ABSTRACT
Objetivo: Avaliar, com dados de mundo real, hospitalizações por influenza e potencialmente relacionadas à influenza e seus custos associados em uma autogestão do Sistema de Saúde Suplementar do Brasil. Métodos: Estudo retrospectivo na base de dados de uma autogestão, de setembro/2016 a agosto/2019, para avaliar o perfil de hospitalizações por três grupos de doença: influenza/pneumonia, outras doenças respiratórias e doenças cardiovasculares. Foram extraídos números absolutos de hospitalizações para cada grupo, assim como taxas de hospitalização, de re-hospitalização, custos totais e custo médio por paciente. Resultados: Foram registradas 1.047 hospitalizações por influenza/pneumonia, 148 por outras doenças respiratórias e 1.773 por doenças cardiovasculares. A maior taxa de hospitalização ocorreu para doenças cardiovasculares, seguida por influenza/pneumonia. Foram gastos R$ 54,5 milhões, R$ 32,4 milhões e R$ 4,1 milhões com hospitalizações relacionadas a doenças cardiovasculares, influenza/pneumonia e outras doenças respiratórias, respectivamente. O maior custo médio por hospitalização, por paciente, foi observado para influenza/pneumonia (R$ 30.952), seguido por doenças cardiovasculares (R$ 30.740) e outras doenças respiratórias (R$ 27.661). Houve um maior número de hospitalizações no grupo com 65 anos ou mais, assim como maiores custos, representando 81,6% a 92,0% do custo total de hospitalizações para todas as faixas etárias. Conclusões: Influenza e doenças potencialmente relacionadas a ela, que incluem doenças respiratórias e cardiovasculares, são responsáveis por impactos clínicos e econômicos relevantes, com maiores custos associados às faixas etárias mais altas. Intervenções para minimizar o impacto da influenza, como vacinação, são de extrema relevância para a redução dos custos associados e devem ser consideradas pelos gestores.
Objective: To evaluate, through real-world data, hospitalizations attributed to influenza or potentially attributed to influenza and their costs in a health insurance from the Brazilian Private Healthcare System. Methods: Retrospective study conducted between September 2016 and August 2019 in a health insurance database to assess the hospitalization profile for three disease groups: influenza/pneumonia, other respiratory diseases and cardiovascular diseases. Absolute numbers of hospitalizations for each group were extracted, as well as hospitalization rate, rehospitalization rate, total costs and average cost per patient. Results: There were 1,047 hospitalizations for influenza/ pneumonia, 148 for other respiratory diseases and 1,773 for cardiovascular diseases. Higher hospitalization rates occurred for cardiovascular disease, followed by influenza/pneumonia. R$ 54.5 million, R$ 32.4 million, and R$ 4.1 million were spent on hospitalizations attributed to cardiovascular disease, influenza/pneumonia and other respiratory diseases, respectively. The highest average cost per hospitalization, per patient, was observed for influenza/pneumonia (R$ 30,952), followed by cardiovascular disease (R$ 30,740) and other respiratory diseases (R$ 27,661). A higher number of hospitalizations at older ages was observed, as well as higher costs, representing 81.6% to 92.0% of the total hospitalization costs for all age groups. Conclusions: Influenza and diseases potentially attributed to influenza, including respiratory and cardiovascular diseases, are responsible for relevant clinical and economic impacts. Higher hospitalization costs were associated with older age groups. Interventions to minimize the impact of influenza such as vaccination are very relevant to promote a cost reduction and should be considered by health managers.
Subject(s)
Respiratory Tract Diseases , Cardiovascular Diseases , Costs and Cost Analysis , Supplemental Health , Influenza, Human , HospitalizationABSTRACT
BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.