O custo do transplante cardíaco pediátrico realizado no Instituto Nacional de Cardiologia: microcusteio baseado na atividade e direcionado pelo tempo
O custo do transplante cardíaco pediátrico realizado no Instituto Nacional de Cardiologia: microcusteio baseado na atividade e direcionado pelo tempo
Data
2023
Autores
Cauduro, Alexandre Souza
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: O Transplante cardíaco pediátrico é a terapia de escolha na insuficiência cardíaca avançada e terminal, e na cardiopatia congênita, sem outras opções de tratamento. O transplante confere o aumento da sobrevida e a melhora da qualidade de vida. Até o momento, poucos foram os estudos encontrados com o objetivo de quantificar o custo unitário do transplante cardíaco pediátrico.
Objetivos: O objetivo primário é a quantificação do custo unitário hospitalar do transplante cardíaco pediátrico, desde a inscrição na lista de espera, até o final do primeiro ano de seguimento, sob a perspectiva do Instituto Nacional de Cardiologia.
Método: O valor unitário resultou da aplicação do microcusteio baseado por atividade e direcionado pelo tempo – TDABC – Time Driven Activity Based Costing. A partir do mapeamento da linha de cuidado e da identificação do uso de recursos operacionais e fixos. Uma cesta de acumulação de custos foi construída para cada atividade que compusesse a linha de cuidado. O tempo consumido na cesta de atividade, foi o direcionador do custo. O custo unitário total resultou da soma do custo acumulado, para cada atividade, acrescido do custo variável individual. Os recursos foram valorados segundo os preços de mercado.
Resultados: O estudo localizou todos os 21 primeiros pacientes submetidos ao transplante cardíaco pediátrico na Instituição. A idade mediana foi de 150 meses (IQ 81m – 168m). A Miocardiopatia Dilatada, a Cardiopatia Congênita e a Miocardiopatia Restritiva foram os diagnósticos de indicação de transplante em 48%,33% e 14%, respectivamente. A mediana do custo hospitalar total acumulado, foi de R$ 93.375,48 (IQ R$61.983,85 – R$127.147,98). O custo acumulado na atividade do Centro de Terapia Intensiva, e o consumo dos recursos diretos, variáveis, como medicamentos e exames, compuseram 53% do custo total, seguido da internação na enfermaria (14%) e a realização da biopsia endomiocardica (12%). O Centro Cirúrgico foi o local com o maior custo de utilização, por hora de uso, com R$706,55/h. O médico e o técnico de enfermagem, são as categorias profissionais com o maior consumo de tempo, por paciente ao dia, na atividade do Centro de Terapia Intensiva, com 6h e 10h, respectivamente. A ocorrência de rejeição ao enxerto cardíaco, correlaciona-se com um maior custo variável (p=0,05).
Conclusão:
O estudo alcançou o objetivo de quantificar o custo unitário hospitalar do transplante
cardíaco pediátrico, desde a inscrição em lista, até o fim do primeiro ano de seguimento. O custo do transplante, sob a perspectiva do provedor dos serviços de saúde, se encontra muito abaixo das referências internacionais, o que pode estar relacionado ao baixo custo dos recursos humanos, praticados pelo setor público de saúde, no Brasil. A ocorrência de rejeição ao enxerto se correlaciona ao maior consumo de insumos e medicamentos.
Palavras-chave: custo, microcusteio, transplante cardíaco.
Introduction: Pediatric heart transplantation is the therapy of choice for advanced and terminal heart failure and congenital heart disease without other treatment options. Transplantation increases survival and improves quality of life. To date, few studies have been found with the aim of quantifying the unit cost of pediatric heart transplantation. Objectives: The primary objective is to quantify the unit hospital cost of pediatric heart transplantation, from registration on the waiting list to the end of the first year of follow-up, from the perspective of the National Institute of Cardiology. Method: The unit value resulted from the application of Time Driven Activity Based Costing (TDABC). Based on mapping the line of care and identifying the use of operational and fixed resources. A cost accumulation basket was built for each activity that made up the line of care. The time consumed in the activity basket was the cost driver. The total unit cost resulted from the sum of the accumulated cost for each activity plus the individual variable cost. Resources were valued according to market prices. Results: The study tracked all 21 of the first patients undergoing pediatric heart transplantation at the Institution. The median age was 150 months (IQ 81m - 168m). Dilated cardiomyopathy, congenital heart disease and restrictive cardiomyopathy were the diagnoses for which transplantation was indicated in 48%, 33% and 14%, respectively. The median total accumulated hospital cost was BRL93,375.48 (IQ BRL61,983.85 – R$127,147.98). The accumulated cost of the Intensive Care Center activity and the consumption of direct, variable resources, such as medicines and tests, made up 53% of the total cost, followed by admission to the ward (14%) and endomyocardial biopsy (12%). The Surgical Center was the place with the highest cost per hour of use, at BRL706.55/h. The doctor and the nursing technician are the professional categories with the highest time consumption per patient per day in the Intensive Care Center, with 6h and 10h, respectively. The occurrence of cardiac graft rejection correlates with a higher variable cost (p=0.05). Conclusion: The study achieved its objective of quantifying the unit hospital cost of pediatric heart transplantation, from registration on the list to the end of the first year of follow-up. The cost of transplantation, from the perspective of the health service provider, is well below international benchmarks, which may be related to the low cost of human resources practiced by the public health sector in Brazil. The occurrence of graft rejection is correlated with higher consumption of inputs and medicines. Keywords: cost, micro-costing, heart transplant.
Introduction: Pediatric heart transplantation is the therapy of choice for advanced and terminal heart failure and congenital heart disease without other treatment options. Transplantation increases survival and improves quality of life. To date, few studies have been found with the aim of quantifying the unit cost of pediatric heart transplantation. Objectives: The primary objective is to quantify the unit hospital cost of pediatric heart transplantation, from registration on the waiting list to the end of the first year of follow-up, from the perspective of the National Institute of Cardiology. Method: The unit value resulted from the application of Time Driven Activity Based Costing (TDABC). Based on mapping the line of care and identifying the use of operational and fixed resources. A cost accumulation basket was built for each activity that made up the line of care. The time consumed in the activity basket was the cost driver. The total unit cost resulted from the sum of the accumulated cost for each activity plus the individual variable cost. Resources were valued according to market prices. Results: The study tracked all 21 of the first patients undergoing pediatric heart transplantation at the Institution. The median age was 150 months (IQ 81m - 168m). Dilated cardiomyopathy, congenital heart disease and restrictive cardiomyopathy were the diagnoses for which transplantation was indicated in 48%, 33% and 14%, respectively. The median total accumulated hospital cost was BRL93,375.48 (IQ BRL61,983.85 – R$127,147.98). The accumulated cost of the Intensive Care Center activity and the consumption of direct, variable resources, such as medicines and tests, made up 53% of the total cost, followed by admission to the ward (14%) and endomyocardial biopsy (12%). The Surgical Center was the place with the highest cost per hour of use, at BRL706.55/h. The doctor and the nursing technician are the professional categories with the highest time consumption per patient per day in the Intensive Care Center, with 6h and 10h, respectively. The occurrence of cardiac graft rejection correlates with a higher variable cost (p=0.05). Conclusion: The study achieved its objective of quantifying the unit hospital cost of pediatric heart transplantation, from registration on the list to the end of the first year of follow-up. The cost of transplantation, from the perspective of the health service provider, is well below international benchmarks, which may be related to the low cost of human resources practiced by the public health sector in Brazil. The occurrence of graft rejection is correlated with higher consumption of inputs and medicines. Keywords: cost, micro-costing, heart transplant.
Description
Palavras-chave
Custo, Microcusteio, transplante cardíaco, Cost, Micro-costing, Heart transplant
Citação
Cuaduro AS. O custo do transplante cardíaco pediátrico realizado no Instituto Nacional de Cardiologia: microcusteio baseado na atividade e direcionado peo tempo. Rio de Janeiro. dissertação [Mestrado Profiossional em Avaliação de Tecnologias em Saúde] Instituto Nacional de Cardiologia - INC; 2023.