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Tecnologias cardíacas em Portugal, 1997-2012: avaliação da eficiência e das qualidades
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Autores
Orientador(es)
Resumo(s)
RESUMO - Introdução
As tecnologias médicas têm um grande impacto no crescimento da despesa em saúde mas nem sempre os benefícios gerados superam esses custos. Os objetivos são analisar a despesa e os benefícios atribuíveis às tecnologias usadas no tratamento da Doença Cardíaca Isquémica (DCI), as desigualdades na sua utilização e a respetiva evolução ao longo do tempo.
Metodologia
Usámos a base de dados dos internamentos nos hospitais públicos Portugueses, ao longo de um período de 15 anos (1997-2012) e indicadores específicos para as tecnologias (Bare Metal Stent e Drug Elluting Stent) para explicar melhor a sua relação com a despesa e com os benefícios. Comparámos ainda custos e benefícios. Analisámos as desigualdades na sua utilização.
Resultados
As tecnologias explicam até cerca de 60% do crescimento da despesa relacionada com a DCI. Estas contribuíram também para limitar o crescimento da mortalidade intra-hospitalar e acelerar a redução das readmissões a 30 dias.
Há diferenças na utilização das tecnologias, sendo menos usadas nas mulheres, nos mais velhos e nos residentes na região do Algarve. Estas diferenças são independentes entre si. As desigualdades de género aumentaram ao longo do tempo, as relacionadas com a idade mantiveram o padrão e as regionais reduziram.
Conclusões
As tecnologias usadas para tratar a DCI foram um importante contributo para a despesa, mas também para os benefícios. Provavelmente estas tecnologias foram custo efetivas.
Parte das desigualdades podem estar associadas a causas anatómicas ou fisiológicas, mas fatores comportamentais dos médicos e dos doentes bem como a difusão das tecnologias são hipóteses que podem ajudar a explicar as desigualdades observadas e a sua evolução.
ABSTRACT - Background Technologies have a major impact on the growth of health expenditure and its benefits do not always outweigh the costs. Our objectives are to analyze the expenditure and benefits attributable to the technologies used to treat Ischemic Heart Disease (IHD), the inequalities and its trends over time. Methods We used the database of hospital admissions in Portuguese public hospitals over a 15-year period (1997-2012) and specific indicators for the technologies (Bare Metal Stent and Drug Eluting Stent) to explain better their association with expenditure, benefits and inequalities. Results The technologies explain up to 60% of the growth of IHD expenditure. The technologies have contributed to limit the growth of in-hospital mortality and boost the decline in 30-day readmissions. Results show differences in the use of technologies. Stents are less used in women, in the elderly and in the residents in the Algarve and these differences are independent of each other. Gender inequalities widened over time, age-related inequalities followed the pattern, not increasing or decreasing, and regional inequalities narrowed. Conclusions The technologies used to treat IHD have been an important contribute to expenditure growth but also to benefits. Anatomical and physiological causes, doctors and patient’s behavioral factors and the diffusion of technology may help to explain the inequalities observed and the trends over time.
ABSTRACT - Background Technologies have a major impact on the growth of health expenditure and its benefits do not always outweigh the costs. Our objectives are to analyze the expenditure and benefits attributable to the technologies used to treat Ischemic Heart Disease (IHD), the inequalities and its trends over time. Methods We used the database of hospital admissions in Portuguese public hospitals over a 15-year period (1997-2012) and specific indicators for the technologies (Bare Metal Stent and Drug Eluting Stent) to explain better their association with expenditure, benefits and inequalities. Results The technologies explain up to 60% of the growth of IHD expenditure. The technologies have contributed to limit the growth of in-hospital mortality and boost the decline in 30-day readmissions. Results show differences in the use of technologies. Stents are less used in women, in the elderly and in the residents in the Algarve and these differences are independent of each other. Gender inequalities widened over time, age-related inequalities followed the pattern, not increasing or decreasing, and regional inequalities narrowed. Conclusions The technologies used to treat IHD have been an important contribute to expenditure growth but also to benefits. Anatomical and physiological causes, doctors and patient’s behavioral factors and the diffusion of technology may help to explain the inequalities observed and the trends over time.
Descrição
Palavras-chave
Tecnologias Despesa Doenças Cardíaca Isquémica Mortalidade intra-hospitalar Readmissões a 30 dias Desigualdades Technologies Expenditure Ischemic Heart Disease In-hospital Mortality 30 Days Readmissions Inequalities