Avaliação do custo do acidente vascular cerebral isquêmico na realidade de um hospital terciário
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2022-12-06
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Universidade Estadual Paulista (Unesp)
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Introdução: O Acidente Vascular Cerebral Isquêmico (AVCi) representa uma das principais causas de morte e incapacidade funcional no mundo. A trombectomia mecânica tem sido uma opção no manejo do AVCi agudo porém, o procedimento não está incluído no Sistema Único de Saúde (SUS). Objetivo: levantar os custos do AVCi na realidade de um hospital terciário Metodologia: A avaliação do custo foi realizada de acordo com Estudos de Microcusteio Aplicados a Avaliações Econômicas em Saúde do Ministério da Saúde. A população de interesse compreendeu os pacientes hospitalizados com diagnóstico de AVCi agudo no Hospital de Clínicas da Faculdade de Medicina de Botucatu (HCFMB) no ano de 2019 divididos em quatro cenários de tratamento considerando os custos diretos médicos de exames de imagem, investigação etiológica, exames laboratoriais, hospitalização, tratamento de suporte, tratamento endovascular, monitoramento de hemorragia. Os custos foram mensurados a partir dos valores SIGTAP e preços pagos pelo HCFMB em 2019. Para cada cenário foi calculado o custo total do tratamento endovascular para o HCFMB, o faturamento SUS (pagamento por produção) e a diferença entre estes dois custos, além de análises de sensibilidade univariadas considerando o número de participantes elegíveis, duração de internação, frequência de hemorragia, assim como o limite de repasse SUS de diárias de unidade de terapia intensiva tornou-se uma variável. Resultados: Em 2019, o HCFMB internou 258 pacientes com AVCi agudo, sendo 231 pacientes no cenário 1, 21 no cenário 2, cenários 3 e 4. No cenário 1, o custo total do HCFMB foi de R$ 1.285.775,57, enquanto o faturamento SUS seria o equivalente a R$ 711.449,97. No cenário 2, estes valores foram de R$ 236.375,89 e R$113.761,34, respectivamente. Nos cenários 3 e 4, o custo total do HCFMB foi de R$ 92.025,30 e R$ 41.331,80, respectivamente, com faturamento SUS de R$ 42.870,91 e R$ 20.572,56. As análises de sensibilidade evidenciaram que a variável número de pacientes foi a que mais influenciou o custo total na perspectiva do HCFMB. Conclusão: O custo total do tratamento endovascular do AVCi agudo para o HCFMB em 2019 foi de R$369.732,99 para um total 27 pacientes. O faturamento SUS seria o equivalente a R$177.204,81, gerando um déficit para o HCFMB de R$192.528,18. Apesar da trombectomia mecânica ainda não ter sido disponibilizado no SUS, observa-se que a principal causa do déficit HCFMB do AVCi deu-se pela não atualização da tabela SIGTAP, cujos valores são muito inferiores ao que é efetivamente pago pelos hospitais.
Introduction: Ischemic Stroke (IS) represents one of the main causes of death and functional disability in the world. Mechanical thrombectomy have been an option in the management of acute stroke, however, the procedure is not included in the Sistema Único de Saúde (SUS). Objective: to raise the costs of stroke in the reality of a tertiary hospital Methodology: The cost assessment was carried out in accordance with the Microcosting Studies Applied to Economic Evaluations in Health of the Ministry of Health. The population of interest comprised patients hospitalized with a diagnosis of acute stroke at the Hospital de Clínicas da Faculdade de Medicina de Botucatu (HCFMB) in 2019, divided into four treatment scenarios considering the direct medical costs of imaging tests, etiological investigation, laboratory tests, hospitalization, supportive care, endovascular treatment, hemorrhage monitoring. The costs were measured based on the SIGTAP values and prices paid by the HCFMB in 2019. For each scenario, the total cost of endovascular treatment for the HCFMB, the SUS billing (payment per production) and the difference between these two costs were calculated, in addition to univariate sensitivity analyzes considering the number of eligible participants, length of stay, frequency of bleeding, as well as the SUS transfer limit for intensive care unit per diems became a variable. Results: In 2019, the HCFMB admitted 258 patients with acute stroke, 231 patients in scenario 1, 21 in scenario 2, scenarios 3 and 4. In scenario 1, the total cost of the HCFMB was BRL 1,285,775.57, while SUS billing would be the equivalent of R$ 711,449.97. In scenario 2, these amounts were R$236,375.89 and R$113,761.34, respectively. In scenarios 3 and 4, the total cost of the HCFMB was BRL 92,025.30 and BRL 41,331.80, respectively, with SUS revenues of BRL 42,870.91 and BRL 20,572.56. Sensitivity analyzes showed that the variable number of patients was the one that most influenced the total cost from the perspective of the HCFMB. Conclusion: The total cost of endovascular treatment of acute stroke for HCFMB in 2019 was BRL 369,732.99 for a total of 27 patients. The SUS billing would be the equivalent of R$177,204.81, generating a deficit for the HCFMB of R$192,528.18. Although mechanical thrombectomy has not yet been made available in the SUS, it is observed that the main cause of the HCFMB deficit in AVCi was due to the non-update of the SIGTAP table, whose values are much lower than what is actually paid by the hospitals.
Introduction: Ischemic Stroke (IS) represents one of the main causes of death and functional disability in the world. Mechanical thrombectomy have been an option in the management of acute stroke, however, the procedure is not included in the Sistema Único de Saúde (SUS). Objective: to raise the costs of stroke in the reality of a tertiary hospital Methodology: The cost assessment was carried out in accordance with the Microcosting Studies Applied to Economic Evaluations in Health of the Ministry of Health. The population of interest comprised patients hospitalized with a diagnosis of acute stroke at the Hospital de Clínicas da Faculdade de Medicina de Botucatu (HCFMB) in 2019, divided into four treatment scenarios considering the direct medical costs of imaging tests, etiological investigation, laboratory tests, hospitalization, supportive care, endovascular treatment, hemorrhage monitoring. The costs were measured based on the SIGTAP values and prices paid by the HCFMB in 2019. For each scenario, the total cost of endovascular treatment for the HCFMB, the SUS billing (payment per production) and the difference between these two costs were calculated, in addition to univariate sensitivity analyzes considering the number of eligible participants, length of stay, frequency of bleeding, as well as the SUS transfer limit for intensive care unit per diems became a variable. Results: In 2019, the HCFMB admitted 258 patients with acute stroke, 231 patients in scenario 1, 21 in scenario 2, scenarios 3 and 4. In scenario 1, the total cost of the HCFMB was BRL 1,285,775.57, while SUS billing would be the equivalent of R$ 711,449.97. In scenario 2, these amounts were R$236,375.89 and R$113,761.34, respectively. In scenarios 3 and 4, the total cost of the HCFMB was BRL 92,025.30 and BRL 41,331.80, respectively, with SUS revenues of BRL 42,870.91 and BRL 20,572.56. Sensitivity analyzes showed that the variable number of patients was the one that most influenced the total cost from the perspective of the HCFMB. Conclusion: The total cost of endovascular treatment of acute stroke for HCFMB in 2019 was BRL 369,732.99 for a total of 27 patients. The SUS billing would be the equivalent of R$177,204.81, generating a deficit for the HCFMB of R$192,528.18. Although mechanical thrombectomy has not yet been made available in the SUS, it is observed that the main cause of the HCFMB deficit in AVCi was due to the non-update of the SIGTAP table, whose values are much lower than what is actually paid by the hospitals.
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AVC Isquêmico, Trombectomia mecânica, Custos, Acidente vascular cerebral, Procedimentos endovasculares - Custos, Atenção terciária à saúde, Stents (Cirurgia), Ischemic stroke, Mechanical thrombectomy, Costs