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Avaliação económica de programas de Reabilitação Respiratória em doentes respiratórios crónicos: impacto no Serviço Nacional de Saúde
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Abstract(s)
Em Portugal, as doenças respiratórias crónicas, em particular a doença pulmonar obstrutiva cronica (DPOC), tem uma expressão significativa no quadro de doenças diagnosticadas.
Face à escassez de recursos e ao aumento crescente das necessidades da população, a pressão sobre os serviços de saúde tem aumentado significativamente, pelo que se torna premente uma utilização eficiente dos recursos disponíveis para que, a custos razoáveis, seja possível obter verdadeiros ganhos em saúde. Assim, perceber qual o verdadeiro impacto económico no SNS decorrente da utilização eficiente de recursos no tratamento da DPOC, mais especificamente, a implementação de programas de reabilitação respiratória, é deveras relevante.
De modo a proceder à avaliação económica deste tipo de programas, recorreu-se a modelos de simulação de Markov e análise custo-efectividade, onde para diferentes cenários hipotetizados foram relacionados os custos decorrentes destes programas com a sua efectividade, número de internamentos evitados, comparando com a terapêutica convencional.
Através da análise de rácios incrementais custo-efectividade, verificou-se que os cenários hipotetizados são custo-efectivos, por apesar de apresentarem mais custos apresentarem também mais benefícios. No entanto, ao comparar o custo por internamento evitado com o custo de um internamento, este valor é bastante superior mesmo para o melhor cenário (9791,50€ vs. 4258,78€). Ao aumentar a eficácia da terapêutica estes rácios tornam-se mais aceitáveis, sendo para o melhor cenário, menores que o custo de internamento de um doente no estadio mais grave. Esta avaliação atende apenas ao impacto nos internamentos evitados, pelo que o real impacto da reabilitação respiratória se encontra subestimado, podendo ser avaliada à luz dessa mesma medida de efectividade.
In Portugal, the burden of respiratory diseases, in particular the chronic obstructive respiratory disease, have a huge expression on the number of diagnosed diseases. Due to the lack of resourses and the increase of healthcare needs by the citzens, the pressure over the healthcare services has been significantly higher, so the need for an efficient use of the available resourses, at reasonable prices it’s urgent, in a way that it’s possible to obtain real health gains. Realize the true economic impact to the NHS, by the eficiente use of the resources in the treatment of COPD, more specificly the respiratory rehabilitation programs, is very importante. In order to procced with the eveluation of this health programs, were used Markov simulation models and cost-effectiveness analysis, in which for different scenarios, the costs of these programs were related to their effectivenesses, hospital admissions avoided, when compared to the convencional therapy. Through the analysis of the incremental cost-effectiveness ratios, it was foud that the hypothesized scenarios are cost-effective, because, although presenting more costs also present more benefits. However, when comparing the cost per hospital admisson avoided with the cost of an hospital admission, this figure is significantly higher, even for the best case scenario (9791,50€ vs. 4258,78€). By increasing the eficacy of the therapy, this rácios become more acceptable, and for the best case scenario, lower than an hospital admisson of a patient in the most severe stage. This evaluation only addresses the impact on avoided hospital admissions, so the real impact of respiratory rehebilitation programs are underestimated, and can only be assessed in light of that same measure of effectiveness.
In Portugal, the burden of respiratory diseases, in particular the chronic obstructive respiratory disease, have a huge expression on the number of diagnosed diseases. Due to the lack of resourses and the increase of healthcare needs by the citzens, the pressure over the healthcare services has been significantly higher, so the need for an efficient use of the available resourses, at reasonable prices it’s urgent, in a way that it’s possible to obtain real health gains. Realize the true economic impact to the NHS, by the eficiente use of the resources in the treatment of COPD, more specificly the respiratory rehabilitation programs, is very importante. In order to procced with the eveluation of this health programs, were used Markov simulation models and cost-effectiveness analysis, in which for different scenarios, the costs of these programs were related to their effectivenesses, hospital admissions avoided, when compared to the convencional therapy. Through the analysis of the incremental cost-effectiveness ratios, it was foud that the hypothesized scenarios are cost-effective, because, although presenting more costs also present more benefits. However, when comparing the cost per hospital admisson avoided with the cost of an hospital admission, this figure is significantly higher, even for the best case scenario (9791,50€ vs. 4258,78€). By increasing the eficacy of the therapy, this rácios become more acceptable, and for the best case scenario, lower than an hospital admisson of a patient in the most severe stage. This evaluation only addresses the impact on avoided hospital admissions, so the real impact of respiratory rehebilitation programs are underestimated, and can only be assessed in light of that same measure of effectiveness.
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Keywords
Reabilitação respiratória DPOC Custo-efectividade Modelação markov