ABSTRACT
Objective: The objective of this study is to describe the general and specific context of hospitalizations for Heart Failure (HF) in the Unified Health System and its main care indicators and economic aspects in the period before and during COVID-19. Methods: The economic indicators were evaluated between January 2011 and June 2022, comparing these indicators before and during the COVID-19 pandemic, using data from the DataSUS Health Information of the Ministry of Health of Brazil. The number of hospitalizations, length of stay, lethality and hospitalization costs were evaluated. The ARIMA method and the general regression model were used to analyze monthly results before and during COVID-19. Results: Hospitalization for HF has decreased in the last 11 years, with the most significant drop in the COVID-19 pandemic. After the pandemic, there was an increase in lethality in patients hospitalized for HF and also an increase in length of stay, despite the decrease in hospitalizations. When analyzing the economic aspects, more than US$ 725 million were spent. The average ticket showed a clear drop in per capita investment, with a real devaluation of 30.46% in the period from 2011 to 2022, which can be related to two main hypotheses: increased effectiveness and effectiveness of the analysis of service costs and/ or chronic underfunding of the Brazilian Public Health System. Conclusion: HF has its lethality worsened over time, especially in the COVID-19 period, also associated with a significant expense with the SUS and a tendency to decrease the allocation of resources.
Objetivo: O objetivo deste estudo é descrever o contexto geral e específico das internações por insuficiência cardíaca (IC) junto ao Sistema Único de Saúde e seus principais indicadores assistenciais e aspectos econômicos no período pré e durante a COVID-19. Métodos: Os indicadores econômicos foram avaliados no período entre janeiro de 2011 e junho de 2022, comparando esses indicadores antes e durante a pandemia por COVID-19, utilizando dados do DataSUS Informações de Saúde do Ministério da Saúde do Brasil. Foram avaliados o número de internações, tempo de internação, etalidade e custos de internação. O método ARIMA e o modelo de regressão geral foram usados para analisar os resultados mensais antes e durante a COVID-19. Resultados: A hospitalização por IC diminuiu nos últimos 11 anos, com queda mais significativa na pandemia da COVID-19. Após a pandemia, houve aumento da letalidade em pacientes internados por IC e também um aumento do tempo de permanência, mesmo diante da diminuição das internações. Ao analisar os aspectos econômicos, foram gastos mais de US$ 725 milhões. O ticket médio apresentou uma clara queda no investimento per capita, com desvalorização real de 30,46% no período de 2011 a 2022, o que pode estar relacionado a duas hipóteses principais: aumento da efetividade e efetividade da análise de custos do atendimento e/ou subfinanciamento crônico do Sistema Público de Saúde Brasileiro. Conclusão: A IC tem sua letalidade agravada ao longo do tempo, principalmente no período da COVID-19, associada também a um gasto relevante com o sistema público brasileiro e a uma tendência de diminuição da alocação de recursos.
Subject(s)
Unified Health System , COVID-19 , Heart FailureABSTRACT
ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.
Subject(s)
Humans , beta-Lactams , Hospitals, Public , Anti-Infective Agents , Health Expenditures , Anti-Bacterial AgentsABSTRACT
Abstract Consumption of carbapenem has increased due to extended-spectrum beta-lactamase-producing bacteria spreading. Ertapenem has been suggested as a not carbapenem-resistance inducer. We performed a scoping review of carbapenem-sparing stewardship with ertapenem and its impact on the antibiotic resistance of Gram-negative bacilli. We searched PubMed for studies that used ertapenem as a strategy to reduce resistance to carbapenems and included epidemiologic studies with this strategy to evaluate susceptibility patterns to cephalosporins, quinolones, and carbapenems in Gram-negative-bacilli. The search period included only studies in English, up to February 2018. From 1294 articles, 12 studies were included, mostly from the Americas. Enterobacteriaceae resistance to quinolones and cephalosporins was evaluated in 6 studies and carbapenem resistance in 4 studies. Group 2 carbapenem (imipenem/meropenem/doripenem) resistance on A. baumannii was evaluated in 6 studies. All studies evaluated P. aeruginosa resistance to Group 2 carbapenem. Resistance profiles of Enterobacteriaceae and P. aeruginosa to Group 2 carbapenems were not associated with ertapenem consumption. The resistance rate of A. baumannii to Group 2 carbapenems after ertapenem introduction was not clear due to a lack of studies without bias. In summary, ertapenem as a strategy to spare use of Group 2 carbapenems may be an option to stewardship programs without increasing resistance of Enterobacteriaceae and P. aeruginosa. More studies are needed to evaluate the influence of ertapenem on A. baumannii.