Cost of a community mental health service: a retrospective study on a psychosocial care center for alcohol and drug users in São Paulo

Becker, Paula; Razzouk, Denise

doi:10.1590/1516-3180.2018.0164310818

Cited by 6 publications

(10 citation statements)

References 11 publications

(12 reference statements)

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“…Neste aspecto, dois provedores de serviços merecem destaque na produção de dados relativos aos custos: CAPS e CMHS, por fornecerem o cuidado em saúde mental de forma pública e voltado para a comunidade. Embora estejam inseridos em sistemas de saúde nacional e internacional respectivamente, ambos foram analisados por mensuração, métodos semelhantes e clareza na delimitação dos custos envolvidos (Wiersma et al, 1991;Daltio, Mari & Ferraz, 2011, Becker & Razzouk, 2018Percudani et al, 2004;Tarricone et al, 2000;Riggeri et al, 2004;Salize et al, 2009). Os serviços hospitalares que oferecem internação psiquiátrica produzem maior valor de custo direto médico hospitalar, devido às diárias que demandam impacto considerável no custo total (Wiersma et al, 1991;Daltio, Mari & Ferraz, 2011).…”

Section: Discussionunclassified

“…Para avaliação das intervenções, os sujeitos da pesquisa foram selecionados por randomização (Wiersma et al, 1991;Tait et al, 2016;Salize et al, 2009) ou pela totalidade de usuários atendidos (Medina et al, 2018). Ou ainda, num intervalo de tempo específico, com determinada característica atribuída (Becker & Razzouk, 2018;Daltio, Mari & Ferraz, 2011). Os dados foram observados de forma retrospectiva (Razzouk et al, 2015) ou prospectiva (Chang et al, 2012), em alguns casos utilizando dados dos prontuários (Lindner, 2009;Son et al, 2019).…”

Section: Discussionunclassified

“…Nesta despesa está inserido o custo com intervenções medicamentosas que foram calculadas através do perfil de utilização individual de cada sujeito da pesquisa (Tait et al, 2016;Ekman et al, 2013;Razzouk et al, 2015). Outras despesas também foram consideradas; entre elas a despesa com o salário dos profissionais de saúde, que representou o maior custo financeiro quando avaliada em serviço comunitário de saúde (Becker & Razzouk, 2018).…”

Section: Discussionunclassified

“…Nível: nível de evidência. Fonte: Dados da própria pesquisa (2021).No geral os estudos foram conduzidos com sujeitos adultos (91,6%), e voltados para a investigação de intervenções específicas geralmente medicamentosas(Becker & Razzouk, 2018;Chang et al, 2012;Razzouk et al, 2015), ou…”

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Avaliação econômica da atenção em saúde mental baseada no financiamento público: Uma revisão integrativa

Araújo

Pacheco

Costa

et al. 2021

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Globalmente, as despesas públicas relacionadas ao cuidado em saúde mental têm sido alvo de diferentes estudos de avaliação econômica, permitindo a compreensão do cenário que engloba a efetividade e o custeio da assistência. Objetivo: Analisar o custo da assistência em saúde mental no contexto do financiamento público. Metodologia: Revisão integrativa, sem delimitação temporal. Utilizado a estratégia PICO para combinações de termos e utilização do operador booleano “AND”, abrangendo bases de dados: Medline via PubMed, LILACS, EMBASE, Web of Science, SCOPUS e COCHRANE LIBRARY. O nível de evidência e a qualidade metodológica de cada estudo foram avaliados. Utilizou-se o método PRISMA. Resultados: Encontrados 266 estudos. Após avaliação por pares, 16 selecionados para compor a revisão. A maioria (75%) das pesquisas foi realizada em países europeus, na perspectiva de provedores de serviços, principalmente, no contexto hospitalar e comunitário. Os estudos envolviam investigações relacionadas aos custos indiretos e diretos, médico hospitalares e não médico hospitalares: de serviços, de intervenções medicamentosas, de transtornos mentais com destaque para esquizofrenia. Foram mensurados através da estatística descritiva, e analisados pelo método de microcusteio (43,7%), com variação temporal de 1 a 36 meses. Quanto aos achados principais destaca-se o impacto no uso dos serviços e no tratamento farmacológico, bem como a descrição de alguns valores médios per capita mensal que foram distintos na avaliação econômica realizada. Conclusão: Este estudo de revisão integrativa traz informações que podem implicar em condutas de gestão e clínicas que podem melhorar e otimizar aspectos do custeio público da assistência em saúde mental.

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Avaliação econômica da atenção em saúde mental baseada no financiamento público: Uma revisão integrativa

Araújo

Pacheco

Costa

et al. 2021

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“…The service has a multiprofessional healthcare staff of two psychiatrists, one general practitioner, one nurse, two nursing technicians, two psychologists, two occupational therapists and one social worker. 21 The inclusion criteria were that the subjects need to be aged 18 years or older, be undergoing treatment at CAPS-ad, be able to understand the interviewer's questions and meet the criteria for a pattern of moderate or severe drug use with regard to at least one drug, i.e. 11 points or more for alcohol use and 4 points or more for cannabis, alcohol and cocaine/crack use, in accordance with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).…”

Section: Setting and Participantsmentioning

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Direct healthcare costs and their relationships with age at start of drug use and current pattern of use: a cross-sectional study

Becker

Razzouk

2021

Sao Paulo Med. J.

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The prevalence and incidence of drug use in Brazil have increased over recent years, and the age at the start of use has become much lower than in the past. 1,2 The Second Brazilian National Survey on Alcohol and Drugs (Levantamento Nacional de Álcool e Drogas, LENAD) showed that among adolescents aged 14 to 17 years, 4.3% were frequent users of cannabis in the past year, 2.3% were frequent users of cocaine, 0.8% frequently used crack and 60% had used alcohol before their 15 th birthday. 2 Additionally, Brazil is ranked as the second largest cocaine market in the world, and national consumption accounts for 20% of the world's cocaine market. 3,4 Early drug use during adolescence is deleterious for the brain maturation process 5,6 and has both short and long-term health consequences, 5-9 including cognitive impairment, 10 substance use disorder, 9 reduced educational and occupational attainment 7,8 and engagement in illicit activities. 11,12 In this regard, preventive programs have been widely implemented for reducing drug use among adolescents and, consequently, for avoiding economic and social costs. 13-15 The great economic impact of substance-related disorders on individuals and society was demonstrated through a study on the burden of diseases in Brazil. 16 This showed that, among the diseases that contributed most to disability-adjusted life years (DALYs) in this country, disorders relating to use of alcohol and other drugs jumped from third place in 1990 to first in 2016 among men, and from tenth to seventh among women, over the same period. Furthermore, substance-related disorders have been indicated to be one of the costliest health conditions for a healthcare system, 17-19 especially regarding hospitalization. 20 In Brazil, there is a lack of data on the costs according to different drug users' profiles, especially considering their relationship to age at the start of use. The long-term economic impact

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Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil

Aceituno,

Razzouk,

Jin

et al. 2024

Epidemiol Psychiatr Sci

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Aims The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil. Methods A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results. Results The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses. Conclusions This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.

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Cost of a community mental health service: a retrospective study on a psychosocial care center for alcohol and drug users in São Paulo

Cited by 6 publications

References 11 publications

Avaliação econômica da atenção em saúde mental baseada no financiamento público: Uma revisão integrativa

Avaliação econômica da atenção em saúde mental baseada no financiamento público: Uma revisão integrativa

Direct healthcare costs and their relationships with age at start of drug use and current pattern of use: a cross-sectional study

Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil

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