Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea

Girardi, Priscyla; Hueb, Whady; Nogueira, Celia R. S. R.; Takiuti, Myrthes Emy; Nakano, Teryo; Garzillo, Cibele Larrosa; Paulitsch, Felipe da Silva; Góis, Aécio Flávio Teixeira de; Lopes, Neuza; Na, Stolf

doi:10.1590/s0066-782x2008001800003

Cited by 15 publications

(7 citation statements)

References 20 publications

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“…Forty-eight studies provided estimates on a coronary revascularization procedure – CABG, PCI, and a hybrid CABG–PCI procedure. Nearly half of the study estimates on revascularization were based on US populations (n=24; 48%); 9 , 10 , 13 , 81 – 102 the remainder came from eleven European (23%), 103 – 113 six Asian (13%), 114 – 119 three Latin American studies (6%), 120 – 122 and three multicountry RCTs (6%). 123 – 125 Hospital cohorts (n=19; 40%), claims analyses (n=14; 29%) and RCTs (n=10; 20%) were the predominant methodologies for revascularization estimates.…”

Section: Resultsmentioning

confidence: 99%

Patient-level costs of major cardiovascular conditions: a review of the international literature

Nicholson¹,

Gandra

Halbert³

et al. 2016

CEOR

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ObjectiveRobust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events.MethodsMEDLINE database was searched electronically for English language studies published during 2007–2012, with cost estimates for CV events of interest – unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values.ResultsAcross the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union.ConclusionThis review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.

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Section: Resultsmentioning

confidence: 99%

Patient-level costs of major cardiovascular conditions: a review of the international literature

Nicholson¹,

Gandra

Halbert³

et al. 2016

CEOR

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“…In Brazil, off-pump surgery has been demonstrated to reduce short-term costs of the procedure in 25% compared to the on-pump CABG, as well as it is cost-effective in the 5-years follow-up comparative analysis of the MASS-III trial. In our country, with severe health budget constraints, this savings could increase the ability to care for patients by one quarter [ 18 - 20 ] .…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Changes During Heart Displacement in Aorta No-Touch Off-Pump Coronary Artery Bypass Surgery: A Pilot Study

Carvalho¹,

Guizilini²,

Murai³

et al. 2018

Braz J Cardiovasc Surg

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ObjectiveTo evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB).MethodsProspective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated.ResultsThere was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively).ConclusionHeart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.

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“…Some authors have considered the values of fixed tables as costs based on Inpatient Hospital Authorization (IHA) or on prices of pre-established packages [ 4 , 12 ] . Others cited the transferred funds from SUS as a direct cost and additional institutional costs as indirect costs [ 13 ] , which may underestimate the real cost of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS)

Silva

Colósimo

Sousa

et al. 2017

Braz J Cardiovasc Surg

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IntroductionCost management has been identified as an essential tool for the general control and evaluation of health organizations.ObjectivesTo identify the coverage percentage of transferred funds from the Unified Health System for coronary artery bypass grafts in a philanthropic hospital having a consolidated costing system in the municipality of São Paulo.MethodsA quantitative, descriptive and cross-sectional research with information provided from a database composed of 1913 patients undergoing coronary artery bypass graft from March 13 to September 30, 2012, including isolated elective coronary artery bypass graft with the use of extracorporeal circulation. It excluded 551 (28.8%) patients, among them 76 (4.0%) deaths and 8 hospitalized patients, since the cost was compared according to the length of hospital stay. Therefore, the sample consisted of 1362 patients.ResultsThe average total cost per patient was $7,992.55. The average fund transfer by the Unified Health System was $3,450.73 (48.66%), resulting in a deficit of $4,541.82 (51.34%).ConclusionThe Unified Health System transfers covered 48.66% of the average total cost of hospitalization. Although the amount transferred increased with increasing costs, it was not proportional to the total cost, resulting in a percentage difference in revenue that was increasingly negative for each increase in cost and hospital stay. Those hospitalized for longer than seven days presented higher costs, older age, higher percentage of diabetics and chronic kidney disease patients and more postoperative complications.

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Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea

Cited by 15 publications

References 20 publications

Patient-level costs of major cardiovascular conditions: a review of the international literature

Patient-level costs of major cardiovascular conditions: a review of the international literature

Hemodynamic Changes During Heart Displacement in Aorta No-Touch Off-Pump Coronary Artery Bypass Surgery: A Pilot Study

Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS)

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