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Estimação dos custos dos internamentos hospitalares associados à Hipertensão arterial na População Portuguesa Continental entre 2006 e 2012 e factores associados
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A “saúde não tem preço”, mas conhecer os custos de uma doença, permite uma alocação mais eficiente na gestão dos recursos em saúde. Em Portugal, a despesa corrente do Estado em saúde tem aumentado de forma quase contínua, e em 2012 atingiu 9,5% do Produto Interno Bruto; o que significa que o Estado gastou 1 474,03 € per capita (Instituto Nacional de Estatística, 2013). As doenças cardiovasculares são a primeira causa de mortalidade na população portuguesa, com um importante impacto económico: cuidados médicos, internamentos, medicamentos, perda de produtividade, entre outros. Em 2011 o grupo farmacológico cardiovascular representava 29,85% dos encargos do Serviço Nacional de Saúde em medicamentos de ambulatório, dos quais 69,85% correspondiam aos medicamentos anti-hipertensores (Direção Geral da Saúde, 2013c; INFARMED, 2011; Nichols et al., 2012).
A Hipertensão arterial é uma das patologias que mais tem contribuído para estes valores: diversos estudos já comprovaram a associação entre a hipertensão e diversas doenças (Apifarma & Doentes, 2011; Nicolau, Machado, & Lira, 2009). Adicionalmente é o fator de risco com maior prevalência na população portuguesa. Os estudos mais recentes estimam que ocorram 11,3 internamentos por 100000 habitantes abaixo dos 70 anos, referindo-se somente à hipertensão, não considerando as consequências desta doença quando não tratada, ou controlada de forma adequada, assim como não estimam os custos totais dos internamentos desta patologia.
O objetivo principal desta dissertação foi estimar os custos dos internamentos associados à Hipertensão arterial na população portuguesa continental no período de 2006 a 2012, e estudar algumas das variáveis susceptíveis de estarem associadas à evolução destes custos, com especial enfoque na vintage média, variável que permite medir o impacto da inovação tecnológica dos medicamentos. Foi realizado um estudo observacional, analítico e longitudinal, com uma abordagem quantitativa. O período de tempo em análise corresponde a 2006-2012, sendo considerada a população de Portugal continental. Os episódios de internamento foram caracterizados quanto à idade, género, custo total, custo médio por episódio, região de saúde, total de dias de internamento, tipo de episódio e demora média. Recorreu-se à regressão linear multivariada para avaliar o efeito nos custos das variáveis explicativas: vintage média, género, escolaridade, idade e doentes medicados. Os resultados evidenciaram que o aumento da idade apresenta uma relação positiva com os custos de internamentos, também o género masculino está associado a custos superiores. Indivíduos com menor escolaridade estão associados a menores custos de internamento, ajustado para as outras variáveis. A vintage também se relaciona de forma inversa: quanto maior for a vintage média, isto é, quanto mais recentes os fármacos utilizados, menores os custos em internamentos estimados. Este estudo fornece informação relevante, pois estima pela primeira vez os custos totais dos internamentos associados à hipertensão entre 2006 e 2012, e por outro lado permite compreender melhor a natureza destes custos, com destaque para os fármacos mais recentes, cujo impacto nos custos é dos mais relevantes. Assim sendo, esta relação deve ser aprofundada de forma a otimizar a sua utilização na prevenção de internamentos associados à hipertensão e consequente redução dos custos.
“Health is priceless”, however knowing the real costs of a disease allows a more efficient allocation in the management of the health care resources. In Portugal the current Government expenditure on health has increased over the years, and in 2012 reached 9,5% of the gross domestic product, which means that the Government has spent about 1 474,03 € per capita (Instituto Nacional de Estatística, 2013). Cardiovascular diseases are the first cause of mortality in the Portuguese population, with a significant economic impact: health care, hospitalizations, medications, lost work days, among many others. In 2011 the cardiovascular group of medicines represented 29,25% of the burden on the National Health Service, when considering the ambulatory market, of which 69,85% corresponded to antihypertensive drugs (Direção Geral da Saúde, 2013c; INFARMED, 2011; Nichols et al., 2012). Hypertension is one of the diseases that has most contributed to this scenario: several studies has demonstrated the association between hypertension and various diseases (Apifarma & Doentes, 2011; Nicolau et al., 2009). It is also the risk factor with the highest prevalence in the Portuguese population. The most recent studies estimate 11,3 hospital admissions per 100 000 people, under 70 years old, but it only refers to hypertension, not considering the consequences of this disease when left untreated or adequately monitored, nor estimate the total costs of the hospitalizations associated with this pathology. The aim of this thesis was to estimate the costs of hospitalizations associated with hypertension in mainland Portuguese population, in 2006-2012, and study some of the variables that may be associated with the evolution of these costs, with special focus on mean vintage, which is a variable that measures the impact of technological innovation of medicines. An observational, analytical, longitudinal study was conducted, with a quantitative approach. The time period under consideration corresponds to 2006-2012, being considered the population of continental Portugal. The hospitalization episodes were characterized in terms of age, gender, total cost, average cost per episode, health region, total days of hospitalization, type of episode and average length of stay. It was used multivariate linear regression to assess the effect of the explanatory variables tested: mean vintage, gender, education, age and medicated patients. The results showed that increasing age has a positive relationship with the costs of hospitalization; also the male gender is associated with higher costs. Individuals with less education are associated with lower costs of hospitalization, adjusted for other variables. The mean vintage is also inversely related with total hospitalization costs: the higher the mean vintage, which means, that more recent drugs are being used in the treatment of hypertension, lower are the estimated admissions costs. This study provides relevant information for estimating the total costs of hospitalizations associated with hypertension, on the other hand allows to better understanding of the nature of these costs, particularly for newer drugs, which cost impact is more relevant, so this relationship should be depth in order to optimize its use in preventing hospitalizations associated with hypertension and reduces costs.
“Health is priceless”, however knowing the real costs of a disease allows a more efficient allocation in the management of the health care resources. In Portugal the current Government expenditure on health has increased over the years, and in 2012 reached 9,5% of the gross domestic product, which means that the Government has spent about 1 474,03 € per capita (Instituto Nacional de Estatística, 2013). Cardiovascular diseases are the first cause of mortality in the Portuguese population, with a significant economic impact: health care, hospitalizations, medications, lost work days, among many others. In 2011 the cardiovascular group of medicines represented 29,25% of the burden on the National Health Service, when considering the ambulatory market, of which 69,85% corresponded to antihypertensive drugs (Direção Geral da Saúde, 2013c; INFARMED, 2011; Nichols et al., 2012). Hypertension is one of the diseases that has most contributed to this scenario: several studies has demonstrated the association between hypertension and various diseases (Apifarma & Doentes, 2011; Nicolau et al., 2009). It is also the risk factor with the highest prevalence in the Portuguese population. The most recent studies estimate 11,3 hospital admissions per 100 000 people, under 70 years old, but it only refers to hypertension, not considering the consequences of this disease when left untreated or adequately monitored, nor estimate the total costs of the hospitalizations associated with this pathology. The aim of this thesis was to estimate the costs of hospitalizations associated with hypertension in mainland Portuguese population, in 2006-2012, and study some of the variables that may be associated with the evolution of these costs, with special focus on mean vintage, which is a variable that measures the impact of technological innovation of medicines. An observational, analytical, longitudinal study was conducted, with a quantitative approach. The time period under consideration corresponds to 2006-2012, being considered the population of continental Portugal. The hospitalization episodes were characterized in terms of age, gender, total cost, average cost per episode, health region, total days of hospitalization, type of episode and average length of stay. It was used multivariate linear regression to assess the effect of the explanatory variables tested: mean vintage, gender, education, age and medicated patients. The results showed that increasing age has a positive relationship with the costs of hospitalization; also the male gender is associated with higher costs. Individuals with less education are associated with lower costs of hospitalization, adjusted for other variables. The mean vintage is also inversely related with total hospitalization costs: the higher the mean vintage, which means, that more recent drugs are being used in the treatment of hypertension, lower are the estimated admissions costs. This study provides relevant information for estimating the total costs of hospitalizations associated with hypertension, on the other hand allows to better understanding of the nature of these costs, particularly for newer drugs, which cost impact is more relevant, so this relationship should be depth in order to optimize its use in preventing hospitalizations associated with hypertension and reduces costs.
Descrição
Palavras-chave
Saúde pública Hipertensão Internamento hospitalar Portugal
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical