ABSTRACT
Objetivo: Estimar o impacto econômico da influenza no Brasil sob a perspectiva dos pagadores de serviços de saúde e da sociedade. Métodos: Utilizando um modelo econômico e dados da literatura e de uma base de dados censitária para fins de reembolso (SIH/SUS), foi calculado o número de casos esperados de influenza resultantes em visitas ambulatoriais, internações e mortes atribuídas à doença no Brasil. Para a construção do modelo econômico, foram considerados custos obtidos por meio dos dados extraídos do Datasus e de fontes publicamente disponíveis para a atenção pública e para a atenção privada, respectivamente. Os custos foram reportados em real brasileiro (BRL). Resultados: Foi estimada a ocorrência anual de 14,9 milhões de casos de influenza no Brasil, segmentados em aproximadamente 97 mil hospitalizações por ano decorrentes de influenza e 5,8 milhões de visitas ambulatoriais. Nos cálculos apresentados, cerca de 12 milhões de dias de produtividade foram perdidos e 78 mil anos de vida foram perdidos em um ano. O impacto econômico da doença foi calculado em 5.622.438.761 BRL, sendo os custos indiretos associados os mais representativos, atribuindo cerca de 69% (3.889.541.452 BRL) do total. Os custos médicos diretos e out-of-pocket representaram aproximadamente 23% (1.312.175.732 BRL) e 7% (420.721.577 BRL), respectivamente. Conclusão: Apesar dos esforços relacionados à vacinação de diversos grupos, a influenza apresenta uma importante carga econômica, reforçando a importância de medidas de saúde pública para a redução de carga da doença. Esse impacto é especialmente relacionado aos custos indiretos gerados pela perda de dias de produtividade e anos de vida perdidos
Objective: To estimate the economic impact of influenza in Brazil, considering society and healthcare payers perspectives. Methods: The expected number of influenza cases resulting from outpatient visits, hospitalizations, and deaths attributed to the disease in Brazil was calculated using an economic model, literature data, and a census database for reimbursement purposes (SIH/SUS). Costs were obtained through data extracted from Datasus and publicly available sources for public and private care, respectively, and reported in Brazilian real (BRL). Results: The occurrence of 14.9 million cases of influenza per year in Brazil was estimated, with about 97 thousand hospitalizations and 5.8 million outpatient visits. In addition, about 12 million productivity days and 78,000 years of life were lost in one year. Total disease economic impact was 5,622,438,761 BRL. Indirect cost was the most representative source of burden, about 69% (3,889,541,452 BRL) of the total. Direct and out-of-pocket medical costs represented approximately 23% (1,312,175,732 BRL) and 7% (420,721,577 BRL), respectively. Conclusion: Despite the efforts related to the vaccination of several groups, influenza has an important economic impact, reinforcing the relevance of public health strategies to reduce the disease burden. This impact is especially related to the indirect costs generated by productivity and years of life lost.
Subject(s)
Brazil , Costs and Cost Analysis , Influenza, Human , Global Burden of DiseaseABSTRACT
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.