Hospital Costs – ABC CARDIOL

ABC

Original Article

Healthcare Utilization and Costs Reduction after Radiofrequency Ablation For Atrial Fibrillation in the Brazilian Private Healthcare System

Eduardo Benchimol Saad et al. Daiane Oliveira Tayar Rodrigo Antonini Ribeiro Silvio Mauro Junqueira Jr. … Priscila Andrade Andre d'Avila

Abstract

Background:

Atrial fibrillation (AF) is the most common arrhythmia worldwide, with significantly associated hospitalizations. Considering its growing incidence, the AF related economic burden to healthcare systems is increasing. Healthcare expenditures might be substantially reduced after AF radiofrequency ablation (AFRA).

Objective:

To compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system.

Methods:

We conducted a retrospective cohort study, based on patients’ billing information from an administrative database. Eighty-three adult patients who had an AFRA procedure between 2014 and 2015 were included. Healthcare resource utilization related to cardiovascular causes, including ambulatory and hospital care, as well as its costs, were analyzed. A p-value of less than 0.05 was considered statistically significant.

Results:

Mean follow-up was 14.7 ± 7.1 and 10.7 ± 5.4 months before and after AFRA, respectively. The 1-year AF recurrence-free rate was 83.6%. Before AFRA, median monthly total costs were Brazilian Reais (BRL) 286 (interquartile range [IQR]: 137-766), which decreased by 63.5% (p = 0.001) after the procedure, to BRL 104 (IQR: 57-232). Costs were reduced both in the emergency (by 58.6%, p < 0.001) and outpatient settings (by 56%, p < 0.001); there were no significant differences in the outpatient visits, inpatient elective admissions and elective admission costs before and after AFRA. The monthly median emergency department visits were reduced (p < 0.001).

Conclusion:

In this cohort, overall healthcare costs were reduced by 63.5%. A longer follow-up could be useful to evaluate if long-term cost reduction is maintained.

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IJCS

Original Article

Impact of Risk Factors for Coronary Artery Disease on Hospital Costs of Patients Undergoing Myocardial Revascularization Surgery in the Brazilian Unified Health System (SUS)

João Luis Barbosa et al. Clarissa Antunes Thiers Carlos Felipe dos Santos Cunha Juliana Moutella … Bernardo Rangel Tura Giulia Principe Orsi Karen Feldman Nathália Rodrigues da Silva Luiz Felipe Faria

Abstract

Background:

Cardiovascular diseases are a major cause of mortality and morbidity. Myocardial revascularization surgery may be indicated for the relief of symptoms and to reduce mortality. However, surgery is a costly procedure and the impact of the number of cardiovascular risk factors on the cost of the procedure has not been established.

Objectives:

To identify the impact of risk factors for coronary artery disease on myocardial revascularization surgery cost.

Methods:

We selected 239 patients undergoing myocardial revascularization surgery at the National Institute of Cardiology in the period from 01 January to 31 December 2013. We included patients aged over 30 years, with indication for the procedure. Patients undergoing combined procedures were excluded.

Results:

Seven patients had only one risk factor, 32 patients had two risk factors, 75 patients had 3 risk factors, 78 patients had four risk factors, 36 patients had 5 risk factors and 11 patients presented 6 risk factors. The total costs, on average, was R$ 14,143.22 in the group with 1 risk factor, R$ 18,380.40 in the group with 2 risk factors, R$ 21,229.51 in the group with 3 risk factors, R$ 24,620.86 in the group with 4 risk factors, R$ 21,337.92 in the group with 5 risk factors and R$ 36,098,35 in the group with 6 risk factors (p = 0.441).

Conclusion:

This study demonstrates that, in a public referral center for highly complex cardiology procedures, there was no significant correlation between the number of cardiovascular risk factors and hospitalization costs.

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ABC

Original Article

Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

David Provenzale Titinger et al. Luiz Augusto Ferreira Lisboa Bruna La Regina Matrangolo Luis Roberto Palma Dallan … Luis Alberto Oliveira Dallan Evelinda Marramon Trindade Ivone Eckl Roberto Kalil Filho Omar Asdrúbal Vilca Mejía Fabio Biscegli Jatene

Abstract

Background:

Heart surgery has developed with increasing patient complexity.

Objective:

To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).

Method:

All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.

Results:

Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.

Conclusion:

Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

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ABC

Artigo Original

Comparative costs between myocardial revascularization with or without extracorporeal circulation

Priscyla B. M. A. Girardi et al. Whady Hueb Célia R. S. R. Nogueira Myrthes E. Takiuti … Teryo Nakano Cibele Larrosa Garzillo Felipe da S. Paulitsch Aécio F. T. Góis Neuza H. M. Lopes Noedir A. Stolf

BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p < 0.001) in patients from the WECC when compared to the SECC group (606.00 ± 525.00 vs. 945.90 ± 440.00), as well as ICU costs: 432.20 ± 391.70 vs. 717.70 ± 257.70, respectively. The duration of the operating room stay were 4.9 ± 1.1 h vs. 3.9 ± 1.0 h, p < 0.001; at the ICU it was 48.2 ± 17.2 h vs. 29.2 ± 26.1h) (p < 0.001), with intubation time of 9.2 ± 4.5 h vs. 6.4 ± 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. CONCLUSION: The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.

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ABC

Artigo Original

Hospital costs of coronary artery bypass grafting on elective coronary patients

Nagib Haddad et al. Eliana Bittar Andréa Fabiana de Marchi Coralice dos Santos Veiga Kantorowitz … Andréa Cotait Ayoub Mayuli Lurbe Fonseca Leopoldo Soares Piegas

OBJECTIVE: To assess hospital costs associated with coronary artery bypass grafting performed on elective coronary patients, and the relation of costs with the number of grafts. METHODS: Descriptive prospective study carried out at Instituto Dante Pazzanese de Cardiologia in April, May and June of 2005. Coronary patients of different ages and both genders were included. Emergency patients, patients with other associated heart conditions and reoperation cases were excluded. Appropriate forms for the operating room, early postoperative period and for the final period in the ward were developed for the initial hospitalization phase preoperatively. RESULTS: The procedure was performed on 103 patients, at an average cost of R$6,990.00 (US$2,784.98), at a minimum of R$5,438.69 (US$2,166.81), and maximum of R$11,778.96 (US$4,692.81); standard deviation was R$1,035.47 (US$412.54) and the confidence interval was 95%, ranging from R$6,790.33 – R$7,190.27 (US$2,705.31 – US$2,864.67). The total average cost for three to five bypass grafts was higher (R$7,148.05) than for one and two bypass grafts (R$6,659.29) and the difference was significant (p < 0.05). CONCLUSION: The highest average costs were in the operating room (R$4,627.97), and in the early postoperative period (R$1,221.39), followed by costs incurred in the ward after the early postoperative period (R$840.04) and by the initial preoperative period in the ward (R$300.90).

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