RESUMEN
Background The use of drug-eluting stents (DESs), compared with bare-metal stents (BMSs), in percutaneous coronary intervention (PCI) has reduced the rate of restenosis, without an impact on mortality but with an increase in costs. Medical literature lacks randomized studies that economically compare these 2 stent types within the reality of the Brazilian Unified Public Health System (SUS). Objective To estimate the incremental cost-effectiveness ratio (ICER) between DES and BMS in SUS patients with single-vessel coronary artery disease. Methods Over a 3-year period, patients with symptomatic single-vessel coronary artery disease were randomized in a 1:2 ratio to receive a DES or BMS during PCI, with a 1-year clinical follow-up. The evaluation included in-stent restenosis (ISR), target lesion revascularization (TLR), major adverse events, and cost-effectiveness for each group. P-values <0.05 were considered significant. Results In the DES group, of 74 patients (96.1%) who completed the follow-up, 1 developed ISR (1.4%), 1 had TLR (1.4%), and 1 died (1.4%), with no cases of thrombosis. In the BMS group, of 141 patients (91.5%), ISR occurred in 14 (10.1%), TLR in 10 (7.3%), death in 3 (2.1%), and thrombosis in 1 (0.74%). In the economic analysis, the cost of the procedure was R$ 5,722.21 in the DES group and R$ 4,085.21 in the BMS group. The effectiveness by ISR and TLR was 8.7% for DES and 5.9% for BMS, with an ICER of R$ 18,816.09 and R$ 27,745.76, respectively. Conclusions In the SUS, DESs were cost-effective in accordance with the cost-effectiveness threshold recommended by the World Health Organization (Arq Bras Cardiol. 2020; 115(1):80-89).
Asunto(s)
Reestenosis Coronaria , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea , Brasil , Reestenosis Coronaria/prevención & control , Análisis Costo-Beneficio , Stents Liberadores de Fármacos/efectos adversos , Humanos , Diseño de Prótesis , Salud Pública , Factores de Riesgo , Stents/efectos adversos , Resultado del TratamientoRESUMEN
Resumo Fundamento O uso do stent farmacológico (SF) comparado ao stent não farmacológico (SNF) na intervenção coronariana percutânea (ICP) reduziu o percentual de reestenose, porém sem impacto na mortalidade, com aumento no custo. A literatura carece de estudos randomizados que comparem economicamente esses dois grupos de stents na realidade do Sistema Único de Saúde (SUS). Objetivo Estimar a razão custo-efetividade incremental (RCEI) entre SF e SNF na coronariopatia uniarterial em pacientes do SUS Métodos Pacientes com coronariopatia uniarterial sintomática foram randomizados em 3 anos para uso de SF ou SNF durante a ICP, na proporção de 1:2, com seguimento clínico de 12 meses. Foram avaliados reestenose intrastent (RIS), revascularização da lesão-alvo (RLA), eventos adversos maiores e custo-efetividade (CE) de cada grupo. Os valores de p < 0,05 foram considerados significativos. Resultados No grupo SF, dos 74 pacientes (96,1%) que completaram o acompanhamento, ocorreu RIS em 1(1,4%), RLA em 1 (1,4%), óbito em 1 (1,4%), sem trombose. No grupo SNF, dos 141 pacientes (91,5%),ocorreu RIS em 14 (10,1%), RLA em 10 (7,3%), óbito em 3 (2,1%) e trombose em 1 (0,74%). Na análise econômica, o custo do procedimento foi de R$ 5.722,21 no grupo SF e de R$4.085,21 no grupo SNF. A diferença de efetividade a favor do grupo SF por RIS e RLA foi 8,7% e 5,9%, respectivamente, com RCEI de R$ 18.816,09 e R$ 27.745,76. Conclusões No SUS, o SF foi custo-efetivo, em concordância com o limiar de CE preconizado pela Organização Mundial da Saúde. (Arq Bras Cardiol. 2020; 115(1):80-89)
Abstract Background The use of drug-eluting stents (DESs), compared with bare-metal stents (BMSs), in percutaneous coronary intervention (PCI) has reduced the rate of restenosis, without an impact on mortality but with an increase in costs. Medical literature lacks randomized studies that economically compare these 2 stent types within the reality of the Brazilian Unified Public Health System (SUS). Objective To estimate the incremental cost-effectiveness ratio (ICER) between DES and BMS in SUS patients with single-vessel coronary artery disease. Methods Over a 3-year period, patients with symptomatic single-vessel coronary artery disease were randomized in a 1:2 ratio to receive a DES or BMS during PCI, with a 1-year clinical follow-up. The evaluation included in-stent restenosis (ISR), target lesion revascularization (TLR), major adverse events, and cost-effectiveness for each group. P-values <0.05 were considered significant. Results In the DES group, of 74 patients (96.1%) who completed the follow-up, 1 developed ISR (1.4%), 1 had TLR (1.4%), and 1 died (1.4%), with no cases of thrombosis. In the BMS group, of 141 patients (91.5%), ISR occurred in 14 (10.1%), TLR in 10 (7.3%), death in 3 (2.1%), and thrombosis in 1 (0.74%). In the economic analysis, the cost of the procedure was R$ 5,722.21 in the DES group and R$ 4,085.21 in the BMS group. The effectiveness by ISR and TLR was 8.7% for DES and 5.9% for BMS, with an ICER of R$ 18,816.09 and R$ 27,745.76, respectively. Conclusions In the SUS, DESs were cost-effective in accordance with the cost-effectiveness threshold recommended by the World Health Organization (Arq Bras Cardiol. 2020; 115(1):80-89)
Asunto(s)
Humanos , Brasil , Análisis Costo-Beneficio , Intervención Coronaria Percutánea , Diseño de Prótesis , Stents/efectos adversos , Salud Pública , Factores de Riesgo , Resultado del Tratamiento , Reestenosis Coronaria/prevención & control , Stents Liberadores de Fármacos/efectos adversosRESUMEN
The purpose of this study was to identify and analyze the assistance provided to the elderly by the supplementary health care system. Information was collected from interviews with managers of chronic diseases management programs and/or of specific programs in this area. Information was organized in cases and analyzed. Eleven companies operating private health plans in the cities of Rio de Janeiro and Sao Paulo were investigated. A general care model for the elderly was defined for the analysis. This model consists in a proposal for a care and assistance system hierarchically organized according to the deterioration of the functional capacity of the elderly (levels of dependence). None of the six companies that had health plans for the elderly already implemented provided full assistance to all enrolled seniors. There are major differences in the stage of development of their programs. Four companies had already implemented plans and two companies had plans in development. Even with the teams of managers and professionals working on some level within the advocated model, none of these companies followed any logic of integrated care and monitoring in all stages of the ageing process in accordance with the degree of dependence of the associate.
Asunto(s)
Servicios de Salud para Ancianos/provisión & distribución , Modelos Teóricos , Anciano , Brasil , HumanosRESUMEN
O propósito deste estudo foi identificar e analisar atividades de atenção ao idoso no âmbito do sistema de saúde suplementar a partir de entrevistas com gestores de programas de gerenciamento de doenças crônicas e/ou programas específicos para este segmento. As informações coletadas foram organizadas na forma de casos e analisadas. Os dados se referem a onze empresas operadoras de planos privados de saúde nas cidades do Rio de Janeiro e São Paulo. Para a análise, foi definido um modelo geral de atenção ao idoso. Este modelo é uma proposta de hierarquização dos cuidados e da assistência, baseado na deterioração da capacidade funcional do idoso (grau de dependência). Entre as seis empresas que têm planos implantados, nenhuma empresa apresentou pleno atendimento a todos os idosos de suas respectivas carteiras. Há grandes diferenças quanto ao estágio de implantação de seus programas. Quatro empresas têm programas implantados e duas empresas têm programas em implantação. Mesmo quando a equipe de gestores e de profissionais atuava dentro de algum nível do modelo preconizado, não foi identificada em empresa alguma uma lógica de cuidado integral e monitoramento em todas as etapas do envelhecimento, visando uma continuidade das ações, de acordo com o grau de dependência do associado.
The purpose of this study was to identify and analyze the assistance provided to the elderly by the supplementary health care system. Information was collected from interviews with managers of chronic diseases management programs and/or of specific programs in this area. Information was organized in cases and analyzed. Eleven companies operating private health plans in the cities of Rio de Janeiro and Sao Paulo were investigated. A general care model for the elderly was defined for the analysis. This model consists in a proposal for a care and assistance system hierarchically organized according to the deterioration of the functional capacity of the elderly (levels of dependence). None of the six companies that had health plans for the elderly already implemented provided full assistance to all enrolled seniors. There are major differences in the stage of development of their programs. Four companies had already implemented plans and two companies had plans in development. Even with the teams of managers and professionals working on some level within the advocated model, none of these companies followed any logic of integrated care and monitoring in all stages of the ageing process in accordance with the degree of dependence of the associate.