Custo Direto do Tratamento do Acidente Vascular Cerebral Isquêmico na Perspectiva de um Hospital Público Terciário (Direct Cost of Treating Ischemic Stroke From the Perspective of a Tertiary Public Hospital).

OBJECTIVES: To measure the direct cost of treating acute ischemic stroke (IS) from the perspective of a public hospital in Brazil (HCFMB) and compare it with the reimbursement by the Unified Health System (SUS), through the Procedure Table Management System, Medicines, Orthoses/Prostheses and Special Materials of the Unified Health System (SIGTAP). METHODS: We performed a micro-costing study; four scenarios were evaluated: standard (1); alteplase (2); alteplase and mechanical thrombectomy (3); mechanical thrombectomy (4). Based on the number of patients hospitalized for ischemic stroke in 2019, hospital cost, and SUS billing were calculated for each scenario. Hospital costs were adjusted for inflation using CCEMG-EPPI-Centre Cost Converter. RESULTS: In 2019, 258 patients were hospitalized due to IS, 89.5% in scenario 1, 8% in scenario 2, 1.5% in scenario 3, 1% in scenario 4. From the hospital's perspective, the cost per patient was estimated at R$7780.13, R$15 741.23, R$28 988.49, R$25 739.79, for scenarios 1, 2, 3 and 4, respectively. The reimbursement by SIGTAP was estimated at R$3079.87, R$5417.21, R$10 901.92, R$10 286.28, respectively. If thrombectomy had been included in the SIGTAP, the last two values would be R$25 393.34 and R$24 248.89. CONCLUSIONS: The hospital cost of treating acute IS in 2019 was estimated at R$2 295 209, the SUS reimbursement at R$889 391.54. With the inclusion of thrombectomy at SIGTAP, this reimbursement would be R$975 282.44, and the loss in the cost of HCFMB per patient in relation to reimbursement by the SUS is greater in scenarios without this procedure.

Challenges in adapting a stroke unit in a middle-income country: warning about costs and underfunding to achieve the Brazilian Ministry of Health's benchmark.

Background: Since the implementation of the stroke care line in Brazil, the relationship (adequacy) of costs spent during hospitalization with the Brazilian Ministry of Health indicators for a stroke unit have not yet been analyzed. Aims: This study aimed to assess the adequacy of a comprehensive stroke center for key performance indicators and analyze the costs involved in hospitalization. We verified the association between stroke severity at admission and care costs during hospitalization. Methods: A retrospective medical chart review of 451 patients was performed using semiautomatic electronic data from a single comprehensive stroke center in Brazil between July 2018 and January 2020. Clinical and resource utilization data were collected, and the mean acute treatment cost per person was calculated. The Kruskal-Wallis test with Dunn's post-test was used to compare the total costs between stroke types and reperfusion therapies. A robust linear regression test was used to verify the association between stroke severity at hospital admission and the total hospitalization costs. Good adequacy rates were observed for several indicators. Results: Data from 451 patients were analyzed. The stroke unit had good adaptation to key performance indicators, but some critical points needed revision and improvement to adapt to the requirements of the Ministry of Health. The average total cost of the patient's stay was the USD 2,637.3, with the daily hospitalization, procedure, operating room, and materials/medication costs equating to USD 2,011.1, USD 220.7, USD 234.1, and USD 98.8, respectively. There was a positive association between the total cost and length of hospital stay (p < 0.001). Conclusion: The stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the costs involved in the hospitalization of patients was verified, and high costs were associated with the length of stay, stroke severity, and mechanical thrombectomy.

Avaliação dos indicadores de óbito e incapacidade dos pacientes atendidos em uma unidade de acidente vascular cerebral / Evaluación de los indicadores de óbito e incapacidad de los pacientes atendidos en una unidad de accidente vascular cerebral / Evaluation of death indicators and disability of patients attended in a stroke unit

RESUMO Objetivo: avaliar indicadores de resultado para mortalidade e grau de incapacidade dos pacientes na alta antes e após implantação da unidade de acidente vascular cerebral. Método: um estudo quantitativo, retrospectivo e transversal, realizado em um hospital público, que teve a unidade de acidente vascular cerebral implantada em 2011. Foram analisados 245 prontuários de pacientes admitidos de 29 de janeiro de 2011 a 28 de janeiro de 2012. Foram 63 pacientes nos seis meses antes da implantação da unidade de acidente vascular cerebral e 182 pacientes nos seis meses após. Utilizou-se na alta hospitalar pelos registros no prontuário a escala de Rankin modificada, possui sete graus (0 a 6) que mensura o comprometimento funcional, variando de "sem incapacidade" até "óbito". Para análise dos dados foi utilizado um software de análise estatística (SAS para Windows®, versão 9.3). Resultados: somando os indicadores 0 e 1 (sem incapacidade e ausência de incapacidade significativa) da escala de Rankin modificada, encontramos 6,72% antes e 42,86% depois da implantação, indicando condição de menor incapacidade na alta após a implantação. A mortalidade foi de 20,69% antes da implantação e 12,73% depois. Conclusão: houve redução do grau de incapacidade dos pacientes e da mortalidade após implantação da unidade de acidente vascular cerebral.

RESUMEN Objetivo: evaluar indicadores de resultado para mortalidad y grado de incapacidad de los pacientes en la alta antes y después de la implantación de la unidad de accidente vascular cerebral. Método: estudio cuantitativo, retrospectivo y transversal, realizado en un hospital público, que tuvo la unidad de accidente vascular cerebral implantada en 2011. Se analizaron 245 prontuarios de pacientes admitidos del 29 de enero de 2011 al 28 de enero de 2012. Fueron 63 pacientes en los seis meses antes de la implantación de la unidad de accidente vascular cerebral y 182 pacientes en los seis meses después. Se utilizó en el alta hospitalaria por los registros en el prontuario la escala de Rankin modificada, posee siete grados (0 a 6) que mide el compromiso funcional, variando de "sin incapacidad" hasta "muerte". Para el análisis de los datos se utilizó un software de análisis estadístico (SAS para Windows®, versión 9.3). Resultados: sumando los indicadores 0 y 1 (sin discapacidad y ausencia de incapacidad significativa) de la escala de Rankin modificada, encontramos el 6,72% antes y el 42,86% después de la implantación, indicando condición de menor incapacidad en la alta después de la implantación. La mortalidad fue del 20,69% antes de la implantación y el 12,73% después. Conclusión: hubo reducción del grado de incapacidad de los pacientes y de la mortalidad después de la implantación de la unidad de accidente vascular cerebral.

ABSTRACT Objective: to evaluate result indicators for mortality and degree of disability of discharged patients before and after the establishment of the stroke unit care. Method: this is a quantitative, retrospective and cross-sectional study. It was conducted in a public hospital, which had the stroke unit care established in 2011. A total of 245 medical records of admitted patients were analyzed from January 29, 2011 to January 28, 2012. An amount of 63 patients were analyzed six months before the establishment of the stroke unit and 182 patients in the subsequent six months. The Modified Rankin Scale was used in medical records of hospital discharge. It has seven scores (0 to 6), which measure the functional impairment, ranging from "no symptoms at all" to "dead". For data analysis, it was used a statistical analysis software (SAS for Windows®, version 9.3). Results: adding the indicators 0 and 1 ("no symptoms at all" and "no significant disability") of the Modified Rankin Scale, we found 6.72% before and 42.86% after the establishment, indicating lower disability condition in discharge after establishment. Mortality was 20.69% before establishment and 12.73% after. Conclusion: there was a reduction of the patient's degree of disability and mortality after establishment of the stroke unit.