Ciclosporina versus tacrolimus no transplante renal no Brasil: uma comparação de custos / Cyclosporine versus tacrolimus in kidney transplants in Brazil: a cost comparison
Cad. saúde pública
;
26(1): 163-174, Jan. 2010. graf, tab
Article
in Portuguese
| LILACS
| ID: lil-539219
RESUMO
No Brasil, o Sistema Único de Saúde (SUS) é responsável maioria dos transplantes renais. Para a manutenção dessas intervenções, os protocolos recomendam uso da ciclosporina ou tacrolimus, associado com corticosteróides e azatioprina ou micofenolato. Na perspectiva do SUS, realizou-se análise econômica sobre recursos ambulatoriais, hospitalares e medicamentos utilizados por paciente e grupo terapêutico. Foi construída coorte de 2000 a 2004, com 5.174 pacientes em transplantes renais e em uso de ciclosporina ou tacrolimus, identificados por relacionamento probabilístico em registros do SUS. A coorte continha 4.015 pacientes em uso de ciclosporina e 1.159 com tacrolimus. A maioria era do sexo masculino, idade < 38 anos, cujos diagnósticos primários mais freqüentes eram nefrites, doenças cardiovasculares e causas indeterminadas. Após 48 meses, observou-se gasto superior para transplantes renais em hospitais do Nordeste, doador cadáver, naqueles em diálises > 24 meses antes do transplantes renais e no grupo do tacrolimus. Constatou-se maior gasto total com recursos hospitalares, ambulatoriais e medicamentos para os transplantes renais em pacientes com esquemas com tacrolimus, quando comparados com o grupo da ciclosporina.
ABSTRACT
In Brazil, the Unified National Health System (SUS) is responsible for the majority of kidney transplants. To maintain these interventions, the guidelines recommend the use of cyclosporine or tacrolimus, associated with corticosteroids and azathioprine or mycophenolate. Taking the perspective of the National Health System, an economic analysis was performed on the outpatient and hospital resources and medicines used by patient and therapeutic group. A cohort was constructed from 2000 to 2004, with 5,174 kidney transplant patients in use of cyclosporine or tacrolimus, identified by probabilistic record linkage from the National Health System. The cohort included 4,015 patients in use of cyclosporine and 1,159 using tacrolimus. The majority were males, age < 38 years, with nephritis, cardiovascular diseases, and indeterminate causes as the most frequent primary diagnoses. After 48 months of follow-up, the expenditures were higher for kidney transplants in hospitals in the Northeast, cadaver donors, patients in dialysis > 24 months before the transplant, and in the tacrolimus group. Total hospital and outpatient costs and expenditure on medication were higher in patients on tacrolimus as compared to the cyclosporine group.
Full text:
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Index:
LILACS (Americas)
Main subject:
Kidney Transplantation
/
Tacrolimus
/
Cyclosporine
/
Graft Rejection
/
Immunosuppressive Agents
Type of study:
Etiology study
/
Practice guideline
/
Health economic evaluation
/
Incidence study
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Adult
/
Humans
/
Male
Country/Region as subject:
South America
/
Brazil
Language:
Portuguese
Journal:
Cad. saúde pública
Journal subject:
Public Health
/
Toxicology
Year:
2010
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Secretaria de Estado da Saúde de Minas Gerais/BR
/
Universidade Federal de Minas Gerais/BR
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