Impacto orçamentário da incorporação da cirurgia robótica para o procedimento de histerectomia sob a perspectiva do SUS
Impacto orçamentário da incorporação da cirurgia robótica para o procedimento de histerectomia sob a perspectiva do SUS
Data
2025
Autores
Lourenço Filho, Ticiano de
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A histerectomia é uma cirurgia comum no Brasil, recomendada
principalmente para tratar problemas ginecológicos, tanto benignos quanto malignos,
como miomas, endometriose, adenomiose e diferentes tipos de câncer ginecológico.
No Sistema Único de Saúde (SUS), ela é a segunda cirurgia mais realizada entre
mulheres em idade reprodutiva, ficando atrás apenas das cesarianas. Entre 2019 e
2023, foram feitas 502.226 histerectomias no SUS, com um custo total de
aproximadamente 640 milhões de reais. Nos últimos anos, a cirurgia robótica tem sido
considerada uma alternativa às técnicas tradicionais, por ser minimamente invasiva e
utilizar sistemas robóticos avançados. Esses sistemas podem permitir movimentos
mais precisos ao cirurgião, além de oferecerem uma visão tridimensional detalhada
do campo cirúrgico. As vantagens potenciais incluem cortes menores, menos dor no
pós-operatório e uma recuperação mais rápida. Apesar disso, os estudos científicos
mostram que não há diferenças estatísticas significativa em termos de eficácia ou
segurança entre a histerectomia robótica e a histerectomia videolaparoscopia, que já
é usada no SUS. Embora a cirurgia robótica prometa benefícios, o alto custo de
aquisição e manutenção dos equipamentos, somado à necessidade de treinamento
específico, ainda são grandes obstáculos para sua implementação em larga escala
na rede pública. Objetivos: O objetivo deste estudo foi fazer uma Análise de Impacto
Orçamentário (AIO) sobre a incorporação da histerectomia robótica no SUS. A análise
comparou os custos da tecnologia robótica com os da laparoscopia convencional,
considerando diferentes cenários de adoção gradual entre 2026 e 2030. Resultados:
Os resultados demonstram que, considerando um cenário com adoção moderada de
crescimento de 5% ao ano, o impacto orçamentário incremental estimado para o
período de 2026 a 2030 seria de aproximadamente 32,5 milhões. Conclusões:
Conclui-se que, apesar de representar um avanço tecnológico significativo, a
incorporação da cirurgia robótica no SUS deve ser feita com cautela, sendo
recomendados estudos adicionais com dados nacionais e experiências-piloto em
centros de referência para avaliar continuamente seus impactos clínicos, econômicos
e organizacionais.
Introduction: Hysterectomy is a common surgery in Brazil, primarily recommended for the treatment of various gynecological conditions, both benign and malignant, such as uterine fibroids, endometriosis, adenomyosis, and different types of gynecological cancers. In the Brazilian Unified Health System (Sistema Único de Saúde - SUS), hysterectomy is the second most frequently performed surgery among women of reproductive age, surpassed only by cesarean sections. Between 2019 and 2023, a total of 502,226 hysterectomies were performed in SUS, at a cumulative cost of approximately 640 million Brazilian reais. In recent years, robotic surgery has emerged as an alternative to traditional surgical techniques, offering a minimally invasive approach through advanced robotic systems. These systems can allow more precise movements for the surgeon, in addition to offering a detailed three-dimensional view of the surgical field. Potential advantages include smaller incisions, reduced postoperative pain, and quicker patient recovery. However, scientific studies have shown no statistically significant differences in efficacy or safety between robotic hysterectomy and laparoscopic hysterectomy, a technique already employed within SUS. Although robotic surgery promises certain benefits, its high acquisition and maintenance costs, along with the necessity for specialized training, present significant barriers to widespread implementation in the public health system. Objectives: This study aimed to perform a Budget Impact Analysis (BIA) regarding the integration of robotic hysterectomy into SUS. The analysis compared the costs of robotic technology with conventional laparoscopy, considering various scenarios of gradual adoption between 2026 and 2030. Results: The results show that, considering a moderate adoption scenario with a 5% annual growth rate, the estimated incremental budget impact for the period from 2026 to 2030 would be approximately 32,5 million Brazilian reais. Conclusions: It is concluded that, although representing a significant technological advancement, the incorporation of robotic surgery into the SUS should be approached with caution. Additional studies using national data and pilot experiences in reference centers are recommended to continuously assess its clinical, economic, and organizational impacts.
Introduction: Hysterectomy is a common surgery in Brazil, primarily recommended for the treatment of various gynecological conditions, both benign and malignant, such as uterine fibroids, endometriosis, adenomyosis, and different types of gynecological cancers. In the Brazilian Unified Health System (Sistema Único de Saúde - SUS), hysterectomy is the second most frequently performed surgery among women of reproductive age, surpassed only by cesarean sections. Between 2019 and 2023, a total of 502,226 hysterectomies were performed in SUS, at a cumulative cost of approximately 640 million Brazilian reais. In recent years, robotic surgery has emerged as an alternative to traditional surgical techniques, offering a minimally invasive approach through advanced robotic systems. These systems can allow more precise movements for the surgeon, in addition to offering a detailed three-dimensional view of the surgical field. Potential advantages include smaller incisions, reduced postoperative pain, and quicker patient recovery. However, scientific studies have shown no statistically significant differences in efficacy or safety between robotic hysterectomy and laparoscopic hysterectomy, a technique already employed within SUS. Although robotic surgery promises certain benefits, its high acquisition and maintenance costs, along with the necessity for specialized training, present significant barriers to widespread implementation in the public health system. Objectives: This study aimed to perform a Budget Impact Analysis (BIA) regarding the integration of robotic hysterectomy into SUS. The analysis compared the costs of robotic technology with conventional laparoscopy, considering various scenarios of gradual adoption between 2026 and 2030. Results: The results show that, considering a moderate adoption scenario with a 5% annual growth rate, the estimated incremental budget impact for the period from 2026 to 2030 would be approximately 32,5 million Brazilian reais. Conclusions: It is concluded that, although representing a significant technological advancement, the incorporation of robotic surgery into the SUS should be approached with caution. Additional studies using national data and pilot experiences in reference centers are recommended to continuously assess its clinical, economic, and organizational impacts.
Description
Palavras-chave
Histerectomia, procedimentos cirúrgicos robóticos, análise de
impacto orçamentário de avanços terapêuticos, hysterectomy, robotic surgical procedures, analysis of the budgetary
impact of therapeutic advances.
Citação
Lourenço Filho T. Impacto orçamentário da incorporação da cirurgia robótica para o procedimento de histerectomia sob a perspectiva do SUS. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2025.