Impacto orçamentário da viscossuplementação no tratamento não cirúrgico da osteoartrite de joelho
Impacto orçamentário da viscossuplementação no tratamento não cirúrgico da osteoartrite de joelho
Data
2017
Autores
Silva, Grasiela Martins da
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
A osteoartrite de joelho é a forma mais comum dentre as doenças articulares e possui estreita relação com a progressão da idade. Afeta cerca de 3,8% da população mundial e se manifesta por dor, edema, rigidez e redução da função articular, impactando na qualidade de vida do paciente. O tratamento é multimodal e consiste nas modalidades: farmacológica, não farmacológica e cirúrgica. A viscossuplementação se constitui em uma injeção de ácido hialurônico exógeno aplicado nas articulações, que se propõe oferecer alívio dos sintomas e a possibilidade de postergação da cirurgia. O presente estudo estimou o impacto orçamentário da associação da viscossuplementação ao tratamento não cirúrgico da osteoartrite de joelho sob a perspectiva do SUS. O impacto orçamentário foi calculado em um horizonte temporal de cinco anos, com base no pressuposto de que 5% dos portadores da doença seguem para tratamento e dos custos diretos da modalidade farmacológica e não farmacológica que constituem o esquema terapêutico padrão (composto por analgésico, anti-inflamatório, opióide e inibidor da bomba de prótons, além da educação para saúde e fisioterapia), associado ao uso do ácido hialurônico. Além do cenário de referência foram construídos dois cenários alternativos que compararam diferentes alternativas de tratamento. A análise principal do estudo, com a inserção de uma ampola de ácido hialurônico ao tratamento padrão estimou um impacto orçamentário ao longo de cinco anos, no valor de R$ 343,5 milhões e de R$ 525 milhões com o esquema para duas ampolas. Já a diacereína, um condroprotetor oral, avaliado como uma opção alternativa de tratamento mostrou um impacto de R$ 704 milhões no orçamento. Este valor representando um aumento de 104,9% e 34,1% em relação à viscossuplementação, com o uso de uma ou duas ampolas de ácido hialurônico, respectivamente. O impacto orçamentário incremental da viscossuplementação, com duas ampolas de ácido hialurônico, como estratégia complementar ao tratamento padrão da osteoartrite de joelho foi estimado em torno de R$ 363 milhões, a serem gastos ao longo de cinco anos. O tratamento com essa tecnologia pode proporcionar maior qualidade de vida ao paciente ao postergar a cirurgia, além de permitir a otimização do fluxo de atendimento nas unidades de saúde. As estimativas apresentadas nesse estudo podem auxiliar o gestor na melhor utilização dos recursos financeiros, e consequente tomada de decisão quanto à incorporação da tecnologia. A possível redução de custos com procedimentos cirúrgicos em consequência da viscossuplementação, associados aos benefícios proporcionados ao paciente merece melhor avaliação por meio de análises econômicas futuras.
Knee osteoarthritis is the most common form of joint disease and is closely related to the progression of age. It affects 3.8% of the world population and is manifested by pain, edema, stiffness and reduction of joint function, impacting the quality of life of the patient. The treatment is multimodal and consists of the modalities: pharmacological, nonpharmacological and surgical. Viscosupplementation is an injection of exogenous hyaluronic acid applied to the joints, which is intended to offer relief of symptoms and the possibility of postponing surgery. The present study estimated the budgetary impact of the viscossupplementation association on the non-surgical treatment of osteoarthritis of the knee under the SUS perspective as payer of the health services. The budgetary impact was calculated over a five-year time horizon, based on the assumption that 5% of patients with the disease go to treatment and the direct costs of the pharmacological and nonpharmacological modality that constitute the standard therapeutic regimen (composed of analgesic, inflammatory, opioid and proton pump inhibitor, as well as education for health and physiotherapy), associated with the use of hyaluronic acid. In addition to the reference scenario, two alternative scenarios were constructed that compared different treatment alternatives. The main analysis of the study, with the insertion of a ampoule of hyaluronic acid to the standard treatment, estimated a budget impact over five years, in the amount of R $ 343.5 million and R $ 525 million with the scheme for two ampoules. Diacerein, an oral chondroprotect, evaluated as an alternative treatment option, showed an impact of R $ 704 million in the budget. This value represented an increase of 104.9% and 34.1% in relation to viscosupupmentation, with the use of one or two ampoules of hyaluronic acid, respectively. The incremental budgetary impact of vissupplementation, with two ampoules of hyaluronic acid, as a complementary strategy to the standard treatment of knee osteoarthritis was estimated at around R $ 363 million, to be spent over five years. The treatment with this technology can provide a better quality of life to the patient when postponing the surgery, besides allowing the optimization of the flow of care in the health units. The estimates presented in this study can help the manager in the best use of financial resources, and consequent decision on the incorporation of technology. The possible reduction of costs with surgical procedures as a consequence of the vissuplementation, associated with the benefits provided to the patient deserves better evaluation through future economic analyzes.
Knee osteoarthritis is the most common form of joint disease and is closely related to the progression of age. It affects 3.8% of the world population and is manifested by pain, edema, stiffness and reduction of joint function, impacting the quality of life of the patient. The treatment is multimodal and consists of the modalities: pharmacological, nonpharmacological and surgical. Viscosupplementation is an injection of exogenous hyaluronic acid applied to the joints, which is intended to offer relief of symptoms and the possibility of postponing surgery. The present study estimated the budgetary impact of the viscossupplementation association on the non-surgical treatment of osteoarthritis of the knee under the SUS perspective as payer of the health services. The budgetary impact was calculated over a five-year time horizon, based on the assumption that 5% of patients with the disease go to treatment and the direct costs of the pharmacological and nonpharmacological modality that constitute the standard therapeutic regimen (composed of analgesic, inflammatory, opioid and proton pump inhibitor, as well as education for health and physiotherapy), associated with the use of hyaluronic acid. In addition to the reference scenario, two alternative scenarios were constructed that compared different treatment alternatives. The main analysis of the study, with the insertion of a ampoule of hyaluronic acid to the standard treatment, estimated a budget impact over five years, in the amount of R $ 343.5 million and R $ 525 million with the scheme for two ampoules. Diacerein, an oral chondroprotect, evaluated as an alternative treatment option, showed an impact of R $ 704 million in the budget. This value represented an increase of 104.9% and 34.1% in relation to viscosupupmentation, with the use of one or two ampoules of hyaluronic acid, respectively. The incremental budgetary impact of vissupplementation, with two ampoules of hyaluronic acid, as a complementary strategy to the standard treatment of knee osteoarthritis was estimated at around R $ 363 million, to be spent over five years. The treatment with this technology can provide a better quality of life to the patient when postponing the surgery, besides allowing the optimization of the flow of care in the health units. The estimates presented in this study can help the manager in the best use of financial resources, and consequent decision on the incorporation of technology. The possible reduction of costs with surgical procedures as a consequence of the vissuplementation, associated with the benefits provided to the patient deserves better evaluation through future economic analyzes.
Description
Palavras-chave
Knee Osteoarthritis, Viscosupplementation, Budgetary Impact, Osteoartrite de Joelho, Viscossuplementação, Impacto Orçamentário
Citação
Silva GM. Impacto orçamentário da viscossuplementação no tratamento não cirúrgico da osteoartrite de joelho. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2017.