P644 Hospitalization and abdominal surgery rates in CD according to drug-dispensing: a temporal trend analysis from the Brazilian public healthcare national system

Abstract Background The impact of current medical options in Crohn’s disease (CD) on hospitalization and surgical rates may be conflicting, and there is lack of data in newly industrialized countries. This study aims to describe temporal trends of proportional hospitalization and CD-related abdominal surgery rates according to drug-dispensing in Brazil, using public healthcare datasets. Methods All CD patients from the unique public healthcare national system (DATASUS) were included from January 2012 to December 2020 and identified according to ICD codes, medication or CD-related procedures. Data extraction was performed with the platform “TT Disease Explorer” (Techtrials Healthcare Data Science), which collects publicly available data via electronic algorithms with automatic updates. Annual rates of all-cause hospitalization and CD-related abdominal surgical procedures were captured and stratified by type of drug dispended. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using poisson (or negative binomial) regression. Results The absolute number of registries of overall drug-dispensing for CD was 178,209, being 32.03% for Azathioprine (AZA), 10.91% for infliximab (IFX) and 10.52% for Adalimumab (ADA). AZA dispensing increased from 28.60% to 30.83% (AAPC 1.15; CI 0.23–2.09; p=0.015), ADA increased from 5.98% to 12.03% (AAPC 8.79; CI 6.33–11.30; p<0.001) and IFX increased from 7.09% to 12.03% (AAPC 7.52; CI 6.94–8.10; p<0.001) (figure 1). A total of 39,161 hospitalizations (all-cause) were captured in the same period. Hospitalization rates with AZA varied from 37.09% to 36.35% (AAPC -0.42, CI -1.08-0.24; p=0.209); for ADA remained stable (13.16% to 13.12%, AAPC -0.03; CI -1.10-1.05; p=0.962) and for IFX increased from 17.93% to 22.49% (AAPC 3.21; CI 1.66–4.79, p<0.001) (figure 2). Regarding CD-related abdominal surgical procedures (n=1181), rates were stable for AZA (AAPC 1.34; CI -8.41–12.12; p=0.797). Considering the use of anti-TNF agents, rates were stable with ADA, varying from 26,7% to 20,0% (AAPC -1.64; CI -13.84-12.29; p=0.807) and decreased from 33,3% to 4,5% for IFX (AAPC -17.05; CI -28.19- -4.17; p=0.011) (figure 3). Conclusion In this large national study, there was an increase in the number of dispensings of AZA, IFX and ADA for CD from 2012–2020 in the public healthcare system in Brazil, due in part to the increasing prevalence of CD. All-cause hospitalization rates remained stable for AZA and ADA, and increased in IFX patients. A reduction in CD-related abdominal surgical procedures was observed in patients who used IFX and were stable with AZA and ADA. These data can be used for future strategic planning in the national public healthcare system (SUS) in CD management in Brazil.

Download Full-text

Estimated hospitalizations attributable to Diabetes Mellitus within the public healthcare system in Brazil from 2008 to 2010: study DIAPS 79

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.03.010 ◽

2014 ◽

Vol 60 (3) ◽

pp. 222-230 ◽

Cited By ~ 5

Author(s):

Roger Rosa ◽

Marcelo Eidi Nita ◽

Roberto Rached ◽

Bonnie Donato ◽

Elaine Rahal

Keyword(s):

Diabetes Mellitus ◽

Healthcare System ◽

Primary Diagnosis ◽

Public Healthcare ◽

Public Healthcare System ◽

The Public ◽

Unified Health System ◽

The Mean ◽

Mean Cost ◽

The Impact

Objective: to estimate the number of hospitalizations attributable to diabetes mellitus (DM) and its complications within the public healthcare system in Brazil (SUS) and the mean cost paid per hospitalization. Methods: the official database from the Hospital Information System of the Unified Health System (SIH/SUS) was consulted from 2008 to 2010. The proportion of hospitalizations attributable to DM was estimated using attributable risk methodology. The mean cost per hospitalization corresponds to direct medical costs in nursing and intensive care, from the perspective of the SUS. Results: the proportion of hospitalizations attributable to DM accounted for 8.1% to 12.2% of total admissions in the period, varying according to use of maximum (self-reported with correction factor) or minimal (self-reported) DM prevalence. The hospitalization rate was 47 to 70.8 per 10.000 inhabitants per year. The mean cost per hospitalization varied from 1.302 Brazilian Reais (BRL) to 1,315 BRL. Assuming the maximum prevalence, hospitalizations were distributed as 10.3% as DM itself, 36.6% as chronic DM-associated complications and 53.1% as general medical conditions. Advancing age was accompanied by an increase in hospitalization rates and corresponding costs, and more pronounced in male patients. Conclusion: the results express the importance of DM in terms of the use of health care resources and demonstrate that studies of hospitalizations with DM as a primary diagnosis are not sufficient to assess the magnitude of the impact of this disease.

Download Full-text

O Direito à Saúde no Brasil em Tempos de Crise Econômica, Ajuste Fiscal e Reforma Implícita do Estado

Revista de Estudos e Pesquisas sobre as Américas ◽

10.21057/repam.v10i3.21860 ◽

2016 ◽

Vol 10 (3) ◽

pp. 28 ◽

Cited By ~ 5

Author(s):

Fabiola Sulpino Vieira ◽

Rodrigo Pucci De Sá E Benevides

Keyword(s):

Healthcare System ◽

Latin American ◽

Health Spending ◽

Right To Health ◽

Constitutional Amendment ◽

Public Healthcare ◽

Public Healthcare System ◽

America Latina ◽

The Right ◽

The Impact

ResumoO objetivo deste artigo é discutir as mudanças recentes no modelo de financiamento da proteção social brasileira e seus impactos na garantia do direito à saúde no Brasil, a partir da promulgação Emenda Constitucional nº 95 de 2016, que institui o chamado “Novo Regime Fiscal”, que limita por 20 anos o crescimento das despesas primárias à taxa de inflação. Para dar suporte à discussão, apresentam-se, inicialmente, os contornos do direito à saúde no Brasil, bem como dados sobre o gasto com saúde do País, comparando-o ao de países da América Latina. São abordados, ainda, os esforços empreendidos para o aumento dos recursos alocados no sistema público de saúde e para a estabilidade do seu financiamento ao longo das últimas décadas. Em seguida, avalia-se o impacto das novas regras fiscais sobre os recursos federais para a saúde em comparação com a regra vigente em 2016, chegando-se à conclusão de que maiores dificuldades serão enfrentadas para a efetivação do direito à saúde no Brasil. Haverá diminuição da participação das despesas primárias do governo federal no Produto Interno Bruto, e da despesa federal com saúde, em particular, revelando o objetivo implícito de redução do tamanho do Estado na recente reforma fiscal.Palavras-chave: Sistema Único de Saúde. Sistema público de saúde. Direito à saúde. Reforma do Estado. Financiamento da saúde. Emenda Constitucional nº 95. ***Derecho a la Salud en Tiempos de Crisis Económica, Austeridad Fiscal y Reforma Implícita del Estado en BrasilResumenEl propósito de este artículo es discutir los recientes cambios en el modelo de financiación de la protección social de Brasil y su impacto en la garantía del derecho a la salud desde la promulgación de la Enmienda Constitucional nº 95, de 2016. Esta Enmienda establece el llamado "Nuevo Régimen Fiscal", que limita durante 20 años el crecimiento del gasto general a la tasa de inflación, excepto de los gastos financieros. Para apoyar la discusión, se presienta, inicialmente, el derecho a la salud en Brasil, así como datos sobre el gasto en salud del país, comparándolo con los gastos de países de América Latina. Los esfuerzos para aumentar los recursos asignados en el sistema de salud pública y para garantizar la estabilidad de su financiación a lo largo de las últimas décadas también son abordados. A continuación, se evalúa el impacto de las nuevas normas fiscales de fondos federales para la salud en comparación con la regla actual, concluyéndose que mayores dificultades son esperadas para la garantía del derecho a la salud en Brasil. Disminuirá la proporción del gasto primario del gobierno federal en el producto interno bruto, y el gasto federal en salud, en particular, revelando el objetivo implícito de reducción del tamaño del Estado en la reciente reforma fiscal.Palabras clave: Sistema Único de Salud. Sistema público de salud. Derecho a la salud. Reforma del estado. Financiación de la atención de la salud. Enmienda Constitucional nº 95. ***The Right to Health in Times of Economic Crisis, Fiscal Austerity and State Implicit Reform in BrazilAbstractThe objective of this article is to discuss the recent changes in the Brazilian social protection financing model and its impacts on the guarantee of the right to health in Brazil, after the enactment of Constitutional Amendment No. 95 of 2016. This Amendment establishes the so-called "New Fiscal Regime" for 20 years, which links the growth of the government expenditure to the inflation rate. To support the discussion, we first present the contours of the right to health in Brazil, as well as data on health spending in the country, comparing it to that of Latin American countries. We also discuss the efforts made to increase the resources allocated to the public healthcare system and to stabilize the spending over the last decades. Next, the impact of the new fiscal rules on the federal resources for health is evaluated in comparison with the current rule, and we conclude that greater difficulties will be faced for the right to health guarantee in Brazil. There will be a decline in the share of federal government expenditures on Gross Domestic Product, and in federal health spending in particular, revealing that the implicit goal of the recent reform is to reduce the State size.Key-words: Unified Health System. Public healthcare system. Right to health. State reform. Healthcare financing. Constitutional Amendment No. 95.

Download Full-text