbursement for almost all the devices studied. Conclusion: The study shows that is possible to map the devices not reimbursed by the public health system, and identified the high costs of hospitalizations and / or procedures involving OPME. It also evidenced the need for studies of Health Technology Assessment to help decision-making of the hospital managers. Product: It was elaborated the technical-scientific opinion (health technology assessment) from the device Kit of the shoulder arthroscopy to contribute with the decision-making of the manager of the local institution.
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Palavras-chave
Custos e análise de custo, Órteses, Próteses e implantes, Avaliação econômica em saúde