Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Reduction of glycated hemoglobin (HbA1c) and cost analysis of treatment with insulin analogues in the state of Paraná: a retrospective cohort study / Redução de hemoglobina glicada (HbA1c) e análise de custo do tratamento com análogas insulinas no estado do Paraná: estudo de coorte retrospectivo

Objective: Diabetes mellitus (DM) is a serious public health problem in Brazil. The goal of this study was to evaluate the effectiveness of long-acting insulin analogues in controlling glycemia in type 1 DM patients and to analyze the direct costs of the treatment. Methods: A retrospective cohort study was undertaken with data collected from the State Health Secretary's 2nd Regional Health Center from the State of Paraná. After randomization, socio-demographic data, the source of their drug prescriptions, and the pharmacotherapeutic profiles of the drugs were collected, along with clinical outcome information, such as glycated hemoglobin (HbA1c) and fasting plasma glucose levels. The direct costs of treatment with analogue insulin were evaluated based on the drugs and supplies acquisition data from the Center for Drugs, Paraná Cemepar. Results: One hundred and forty-eight type 1 diabetes mellitus patients, older than 18 years of age, were included in the cohort study. The HbA1c reduction after the insulin treatment was 0.36 ± 2.75, and the direct costs to reduce this parameter by 1% over a period of 24 months were U$ 1,806. The estimated costs to reduce HbA1c by 1% are U$ 5,016. Conclusions: In this study, we were able to estimate the public health system costs of using insulin analogues to reduce HbA1c by 1% in patients with type 1 DM. This information will assist clinicians in decision-making regarding insulin treatment.

Objetivo: Diabetes mellitus (DM) é um grave problema de saúde pública no Brasil. O objetivo deste estudo foi avaliar a redução da HbA1c em pacientes usuários de insulinas análogas de longa duração no controle glicêmico de pacientes com DM tipo 1 e avaliar custos diretos do tratamento com insulinas análogas. Métodos: O estudo é uma coorte retrospectiva e análise de custos para o tratamento de DM tipo 1, com pacientes pertencentes a 2a Regional de Saúde do estado do Paraná. Após randomização dos pacientes, foram coletados dados sociodemográficos, origem da prescrição e seu perfil farmacoterapêutico, além dos desfechos clínicos, como hemoglobina glicada (HbA1c) e glicemia em jejum. Foi realizada uma análise dos custos diretos do tratamento com insulinas análogas, e os valores foram obtidos por meio dos dados de compra dos medicamentos e insumos realizados pelo Centro de Medicamentos Básicos do Paraná (Cemepar). Resultados: Foram incluídos 148 pacientes maiores de 18 anos. A variável avaliada foi redução na HbA1c que, entre os pacientes, foi de 0,36 ± 2,75. Os resultados médios dos custos diretos totais do tratamento com DM tipo 1 durante 24 meses foram de R$ 7.224,00, para obter redução em 0,36% dos valores de HbA1c. O custo teórico para a redução em 1% de HbA1c é de R$ 20.064,00. Conclusões: Neste estudo foi possível estimar o custo para o sistema público de saúde, da redução de 1% da HbA1c em pacientes com DM tipo 1 usando insulinas análogas. Essa informação serve de subsídios para gestores e clínicos na tomada de decisão do tratamento com insulinas.

Cost-minimization analysis of oral and intravenous administration of linezolid in a public hospital in southern Brazil / Análise de custo-minimização entre as vias de administração oral e endovenosa de linezolida em um hospital público da região sul do Brasil

Due to the paucity of cost-minimization studies about linezolid, the aim of this study was to estimate the cost differential between intravenous and oral administration. A retrospective cohort study and costminimization analysis was conducted between August 2009 and August 2013 in a public hospital in southern Brazil. Inpatient records were evaluated for 152 patients who received linezolid intravenously or orally. Over two-thirds of the patients (103, 67.8%) received the antibiotic by the intravenous route only (IV group), and the remainder received the antibiotic both routes sequentially (mixed group). In the IV group, 33 patients (31.7%) were eligible to receive the antibiotic orally. The total cost per patient (mean) after changing from intravenous to oral administration was significantly lower than the real cost paid per patient (mean) (p<0.001). The cost savings associated with switching to oral linezolid administration would be US$14,328.32 over four years. Pharmacoeconomic analyses of linezolid therapy can inform hospitals' decisions about the rational use of therapeutics and economic resources.

Devido à escassez de estudos de custo-minimização a cerca da linezolida, o objetivo deste estudo foi estimar a diferença de custo entre a administração intravenosa e oral desse antibiótico. Um estudo de coorte retrospectiva e uma análise de custo-minimização foram realizados entre agosto de 2009 e agosto de 2013, em um hospital público do sul do Brasil. Foram avaliados os prontuários médicos de 152 pacientes que receberam linezolida por via intravenosa e / ou oralmente. Mais de dois terços dos pacientes (103, 67.8%) receberam o medicamento exclusivamente por via intravenosa (grupo IV), e o restante (grupo misto) recebeu o antibacteriano por via intravenosa e por via oral sequencialmente. No grupo IV, 33 pacientes (31.7%) eram elegíveis para receber o antibiótico por via oral. O custo médio total por paciente após a troca hipotética da via de administração intravenosa para oral foi significativamente mais baixo do que o custo médio real pago por cada tratamento com linezolida (p <0.001). A economia de custos associados com a mudança para a administração oral de linezolida seria de US $ 14,328.32 ao longo de quatro anos. A análise farmacoeconômica da terapia com linezolida pode orientar as decisões dos hospitais quanto ao uso racional de terapêuticas e de recursos econômicos.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil.

CONTEXT AND OBJECTIVE: Drug interactions form part of current clinical practice and they affect between 3 and 5% of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. METHODS: Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. RESULTS: Most of the patients were female (69.8%), married (59.4%) and in the age group of 60 years or over (56.3%), with an income less than or equal to three minimum monthly salaries (81.3%) and less than eight years of schooling (69.8%); 90.6% of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5%). The frequency of drug interactions was 66.6%. Among the 154 potential drug interactions, 4.6% were classified as major, 65.6% as moderate and 20.1% as minor. CONCLUSION: The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil / Frequência de potenciais interações entre drogas nas prescrições médicas em uma cidade do Sul do Brasil

CONTEXT AND OBJECTIVE: Drug interactions form part of current clinical practice and they affect between 3 and 5 percent of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. METHODS: Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. RESULTS: Most of the patients were female (69.8 percent), married (59.4 percent) and in the age group of 60 years or over (56.3 percent), with an income less than or equal to three minimum monthly salaries (81.3 percent) and less than eight years of schooling (69.8 percent); 90.6 percent of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5 percent). The frequency of drug interactions was 66.6 percent. Among the 154 potential drug interactions, 4.6 percent were classified as major, 65.6 percent as moderate and 20.1 percent as minor. CONCLUSION: The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.

CONTEXTO E OBJETIVO: As interações medicamentosas fazem parte da prática corrente na clínica médica e a sua incidência oscila entre 3 por cento e 5 por cento nos pacientes fazendo uso da polifarmácia. O objetivo do estudo foi identificar a frequência de interações droga-droga potenciais em prescrições de pacientes adultos e idosos. TIPO DE ESTUDO E LOCAL: Inquérito farmacoepidemiológico de corte transversal, realizado de 12/2006 a 02/2007 no conjunto habitacional Parque Verde, Cascavel, Paraná, Brasil. MÉTODO: A amostra foi por conglomerado e estratificada, proporcional ao total de residências no conjunto habitacional, constituída de 95 residências, com 96 pacientes de 19 anos ou mais, sexo feminino e masculino, com prescrição de no mínimo duas especialidades farmacêuticas. As interações foram identificadas de acordo com os softwares DrugDigest, Medscape, Micromedex. RESULTADOS: A maioria dos pacientes pertencia ao gênero feminino (69,8 por cento), em situação conjugal casada (59,4 por cento), com renda menor ou igual a três salários mínimos (81,3 por cento), faixa etária 60 anos ou mais (56,3 por cento) e 8 anos ou menos de estudo (69,8 por cento) com 90,6 por cento dos pacientes moravam com mais outra pessoa. O total de especialidades farmacêuticas foi de 406, correspondendo a uma média de 4,2 medicamentos por paciente. Os fármacos mais prescritos foram os anti-hipertensivos (47,5 por cento). A frequência de interações medicamentosas foi de 66,6 por cento. Dentre as 154 interações medicamentosas potenciais, 4,6 por cento foram classificadas como maior e 65,6 por cento como moderada e 20,1 por cento como menor. CONCLUSÃO: A alta frequência de prescrições de drogas com potencial de interações diferenciado indica uma situação ainda pouco explorada, mas real em pesquisa domiciliar.

Detecção de risco de interações entre fármacos antidepressivos e associados prescritos a pacientes adultos / Interaction risk detection between antidepressant and associated drugs prescribed for adult patients

CONTEXTO: O uso de fármacos combinados para o tratamento de patologias diversas em psiquiatria tem aumentado progressivamente. Os antidepressivos estão envolvidos em diversas interações farmacológicas clinicamente importantes. OBJETIVO: Detectar risco de interações entre fármacos antidepressivos e associados prescritos a pacientes adultos. MÉTODOS: Pesquisa retrospectiva e descritiva foi desenvolvida em uma farmácia magistral da cidade de Cascavel, Paraná. Os dados foram coletados de 151 receituários médicos de pacientes adultos (19 anos ou mais), envolvendo fármacos antidepressivos e associados entre outubro e novembro de 2005. O estudo limitou-se às variáveis registradas no receituário médico (sexo, idade, fármaco antidepressivo e associado prescrito). RESULTADOS: A categoria de 31 a 40 anos de idade foi a mais freqüente (32,46 por cento) e o sexo foi o feminino (64,90 por cento). Os fármacos antidepressivos tricíclicos (ADT) e associados apresentaram um total de oito episódios de interações relativos ao grau de severidade, sendo quatro de grau moderado e quatro menor. Em relação aos fármacos antidepressivos inibidores seletivos da recaptura de serotonina (ISRS) e associados, o risco de ocorrência foi de 16 casos; quatro de severidade menor, dez moderada e dois maior. CONCLUSÃO: Os dados mostram que os pacientes com prescrição de fármacos ISRS e associados possuíam mais risco de interações de maior severidade, totalizando o dobro de interações em relação aos ADTs.

BACKGROUND: The combination of drugs for the treatment of psychiatric disorders has become a relatively frequent practice. The antidepressants are involved in several clinically important pharmacological interactions. OBJECTIVES: To detect the risk of interactions between antidepressants and associated drugs prescribed for adults patients. METHODS: Data on 151 medical prescriptions of antidepressants and other psychiatric drugs were retrospectively assessed at a teaching pharmacy in the city of Cascavel (state of Parana, Brazil), between October and November 2005. Only prescriptions provided for adults patients (19 years and older) were analyzed. RESULTS: Prescriptions were most frequently provided for female patients (64.9 percent), and for patients in the 31 to 40 year-old age group (32.5 percent). Considering prescription information only, we identified a clinically relevant risk of drug-drug interactions in eight prescriptions of tricyclic antidepressants (TADs) and associated drugs; the putative consequence of such pharmacological interaction was considered moderately relevant in four of these. The co-prescription of selective serotonin reuptake inhibitors (SSRIs) with other related drugs bearing a putative risk of interaction was observed in 16 cases, two of which involved a significant risk, ten a moderate risk, and four a minor risk of clinically relevant consequences. DISCUSSION: We provide evidence that the risk of pharmacological interactions may be often overlooked in the prescription of antidepressants (TAD and SSRIs) and related drugs in this clinical setting.