Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals / Comparação entre padrões de tromboprofilaxia na artroplastia em hospitais público e privado

Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system.Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization).Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively.Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.

Objetivo Comparar a terapia para profilaxia de tromboembolismo venoso e os custos de pacientes submetidos à artroplastia total de joelho e de quadril dentro do sistema de saúde brasileiro.Métodos Estudo retrospectivo com pacientes submetidos à artroplastia no ano de 2010, em um hospital público e dois hospitais privados no Estado de São Paulo, por meio da revisão de prontuários. Os custos foram estimados com base na utilização de recursos em saúde durante a hospitalização. Análise descritiva de frequência e média (desvio padrão), de acordo com o tipo de atendimento em saúde (público ou privado).Resultados Um total de 215 pacientes foram avaliados, sendo 56,3% submetidos à cirurgia de joelho e 43,7% à cirurgia de quadril. Cerca de 88% e 98% dos pacientes provenientes do serviço público e privado de saúde, respectivamente, receberam algum tipo de profilaxia para tromboembolismo, sendo a enoxaparina o medicamento mais utilizado em ambos sistemas. O custo total da profilaxia foi de R$ 1.873,01 (R$ 26,38 por paciente) no serviço público e R$ 21.559,73 (R$ 163,33 por paciente) no serviço privado. Para os indivíduos com tromboembolismo, o custo médio da internação foi de R$ 6.210,80 e R$ 43.792,59 por paciente atendido nos serviços de saúde público e privado, respectivamente.Conclusão A profilaxia em pacientes submetidos à artroplastia é mais utilizada em pacientes do serviço de saúde privado do que público, apesar dos altos custos em ambos os serviços. Os pacientes com tromboembolismo tiveram um custo maior do que aqueles apenas com profilaxia, mostrando que a prevenção está associada a um maior custo-benefício.

Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals.

OBJECTIVE: To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system. METHODS: A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization). RESULTS: A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively. CONCLUSION: Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.