Análise econômica das terapias hemodiálise e diálise peritoneal de início urgente
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Data
2021-11-05
Autores
Brabo, Alexandre Minetto [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O início de terapia renal substitutiva (TRS) de modo não planejado em portadores de doença renal crônica (DRC) é situação frequente mundialmente. Ao se comparar métodos de TRS neste cenário, a diálise peritoneal (DP) tem se evidenciado como opção terapêutica quando comparada à hemodiálise (HD). Na TRS planejada, os custos da DP são inferiores aos da HD, porém a literatura carece destas análises quando o início é urgente. Objetivo: Avaliar clínica e economicamente, na perspectiva do Sistema Único de Saúde (SUS), a estratégia de iniciar a TRS de forma não planejada em pacientes do HC-FMB no primeiro ano de terapia ambulatorial. Metodologia: Análise econômica através de dados primários de pacientes incidentes em DP e HD não planejada no HC-FMB entre 01º de janeiro de 2016 a 01º de janeiro de 2018, com seguimento de doze meses a partir do início da diálise ambulatorial. A coleta de dados de custos ocorreu durante o acompanhamento, diretamente dos prontuários médicos, computando tempo e sessões de terapia dialítica, utilização de medicações de alto custo, procedimentos em acessos dialíticos e eventos ocorridos, possibilitando a estimativa de custos pelos valores repassados pelo SUS durante período em diálise. A análise foi por intenção de tratamento e realizada nos softwares SAS para Windows, Stata, Statistical Software e Microsoft Office 2013. Na análise econômica, utilizou-se método de bootstrapping e construção de plano e curva de custo-efetividade incremental Resultados: Ao final de um ano, não houve diferenças entre aspectos clínicos e econômicos ao iniciar a TRS de maneira não planejada por DP e HD. A razão de custo-efetividade incremental foi de R$ 31.517,05. Em todos os cenários avaliados, a DP apresentou razões de custo-efetividade incrementais aceitáveis. Conclusão: DP é opção viável de TRS de início urgente, com desfechos e custos semelhantes à HD
Introduction: The unplanned initiation of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) is a frequent situation worldwide. When comparing RRT methods in this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option when compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD, but the literature lacks these analyzes when the start is urgent. Objective: To clinically and economically evaluate the strategy of unplanned initiation of RRT in patients during the first year of outpatient therapy from the perspective of the Brazilian public health system, Sistema Único de Saúde (SUS). Methodology: Economic analysis through primary data of patients who had unplanned PD and HD at the Hospital das Clínicas da Faculdade de Medicina de Botucatu between January 1, 2016 and January 1, 2018, with a twelve-month followup from the start of outpatient dialysis. The collection of cost data took place during the follow-up, directly from the medical records, computing time and dialysis therapy sessions, use of high-cost medications, procedures in dialysis accesses and events that occurred, making it possible to estimate costs by the amounts transferred by SUS during period on dialysis. The analysis was by intention-to-treat and performed using SAS software for Windows, Stata, Statistical Software and Microsoft Office 2013. In the economic analysis, a bootstrapping method was used and an incremental costeffectiveness plane and curve were constructed. Results: At the end of one year, there were no differences between clinical and economic aspects when starting RRT unplanned by PD and HD. The incremental cost-effectiveness ratio was R$31,517.05. In all scenarios evaluated, PD presented acceptable incremental cost-effectiveness ratios. Conclusion: PD is a viable option for urgent start RRT, with outcomes and costs similar to HD, making it interesting due to the associated opportunity cost.
Introduction: The unplanned initiation of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) is a frequent situation worldwide. When comparing RRT methods in this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option when compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD, but the literature lacks these analyzes when the start is urgent. Objective: To clinically and economically evaluate the strategy of unplanned initiation of RRT in patients during the first year of outpatient therapy from the perspective of the Brazilian public health system, Sistema Único de Saúde (SUS). Methodology: Economic analysis through primary data of patients who had unplanned PD and HD at the Hospital das Clínicas da Faculdade de Medicina de Botucatu between January 1, 2016 and January 1, 2018, with a twelve-month followup from the start of outpatient dialysis. The collection of cost data took place during the follow-up, directly from the medical records, computing time and dialysis therapy sessions, use of high-cost medications, procedures in dialysis accesses and events that occurred, making it possible to estimate costs by the amounts transferred by SUS during period on dialysis. The analysis was by intention-to-treat and performed using SAS software for Windows, Stata, Statistical Software and Microsoft Office 2013. In the economic analysis, a bootstrapping method was used and an incremental costeffectiveness plane and curve were constructed. Results: At the end of one year, there were no differences between clinical and economic aspects when starting RRT unplanned by PD and HD. The incremental cost-effectiveness ratio was R$31,517.05. In all scenarios evaluated, PD presented acceptable incremental cost-effectiveness ratios. Conclusion: PD is a viable option for urgent start RRT, with outcomes and costs similar to HD, making it interesting due to the associated opportunity cost.
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Palavras-chave
Diálise peritoneal, Hemodiálise, Diálise, Nefrologia, Custos, Cuidados hospitalares - Custos, Cuidados médicos - Custos, Economia da saúde