Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation

Abstract

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval -5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs.

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

“…There were 7 studies covering 2 topics each [3,13,14,15,16,17,18] and 7 meta-analyses [19,20,21,22,23,24,25]. 20 studies (29.4%) were from Europe [3,5,9,10,11,12,15,22,26,27,28,29,30,31,32,33,34,35,36,37,38,] 20 from the US [4,14,17,19,20,24,39,40,41,42,43,44,45,46,47,48,49,50,51,52], 3 studies (4.4%) from US plus Europe [23,53,54], 6 studies (8.8%) from Japan [16,55,56,57,58,59], 6 studies (8.8%) from China [18,25,60,61,62,63], 2 studies (3.0%) from Hong Kong [13,64,65], 3 studies (4.4%) from Canada [66,67,68], 3 studies (4.4%) from India [21,69,70] and 5 studies (7.4%) from other countries [7,71,72,73,74]. 21 studies (30.9%) used the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) scale for assessment of OM.…”

“…These studies focus on the effects of the different treatment options for OM and are not primarily epidemiological studies or HRQoL studies of OM. The only exception made was the study of Bezinelli and colleagues reporting cost and resource use with or without low-level laser therapy (LLLT) [7]. Relevant JA concerning studies on OM were identified by subsequent screening of title, abstract and full text.…”

A Odontologia hospitalar nos hospitais públicos vinculados a secretaria do estado da saúde de São Paulo

“…Alguns trabalhos tem mostrado também que o tratamento odontológico a esse tipo de paciente evita ou minimiza comorbidades importantes, tornando-se custo-efetivo e, assim, contribuindo para a redução do custo geral do tratamento médico. (Morais et al, 2006;Antunes et al, 2007;Schubert et al, 2007;Eduardo et al, 2009;Kuhn et al, 2009;Bezinelli et al, 2014).…”

“…Por outro lado, estudos e experiências em hospitais têm mostrado que a inserção do Cirurgião-Dentista na equipe multiprofissional de atendimento ao paciente sob internação contribui para minimizar o risco de infecção, melhorar a qualidade de vida, reduzir o tempo de internação, diminuir a quantidade de prescrição de medicamentos e a indicação de nutrição parenteral, além de promover um atendimento completo ao paciente. (Sonis et al, 2001;Sonis et al, 2004;Morais et al, 2006;Vera-Llonch et al, 2007;Eduardo et al, 2008;Bezinelli et al, 2013). Nosso trabalho trata-se de um estudo transversal com o objetivo de foundation.…”

“…Porém, ainda hoje, a maioria dos pacientes internados estão desprovidos de ações em saúde bucal nos Hospitais Brasileiros (Godoi et al, 2009;Costa et al, 2013 (Sonis et al, 2001;Sonis et al, 2004;Morais et al, 2006;Vera-Llonch et al, 2007;Eduardo et al, 2008;Bezinelli et al, 2014).…”