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BACKGROUND: Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. RESEARCH DESIGN AND METHODS: Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. RESULTS: A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost. CONCLUSIONS: Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.

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INTRODUCTION: Blood transfusion is one of the most common medical practices worldwide. However, current scientific literature has shown that the immunomodulatory effects of blood transfusion are associated with an increased likelihood of infection, prolonged hospitalization, and morbimortality. Also, it means high costs for healthcare systems. METHODS: In this context, acknowledging that blood transfusions are essentially heterologous cell transplantations, the use of therapeutic options has gained strength and is collectively known as the patient blood management (PBM) program. PBM is an approach based on three main pillars: (1) treating anemias and coagulopathies in an optimized manner, especially in the preoperative period; (2) optimizing perioperative hemostasis and the use of blood recovery systems to avoid the loss of the patient's blood; (3) anemia tolerance, with improved oxygen delivery and reduced oxygen demand, particularly in the postoperative period. RESULTS: Current scientific evidence supports the effectiveness of PBM by reducing the need for blood transfusions, decreasing associated complications, and promoting more efficient and safer blood management. Thus, PBM not only improves clinical outcomes for patients but also contributes to the economic sustainability of healthcare systems. CONCLUSION: The aim of this review was to summarize PBM strategies in a comprehensive, evidence-based approach through a systematic and structured model for PBM implementation in tertiary hospitals. The recommendations proposed herein are from researchers and experts of a high-complexity university hospital in the network of the Sistema Único de Saúde, presenting itself as a strategy that can be followed as a guideline for PBM implementation in other settings.

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Resumo Fundamento O choque cardiogênico (CC) refratário está associado com altas taxas de mortalidade, e o uso de oxigenação por membrana extracorpórea venoarterial (VA-ECMO, do inglês venoarterial extracorporeal membrane oxygenation) como uma opção terapêutica tem gerado discussões. Nesse sentido, sua custo-efetividade, principalmente em países de baixa e média renda como o Brasil, continua incerto.Objetivos: Conduzir uma análise de custo-efetividade na perspectiva do Sistema Único de Saúde (SUS) para avaliar a custo-efetividade de VA-ECMO combinado com o tratamento padrão em comparação ao tratamento padrão isolado em pacientes adultos com CC refratário. Métodos Acompanhamos uma coorte de pacientes com CC refratário tratados com VA-ECMO em centros de assistência terciária do sul brasileiro. Coletamos dados de desfechos e custos hospitalares. Realizamos uma revisão sistemática para complementar nossos dados e usamos o modelo de Markov para estimar a razão de custo-efetividade incremental (RCEI) por ano de vida ajustado pela qualidade (QALY) e por ano de vida ganho. Resultados Na análise do caso-base, a VA-ECMO gerou uma RCEI de Int$ 37 491 por QALY. Análises de sensibilidade identificaram o custo de internação, o risco relativo de sobrevida, e a sobrevida do grupo submetido à VA-ECMO como principais variáveis influenciando os resultados. A análise de sensibilidade probabilística mostrou um benefício do uso de VA-ECMO, com uma probabilidade de 78% de custo-efetividade no limiar recomendado de disposição a pagar. Conclusões Nosso estudo sugere que, dentro do SUS, VA-ECMO pode ser uma terapia custo-efetiva para o CC refratário. Contudo, a escassez de dados sobre a eficácia e de ensaios clínicos recentes que abordem seus benefícios em subgrupos específicos de pacientes destaca a necessidade de mais pesquisas. Ensaios clínicos rigorosos, incluindo perfis diversos de pacientes, são essenciais para confirmar a custo-efetividade com uso de VA-ECMO e assegurar acesso igualitário a intervenções médicas avançadas dentro dos sistemas de saúde, especialmente em países com desigualdades socioeconômicas como o Brasil.

Abstract Background Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients. Methods We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained. Results In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold. Conclusions Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil.

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INTRODUCTION: Hospital-associated infections (HAIs) are associated with increased mortality and prolonged hospital length-of-stay (LOS). Although some studies have shown that HAIs are associated with increased costs, these studies only used cost estimates, were carried out in a small number of centres, or only in high-income countries. METHODS: We carried out a prospective cohort study in ten Brazilian intensive care units (ICUs) selected from a collaborative platform study (IMPACTO MR). We included all patients aged 18 years or older admitted from October 2019 to December 2021 and who had an ICU LOS of at least two days. The costs were adjusted for official inflation until December 2022 and converted into international dollars using the 2021 purchasing power parity (PPP) conversion rate. We used a propensity score matching method to compare patients with HAIs and patients without HAIs, and patients with and without ventilator-associated pneumonia (VAP), central-line bloodstream infection (CLABSI), catheter-associated urinary tract infection (CA-UTI) and multidrug-resistant (MDR) HAIs. RESULTS: We included 7,953 patients in the study, of whom 574 (7.2%) had an HAI during their ICU stay. After propensity-score matching, patients with HAIs had ICU costs that were more than three times higher than those of patients without HAIs [$ 19,642 (IQR; 12,884-35,134) vs. 6,086 (IQR; 3,268-12,550); p <0.001). Patients with VAP, CLABSI, and CA-UTI, but not with MDR-HAIs also had higher total ICU costs. CONCLUSIONS: HAIs acquired in the ICU are associated with higher ICU costs. These findings were consistent across specific types of infection.

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OBJECTIVES: Excess weight, measured by a high body mass index (BMI), is associated with the onset of many diseases, which can, in turn, lead to disability and premature death, subsequently placing a significant burden on healthcare services. This study analysed the burden of disease and the direct costs to the Brazilian Unified Health System (Sistema Único de Saúde [SUS]) attributable to high BMI in the Brazilian population. STUDY DESIGN: Ecological study. METHODS: This ecological study had two components: (1) a time-series assessment to analyse the burden of diseases attributable to high BMI from 1990 to 2019 in Brazil; and (2) a cross-sectional design to estimate the direct costs of SUS hospitalisations and outpatient procedures attributable to high BMI in 2019. Estimates from the Global Burden of Disease study and the costs of hospital admissions and outpatient procedures from the Department of Informatics of the Brazilian Unified Health System were used. Deaths, years of life lost to premature death (YLLs), years lived with disability (YLDs), and years of life lost adjusted for disability (DALYs) were analysed. The direct health cost was obtained in Brazilian Real (R$) and converted in international Dollars (INT$). RESULTS: The current study found a reduction in the number of DALYs, YLLs, and deaths per 100,000 population of cardiovascular disease (CVD) attributable to high BMI and an increase in YLD due to diabetes and cardiovascular disease attributable to high BMI from 1990 to 2019. In 2019, high BMI resulted in 2404 DALYs, 658 YLDs, 1746 YLLs, and 76 deaths per 100,000 inhabitants. In the same year, INT$377.30 million was spent on hospitalisations and high- and medium-complexity procedures to control non-communicable diseases attributable to high BMI. The states in the South and Southeast regions of Brazil presented the highest total cost per 10,000 inhabitants. CVDs and chronic kidney disease showed the highest costs per hospital admission, whereas neoplasms and CVDs presented the highest costs for outpatient procedures. CONCLUSIONS: High BMI causes significant disease burden and financial costs. The highest expenses observed were not in locations with the highest burden of disease attributable to high BMI. These findings highlight the need to improve current public policies and apply cost-effective intervention packages, focussing on equity and the promotion of healthier lifestyles to reduce overweight/obesity, especially in localities with low socioeconomic status.

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Objetivo: Analisar o impacto da demarcação da estomia de eliminação nos custos assistenciais do cuidado aos pacientes demarcados e não demarcados e seus desdobramentos. Método: Pesquisa de avaliação econômica em saúde baseada em dados primários retrospectivos. Os dados foram obtidos dos prontuários de pacientes do Serviço de Atenção à Saúde da Pessoa Ostomizada, em Belo Horizonte (MG), atendidos entre 2015 e 2021. A amostra foi composta de 40 pacientes, sendo 20 demarcado e 20 não demarcado. Foi aplicado o teste de Mann-Whitney para amostras independentes e analisado o tamanho do efeito, que foi corrigido com o uso do teste g de Hedge, considerando o risco de baixo poder amostral. Resultados: Identificou-se o custo médio de R$ 5.201.47 para o grupo dos pacientes não demarcados, que foi 23,88% maior que o custo de R$ 3.959,27 para o grupo dos demarcados. A maioria dos pacientes eram do sexo feminino, com idade média de 60,7 anos, casados e pardos. O câncer colorretal foi a causa mais comum em estomias, enquanto a dermatite foi a complicação mais frequente. Observou-se que as complicações implicaram o aumento dos custos. Conclusão: A demarcação impacta os custos dos cuidados de saúde das pessoas com estomia de eliminação. (AU)

Objetivo: Analizar el impacto de la demarcación de la ostomía de eliminación en los costos asistenciales del cuidado a los pacientes demarcados y no demarcados y sus desdoblamientos. Método: Investigación de evaluación económica en salud basada en datos primarios retrospectivos. Los datos fueron obtenidos de los prontuarios de pacientes del Servicio de Atención a la Salud de Personas Ostomizadas, en Belo Horizonte (Minas Gerais ­ MG), Brasil, atendidos entre 2015 y 2021. La muestra estuvo compuesta por 40 pacientes, 20 demarcados y 20 no demarcados. Se realizó la prueba de Mann-Whitney para muestras independientes y el análisis del tamaño del efecto corregido se realizó mediante la prueba de Hedge g considerando el riesgo de bajo poder muestral. Resultados: Se identificó un costo promedio de R$ 5.201,47 para el grupo de pacientes no demarcados, que fue un 23,88% superior al costo de R$ 3.959,27 en el grupo de pacientes demarcados. La mayoría de los pacientes eran mujeres, con una edad media de 60,7 años, casadas y de raza mixta. El cáncer colorrectal fue la causa más común de estomías, mientras que la dermatitis fue la complicación más frecuente. Se observó que las complicaciones resultaron en un aumento de los costos. Conclusión: La demarcación tiene un impacto en los costos de atención de la salud de las personas con estomía de eliminación. (AU)

Objective: To analyze the impact of stoma site marking on healthcare costs for patients who underwent marking and those who did not, as well as the subsequent outcomes. Method: We conducted an economic evaluation in healthcare based on retrospective primary data. We obtained the data from the medical records of patients treated at the Health Care Service for Ostomy Patients in Belo Horizonte, Minas Gerais, Brazil, between 2015 and 2021. The sample consisted of 40 patients, with 20 who underwent stoma site marking and 20 who did not. We applied the Mann-Whitney test for independent samples and analyzed the effect size, which was adjusted using Hedge's g test, considering the risk of low sample power. Results: The study identified an average cost of R$5,201.47 (US$938.19) for the group of patients who did not undergo stoma site marking, which was 23.88% higher than the cost of R$3,959.27 (US$938.19) for the group who did. Most patients were female, with an average age of 60.7 years, married, and of mixed race. Colorectal cancer was the most common cause of stoma creation, while dermatitis was the most frequent complication. We observed that complications led to increased costs. Conclusion: Stoma site marking significantly affects the healthcare costs for individuals with elimination stomas. (AU)

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OBJECTIVE: To estimate the disability and costs of the Brazilian Unified Health System for IHD attributable to trans-fatty acid (TFA) consumption in 2019. DESIGN: This ecological study used secondary data from the Global Burden of Disease (GBD) Study 2019 to estimate the years lived with disability from IHD attributable to TFA in Brazil in 2019. Data on direct costs (purchasing power parity: 1 Int$ = R$ 2·280) were obtained from the Hospital and Ambulatory Information Systems of the Brazilian Unified Health System. Moreover, the total costs in each state were divided by the resident population in 2019 and multiplied by 10 000 inhabitants. The relationship between the socio-demographic index, disease and economic burden was investigated. SETTING: Brazil and its twenty-seven states. PARTICIPANTS: Adults aged ≥ 25 years of both sexes. RESULTS: IHD attributable to TFA consumption resulted in 11 165 years lived with disability (95 % uncertainty interval 932­18 462) in 2019 in Brazil. A total of Int$ 54 546 227 (95 % uncertainty interval 4 505 792­85 561 810) was spent in the Brazilian Unified Health System in 2019 due to IHD attributable to TFA, with the highest costs of hospitalisations, for males and individuals aged ≥ 50 years or over. The highest costs were observed in Sergipe (Int$ 6508/10 000; 95 % uncertainty interval 576­10 265), followed by the two states from the South. Overall, as the socio-demographic index increases, expenditures increase. CONCLUSIONS: TFA consumption results in a high disease and economic IHD burden in Brazil, reinforcing the need for more effective health policies, such as industrial TFA elimination, following the international agenda.

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OBJECTIVES: This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019. STUDY DESIGN: Ecological study. METHOD: This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019. RESULTS: Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium. CONCLUSION: Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality.

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ABSTRACT OBJECTIVE To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager's perspective, the article also presents estimates from the patient's perspective, based on the transportation costs associated with each type of consultation. METHOD Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. RESULTS Considering only the local SUS manager's perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. CONCLUSION The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

RESUMO OBJETIVO Apresentar os resultados da análise de custos para a modalidade de consulta remota (teleconsulta) em comparação à consulta presencial, em pacientes com diabetes do tipo 2, no Sistema Único de Saúde (SUS) brasileiro, na cidade Joinville, Santa Catarina. Para além dos custos, sob a perspectiva do gestor local, o artigo também apresenta estimativas sob perspectiva do paciente, a partir dos custos de transporte associados a cada modalidade de consulta. MÉTODO Foram coletados dados de 246 consultas, remotas e presenciais, entre 2021 e 2023, no contexto de um ensaio clínico randomizado sobre o impacto da teleconsulta realizado na cidade de Joinville, SC. As teleconsultas foram realizadas em Unidades Básicas de Saúde (UBS) e as consultas presenciais no Centro de Saúde Especializada. Para o cálculo dos custos, foi utilizado o método de custos baseado em tempo e atividade (TDABC) e, para o cálculo dos custos relativos aos transportes dos pacientes, foram coletados dados diretamente com os participantes da pesquisa. Foram analisados e comparados descritivamente os custos médios e o tempo de realização de cada modalidade de consulta em diferentes cenários e perspectivas. RESULTADOS Considerando apenas a perspectiva do gestor local do SUS, os custos para a realização da teleconsulta se mostraram 4,5% maiores do que para uma consulta presencial. Contudo, quando considerados os custos de transporte associados a cada paciente, o valor estimado da consulta presencial passa a ser 7,7% maior e, no caso de consultas em outros municípios, 15% maior do que a teleconsulta. CONCLUSÃO Os resultados demonstram que a incorporação da teleconsulta dentro do SUS pode trazer vantagens econômicas, a depender da perspectiva e do cenário considerado, além de ser uma estratégia com potencial para aumentar o acesso à atenção especializada na rede pública.

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Abstract This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8-8.1), and the total cost of the teaching activity would be $684 (IQR:672-696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved.