Custo-efetividade do cateterismo venoso central guiado por ultrassonografia no SUS
Custo-efetividade do cateterismo venoso central guiado por ultrassonografia no SUS
Arquivos
Data
2016
Autores
Boller, Carlos Eduardo Pessanha
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
O Cateterismo Venoso Central é um procedimento muito utilizado nas Unidades de Terapia Intensiva e consiste na inserção de um dispositivo por meio da rede venosa e posicionamento na veia cava. O pneumotórax e a punção arterial acidental são suas principais complicações quando realizado em Veia Subclávia e Veia Jugular Interna, respectivamente, podendo ter associação com variações anatômicas, alterações fisiológicas ou treinamento insuficiente. A ultrassonografia vem sendo utilizada como auxiliar no Cateterismo Venoso Central com o objetivo de minimizar riscos e reduzir complicações. O presente estudo apresenta uma avaliação econômica de custo-efetividade comparando a técnica de cateterismo venoso central guiada pelo ultrassom com a técnica padrão, realizada em adultos, sob a perspectiva do Sistema Único de Saúde brasileiro. A partir de uma busca sistemática na base de dados Medline via Pubmed, os dados de prevalência para a construção do modelo econômico foram levantados e sumarizados por meio de meta- análises. Uma árvore de decisão foi construída com base em um cenário hipotético descrito como uma unidade de atendimento terciário de saúde já em uso do equipamento de ultrassonografia para auxiliar o procedimento, e com equipe técnica habilitada. Os custos diretos estimados para os materiais e procedimentos foram valorados utilizando bancos de registros de compras nacionais. Foi adotado o valor de R$28.876,00 (1 PIB per capita brasileiro - 2016) como limiar de Custo-Efetividade. Realizada análise de sensibilidade determinística e probabilística. A razão do custo-efetividade incremental para a ultrassonografia no sítio Veia Jugular Interna foi de R$14.922,34 para cada complicação grave evitada. Após a realização da análise probabilística identificou-se que 63,6% das simulações foram custo-efetivas e apenas 8,9% não foram efetivas em relação à técnica padrão. No sítio Veia Subclávia, a razão de custo-efetividade incremental estimada para a ultrassonografia foi de R$1.159,19 por complicação grave evitada. Após a realização da análise probabilística, identificou-se que 80,1% das simulações foram custo-efetivas, sendo 13,2% destas dominantes. Desta forma, conclui-se que a intervenção avaliada é eficaz, segura e custo-efetiva em ambos os sítios, sendo mais custo-efetiva na punção de Veia Subclávia.
Central Venous Catheterization (CVC) is a procedure that is widely used in intensive care units and consists of inserting a catheter into the vein and positioning it in the vena cava. The most common complications are pneumothorax and arterial puncture when the procedure is performed in the subclavian and internal jugular vein, respectively. Complications may be associated with anatomical variations, physiological changes or insufficient staff training. Ultrasonography has been used to assist Central Venous Catheterization and minimize risks and reduce complications. This study aims to develop a cost-effectiveness economic evaluation comparing the ultrasound (US)-guided catheterization technique to the standard technique, performed in adults in the Brazilian Unified Health System (SUS). This study used a structured search in the Medline database through the Pubmed interface. Prevalence data for building the model were collected and summarized through meta-analysis. The decision tree considered the hypothetical scenario of a tertiary health care unit , already equipped with US to perform CVC, along with technical staff qualified for the procedure. Estimated direct costs for materials and procedures were valued in national public procurement databases. The threshold for the Incremental Cost-Effectiveness adopted was BRL 28,876.00 (1 GDP per capita - 2016). Deterministic sensitivity and probabilistic sensitivity were performed. The incremental cost-effectiveness ratio estimated for the US on the Internal Jugular Vein was BRL 14,922.34 for each serious complication avoided. Probabilistic analysis found that 63.6% of simulations were cost-effective and only 8.9% were not effective in relation to the standard technique. For the subclavian vein site, the estimated incremental cost-effectiveness ratio for US was BRL 1,159.19 for each serious complication avoided. Probabilistic analysis, found that 80.1% of the simulations were cost-effective, and 13.2% of these were dominant. Thus, it was concluded that the studied intervention is effective, safe and cost-effective at both sites, and the most cost-effective procedure was subclavian vein puncture.
Central Venous Catheterization (CVC) is a procedure that is widely used in intensive care units and consists of inserting a catheter into the vein and positioning it in the vena cava. The most common complications are pneumothorax and arterial puncture when the procedure is performed in the subclavian and internal jugular vein, respectively. Complications may be associated with anatomical variations, physiological changes or insufficient staff training. Ultrasonography has been used to assist Central Venous Catheterization and minimize risks and reduce complications. This study aims to develop a cost-effectiveness economic evaluation comparing the ultrasound (US)-guided catheterization technique to the standard technique, performed in adults in the Brazilian Unified Health System (SUS). This study used a structured search in the Medline database through the Pubmed interface. Prevalence data for building the model were collected and summarized through meta-analysis. The decision tree considered the hypothetical scenario of a tertiary health care unit , already equipped with US to perform CVC, along with technical staff qualified for the procedure. Estimated direct costs for materials and procedures were valued in national public procurement databases. The threshold for the Incremental Cost-Effectiveness adopted was BRL 28,876.00 (1 GDP per capita - 2016). Deterministic sensitivity and probabilistic sensitivity were performed. The incremental cost-effectiveness ratio estimated for the US on the Internal Jugular Vein was BRL 14,922.34 for each serious complication avoided. Probabilistic analysis found that 63.6% of simulations were cost-effective and only 8.9% were not effective in relation to the standard technique. For the subclavian vein site, the estimated incremental cost-effectiveness ratio for US was BRL 1,159.19 for each serious complication avoided. Probabilistic analysis, found that 80.1% of the simulations were cost-effective, and 13.2% of these were dominant. Thus, it was concluded that the studied intervention is effective, safe and cost-effective at both sites, and the most cost-effective procedure was subclavian vein puncture.
Description
Palavras-chave
Technology Assessment, Biomedical, Evidence-Based Medicine, Practice Patterns, Physicians’, Cost-Benefit Analysis, Ultrasonography, Interventional, Catheterization, Central Venous, Avaliação de Tecnologia Biomédica, Medicina Baseada em Evidências, Padrões de Prática Médica, Análise Custo-Benefício, Ultrassonografia de Intervenção, Cateterismo Venoso Central
Citação
Boller CEP. Custo-efetividade do cateterismo venoso central guiado por ultrassonografia no SUS. Rio de Janeiro. Dissertação [mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2016.