Custos diretos e indiretos do tratamento de pacientes com espondilite anquilosante pelo sistema público de saúde brasileiro

Abstract

The Brazilian public health system's spending related to ankylosing spondylitis has increased in recent years. An important part of these costs is due to the introduction of new, more expensive health technologies, as in the case of nuclear magnetic resonance and, mainly, the incorporation of anti-tumour necrotic factor therapy into the therapeutic arsenal. The mean annual direct and indirect cost to the Brazilian public health system to treat a patient with ankylosing spondylitis, according to our findings, is US$ 23,183.56.

Costs of Drug Therapy in Patients with Ankylosing Spondylitis in Brazil

“…The median monthly cost for anti-TNF treatment was US $1182 per patient, with etanercept associated with the lowest cost, followed by adalimumab and infliximab. Azevedo et al [4] estimated that in Brazil, the mean direct cost per month for AS in 2011 was US$ 1758 per patient and that anti-TNF drugs accounted for 96% of these expenses.…”

“…Since AS is highly prevalent among patients in the most productive age ranges, indirect costs are an important driver of total costs on AS therapy [4, 7]. Treated patients can expect an improved quality of life and a cessation/modulation of disease progression, potentially decreasing both the direct costs of the disease, including use of other medications and health services, and indirect costs associated with disability, early retirement and sick leave [3, 4, 13]. In Brazil, the annual per capita indirect costs due to AS have been reported to be US$ 3623 in terms of retirement and US$ 2451 in terms of sick leave [4].…”

“…Treated patients can expect an improved quality of life and a cessation/modulation of disease progression, potentially decreasing both the direct costs of the disease, including use of other medications and health services, and indirect costs associated with disability, early retirement and sick leave [3, 4, 13]. In Brazil, the annual per capita indirect costs due to AS have been reported to be US$ 3623 in terms of retirement and US$ 2451 in terms of sick leave [4]. Nevertheless, another Brazilian study focusing on patients with rheumatic diseases reported that after 6 months of treatment with biological drugs, the quality of life improved in the sample as a whole and in participants with AS.…”

“…In Brazil, the estimated direct cost of AS treatment was US$21,091 per patient/year in 2011 for outpatients of a rheumatology service. Medications accounted for 96% of the cost, and 63% of patients were using the tumour necrosis factor blockers (anti-TNF) infliximab, etanercept or adalimumab [4]. The anti-TNF drugs are second-line treatment for AS and are used in patients whose disease activity remains high despite the use of nonsteroidal anti-inflammatory drugs (NSAIDs).…”

Intervenção Fisioterapêutica Em Indivíduos Com Espondilite Anquilosante

“…Em nosso estudo, os indivíduos faziam uso de terapia medicamentosa e mantiveram-na durante o tratamento fisioterapêutico, porém não se observou alívio da dor nem melhora da qualidade de vida quando comparados os resultados pré e pós-intervenção. Os gastos do sistema público de saúde brasileiro com portadores de EA têm aumentado nos últimos anos, especialmente em virtude da incorporação de novas terapias medicamentosas, fazendo--se necessário uma abordagem multiprofissional contínua para minimizar os impactos socioeconômicos (21) . Neste sentido, a fisioterapia tem se mostrado uma estratégia útil no manejo da EA, pois seus efeitos incluem melhora do quadro doloroso, da mobilidade da coluna vertebral e qualidade de vida (14,18) , além de poder incrementar o tratamento medicamentoso, o que poderia reduzir os gastos públicos com o acervo farmacológico.…”