RESUMO
OBJECTIVES: To measure the direct cost of treating acute ischemic stroke (IS) from the perspective of a public hospital in Brazil (HCFMB) and compare it with the reimbursement by the Unified Health System (SUS), through the Procedure Table Management System, Medicines, Orthoses/Prostheses and Special Materials of the Unified Health System (SIGTAP). METHODS: We performed a micro-costing study; four scenarios were evaluated: standard (1); alteplase (2); alteplase and mechanical thrombectomy (3); mechanical thrombectomy (4). Based on the number of patients hospitalized for ischemic stroke in 2019, hospital cost, and SUS billing were calculated for each scenario. Hospital costs were adjusted for inflation using CCEMG-EPPI-Centre Cost Converter. RESULTS: In 2019, 258 patients were hospitalized due to IS, 89.5% in scenario 1, 8% in scenario 2, 1.5% in scenario 3, 1% in scenario 4. From the hospital's perspective, the cost per patient was estimated at R$7780.13, R$15 741.23, R$28 988.49, R$25 739.79, for scenarios 1, 2, 3 and 4, respectively. The reimbursement by SIGTAP was estimated at R$3079.87, R$5417.21, R$10 901.92, R$10 286.28, respectively. If thrombectomy had been included in the SIGTAP, the last two values would be R$25 393.34 and R$24 248.89. CONCLUSIONS: The hospital cost of treating acute IS in 2019 was estimated at R$2 295 209, the SUS reimbursement at R$889 391.54. With the inclusion of thrombectomy at SIGTAP, this reimbursement would be R$975 282.44, and the loss in the cost of HCFMB per patient in relation to reimbursement by the SUS is greater in scenarios without this procedure.
RESUMO
The aim of this study was to evaluate the evolution of COVID-19 related to race/skin color among Brazilian pregnant women registered on the Sistema de Informação de Vigilância da Gripe (SIVEP Gripe). This is a population-based study, based on the data from SIVEP Gripe, with data collected at two time points, August 2020 and February 2021. From the complete database (575,935 cases on August 8, 2020 and 1,048,576 cases on January 2, 2021), the weeks 13 to 32 (563,851 cases) and 33 to 53 (469,241 cases) were selected. We selected cases of pregnant women with white, brown and black skin color and final evolution (1,884 and 1,286 cases). The final sample (939 and 858 cases) was defined by including participants who had all the targeted information recorded. The outcome variables were hospitalization, Intensive Care Unit (ICU) admission and COVID-19 deaths. The present study identified that there was a drop of approximately two-thirds in the proportion of pregnant women who required ICU care or died, when comparing the first and second periods. In the second period, black pregnant women had approximately five times higher risk of death compared to white and brown women.
