Tuberculose em Salvador: custos para o sistema de saúde e para as famílias

Abstract

ObjectiveTuberculosis is one the greatest causes of mortality worldwide, but its economic effects are not well known. This study had the objective of estimating the costs to the public and private healthcare systems and to families of tuberculosis treatment and prevention. Methods This study was made in the municipality of Salvador, State of Bahia, Brazil, in 1999. Data for estimating the costs to the healthcare system were collected from the Department of Health, healthcare facilities and a philanthropic institution. The public and private costs were analyzed using cost accounting methodology. Cost data relating to families were collected by means of questionnaires, and included data on transportation, food and other expenses, and also income losses associated with this disease. ResultsThe average cost of treating one new case of tuberculosis was approximately US$ 103. The cost of treating one multiresistant patient was 27 higher than this. The cost to the public services consisted of 65% on hospitalization, 32% on treatment, and only 3% on prevention. The families committed around 33% of their income on expenses related to tuberculosis. Conclusion Despite the fact that the families did not have to pay for medications and treatment, given that this service is offered by the State, the costs to families related to loss of income due to the disease were very high. The proportion of public service funds utilized for prevention is small. Greater investment in prevention campaigns not only might diminish the numbers of cases but also might lead to earlier diagnosis, thus reducing the costs associated with hospitalization. The lack of an integrated cost accounting system makes it impossible to visualize costs across the various sectors.

Características da tuberculose pulmonar em área hiperendêmica: município de Santos (SP)

“…This illustrates the social cost of TB and the impact of such cases on the budget of the TB control program, since it is estimated that the cost of hospital treatment is 14 times higher than that of outpatient treatment. (20) It has been demonstrated that 65% of the TB control program budget is expended for hospitalizations, and that the families of patients allocate 33% of their income to expenses related to the maintenance of the patients during hospital treatment. (20) The high proportion of hospitalizations can be partly explained by the low adherence to treatment, which increases the risk of developing severe forms of the disease, (14,15) or by the high prevalence of patients with TB/ HIV coinfection, (18) as well as by the fact that TB is a hyperendemic disease in the community studied, creating conditions for a more marked only the intrinsic limitations of the surveillance but also underreporting, the lack of complete information and the difficulties that arise from working with multiple data sources, as well as the fact that only cases of PTB were analyzed.…”

New drugs in Brazil: do they meet Brazilian public health needs?

“…In a county in northeastern Brazil the cost of treatment of each new case was approximately US$ 103, but 27 times higher for treatment of multidrugresistant tuberculosis. The disease incurs expenses of approximately 33% of the patient's family income; and of the public health care services' expenditure on tuberculosis, up to 65% is required for hospitalizations and 32% for treatment, with only 3% being left for prevention (47). These costs have been estimated to be enough to fund R&D of a new drug for tuberculosis (26).…”

Morbimortalidade hospitalar por tuberculose pulmonar na Bahia e entre 2010 a 2014

“…Além disso, os gastos com essa doença também oneram os orçamentos familiares, que pode estar relacionado diretamente ao tratamento e principalmente à perda de renda por conta da doença e internação. 6 As internações por TB também demonstram ser dispendiosas para os cofres públicos principalmente por se tratarem em geral de casos graves que envolvem comorbidades e complicações -tratamentos específicos e mais caros -e caracterizam-se por uma menor taxa de cura, maior tempo de internação e grande número de evolução para óbito. 7 Para a realização de tal estudo, foram utilizados dados secundários do SIH/SUS, o que pode gerar limitações, seja pela qualidade destes ou por agregar somente atendimentos do sistema público de saúde do Brasil.…”

“…Essa variável é apresentada neste estudo e mostra-se semelhante a outras publicações. 6,11,12 Há possibilidade de que a maior produtividade e o menor acesso de homens aos serviços de saúde sejam um fator determinante para a infecção. 13,14 Em relação à raça/cor ficou evidenciada a limitação do presente estudo em consequência do subregistro para esta variável.…”

“…Outro estudo aponta que, apesar do tratamento gratuito, a doença traz um alto custo para as famílias, como perda de rendimento relacionado à internação. 6 Estima-se ainda que, cerca de 30% dos casos de TB no Brasil são identificados somente no momento em que ocorre hospitalização por agravamento do quadro, que geralmente decorre de problemas com o acesso aos serviços de saúde ou até mesmo diagnóstico tardio. Por conseguinte, nos casos de hospitalização, notam-se alguns fatores alarmantes, como baixa taxa de cura e altas taxas de mortalidade e complicações, quando comparado com os casos tratados em serviço ambulatorial.…”