Evolution of incidence, mortality and cost of nontraumatic abdominal emergencies treated in Brasil in a period of nine years.

OBJECTIVE: To evaluate the incidence, mortality and cost of non-traumatic abdominal emergencies treated in Brazilian emergency departments. METHODS: This paper used DataSus information from 2008 to 2016 (http://www.tabnet.datasus.gov.br). The number of hospitalizations, costs - AIH length of stay and mortality rates were described in acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis, gastric and duodenal ulcer, and inflammatory intestinal disease. RESULTS: The disease that had the highest growth in hospitalization was diverticular bowel disease with an increase of 68.2%. For the period of nine years, there were no significant changes in the average length of hospital stay, with the highest increase in gastric and duodenal ulcer with a growth of 15.9%. The mortality rate of gastric and duodenal ulcer disease increased by 95.63%, which is significantly high when compared to the other diseases. All had their costs increased but the one that proportionally had the highest increase in the last nine years was the duodenal and gastric ulcer, with an increase of 85.4%. CONCLUSION: Non-traumatic abdominal emergencies are extremely prevalent. Hence, the importance of having updated and comparative data on the mortality rate, number of hospitalization and cost generated by these diseases to provide better healthcare services in public hospitals.

Evolution of incidence, mortality and cost of nontraumatic abdominal emergencies treated in Brasil in a period of nine years

SUMMARY OBJECTIVE: To evaluate the incidence, mortality and cost of non-traumatic abdominal emergencies treated in Brazilian emergency departments. METHODS: This paper used DataSus information from 2008 to 2016 (http://www.tabnet.datasus.gov.br). The number of hospitalizations, costs - AIH length of stay and mortality rates were described in acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis, gastric and duodenal ulcer, and inflammatory intestinal disease. RESULTS: The disease that had the highest growth in hospitalization was diverticular bowel disease with an increase of 68.2%. For the period of nine years, there were no significant changes in the average length of hospital stay, with the highest increase in gastric and duodenal ulcer with a growth of 15.9%. The mortality rate of gastric and duodenal ulcer disease increased by 95.63%, which is significantly high when compared to the other diseases. All had their costs increased but the one that proportionally had the highest increase in the last nine years was the duodenal and gastric ulcer, with an increase of 85.4%. CONCLUSION: Non-traumatic abdominal emergencies are extremely prevalent. Hence, the importance of having updated and comparative data on the mortality rate, number of hospitalization and cost generated by these diseases to provide better healthcare services in public hospitals.

RESUMO OBJETIVO: Avaliar a evolução da Incidência, mortalidade e custo das urgências abdominais não traumáticas atendidas nos serviços de emergência do Brasil durante o período de nove anos. MÉTODOS: Este trabalho utilizou informações do DataSus de 2008 a 2016, (http://www.tabnet.datasus.gov.br). Foram analisados número de internações, valor médio das internações (AIH), valor total das internações, dias de permanência hospitalar e taxa de mortalidade das seguintes doenças: apendicite aguda, colecistite aguda, pancreatite aguda, diverticulite aguda, úlcera gástrica e duodenal, e doença inflamatória intestinal. RESULTADOS: A doença que teve o maior crescimento do número de internações foi a doença diverticular do intestino, com o valor de 68,2%. Ao longo dos nove anos não houve grandes variações da média de permanência hospitalar, sendo que o maior aumento foi o da úlcera gástrica e duodenal, com crescimento de 15,9%. A taxa de mortalidade da doença por úlcera gástrica e duodenal teve um aumento de 95,63%, consideravelmente significante quando comparada com as outras doenças. Todas tiveram seus valores de AIH aumentados, porém, a que proporcionalmente teve o maior aumento nos últimos nove anos foi a úlcera gástrica e duodenal, com um acréscimo de 85,4%. CONCLUSÃO: As urgências abdominais de origem não traumática são de extrema prevalência, por isso a importância em ter dados atualizados e comparativos sobre a taxa de mortalidade, o número de internações e os custos gerados por essas doenças, para melhor planejamento dos serviços públicos de saúde.

Infecciones respiratorias agudas en niños: costo para las familias y utilización de servicios / Acute respiratory infections in children: cost for families and resource utilization

Se comenta un artículo publicado recientemente en el que se estiman los costos que implica para las familias la internaciónde un niño por infección respiratoria aguda baja (IRAB) se comparan los mismos entre un centro de tercer nivelde atención (Hospital Garrahan) y otros de menor complejidad ubicados en la provincia de Buenos Aires, y se exploranlos motivos por los que la población, aún debiendo afrontar mayores gastos, consulta fuera de su área programática. Seresalta la escasez de antecedentes respecto de este tipo de investigaciones en Argentina, y su importancia, dada la relevanciasanitaria y social del problema.El carácter catastrófico de un episodio de internación por IRAB para las familias analizadas, hasta el 80% pobres e indigentes,se manifiesta en el hallazgo de que cada episodio (de aproximadamente 8,5 días de duración) implica un gastode 20 a 40% de los ingresos totales del grupo familiar, afectando en mayor grado a los indigentes.Se discuten algunos aspectos que hacen a la orientación espontánea de la demanda por fuera de las redes sanitariasprevistas. Se comenta críticamente que el desarrollo de tales redes suele depender más de consideraciones políticas yterritoriales, que de concepciones funcionales.Se enfatiza en la necesidad de promover análisis de este tipo, como basamento para la planificación y el desarrollo delproceso de adecuación de la oferta a las necesidades de la población.

This editorial comments on a recently published work about estimated cost for families related to hospitalisation of childrenwith acute lower respiratory infection (ALRI) according to complexity and location of hospital. lt also explores family reasonsfor attend¡ng hospitals outs¡de their programmatic area, even at risk of higher cost. lt also refers to the shortage of local coslrelated information and its importance in relation to sanitary and social issues. The catastroph¡c characteristics of an episodeof acute lower respiratory infection related hospitalisation for the families ¡n the study, 80% of which were of low socio-eco-nomic background, are exemplified by the fact that 20-40% of total family income were spent during a single episode, thisaffecting in a higher degree those families with lowest socio-economic situation.Another aspects discussed here are related to spontaneous demand or¡entation outside provided local sanitary network.These networks usually rely on political and territor¡al cons¡derations rather than functionality issues. The author states theneed of this type of economic analysis for planning and developing adequacy of health services offer in relation to popula-tion needs

[Hemolytic uremic syndrome (HUS): medical and social costs of treatment]. / Evaluación de costos directos e indirectos del tratamiento del síndrome urémico hemolítico en sus distintas etapas evolutivas.

Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.

Evaluación de costos directos e indirectos del tratamiento del síndrome urémico hemolítico en sus distintas etapas evolutivas / Hemolytic uremic syndrome (HUS): medical and social costs of treatment

Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.(AU)

Evaluación de costos directos e indirectos del tratamiento del síndrome urémico hemolítico en sus distintas etapas evolutivas / Hemolytic uremic syndrome (HUS): medical and social costs of treatment

Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.

Avaliação econômica da doença pulmonar obstrutiva crônica e de suas agudizações: aplicação na América Latina / Economic evaluation of the impact of chronic obstructive pulmonary disease and its acute exacerbations on Latin America

A doença pulmonar obstrutiva crônica tem elevada prevalência em todo o mundo. Estima-se que entre 7 por cento e 10 por cento da população adulta seja afetada. No Brasil, a bronquite crônica tem uma prevalência de 12,7 por cento na população de mais de 40 anos. Os estudos econômicos têm grande relevância em doenças de alta prevalência. A maioria dos estudos relacionados aos custos da doença pulmonar obstrutiva crônica provém de bases de dados nacionais de saúde. Poucos estudos avaliaram os custos sanitários diretos da doença. A partir destes, conclui-se que um paciente portador de doença pulmonar obstrutiva crônica gera um custo direto anual de 1.200 a 1.800 dólares. O custo correlaciona-se com a gravidade da doença: os pacientes graves geram um custo duas vezes maior que os menos graves, e por isso é vital o diagnóstico precoce. A estratégia mais custo-efetiva é a detecção precoce da doença, associada a campanhas contra o tabagismo. Em estágios avançados da doença, a hospitalização é responsável pelos custos mais elevados. Neste caso, o tratamento correto das agudizações é crucial como estratégia custo-efetiva. O custo médio de uma internação no Brasil é de 2.761 reais, o que representa quase o valor do tratamento ambulatorial por um ano. A antibioticoterapia é responsável por pequena parte do custo total da agudização. O uso de antibióticos mais eficazes pode ser uma estratégia custo-efetiva por reduzir a taxa de fracasso de tratamento. A análise econômica deve permitir a identificação e aplicação de estratégias custo-efetivas para o tratamento da doença.