Resumen
Inexiste guia prático para orientar a intensidade do tratamento farmacológico de pacientes com insuficiência cardíaca (IC) crônica. Testamos a hipótese se a farmacoterapia orientada pelas concentrações da fração amino-terminal do Pro-BNP (proBNP) produziria melhores desfechos e menores custos comparado ao monitoramento clínico isoladamente, em pacientes com IC crônica. Desenvolvemos árvore de decisão para análise de custo-efetividade modelada para o Sistema Privado de Saúde. Utilizamos dados de efetividade publicados em ensaio clínico controlado randomizado e dados de custos do tratamento obtidos dos estudos brasileiros sobre custos da IC. A unidade de efetividade foi "internação hospitalar evitada". A árvore de decisão e as análises estatísticas foram conduzidas no programa TreeAge Pro Healthcare. O grupo monitorado pelo proBNP apresentou 63% de redução na internação hospitalar comparativamente ao grupo clínico, no período de 12 meses. O custo médio do monitoramento do grupo proBNP foi de R$ 2884 versus R$ 3134 do grupo clínico. A efetividade do grupo proBNP foi de 89% versus 72% do grupo clínico. A redução da internação hospitalar obtida no grupo proBNP proporcionou custo final menor comparativamente ao grupo clínico. Concluímos que o uso do proBNP pode ser estratégia redutora de custos no monitoramento do tratamento de pacientes com IC.
Clasificación en siicsalud
Artículos originales> Expertos de Iberoamérica>
página www.siicsalud.com/des/des051/06n23003.htm
Especialidades
Principal: Diagnóstico por Imágenes
Relacionadas: Cardiología, Medicina Interna
Enviar correspondencia a:
Denizar Vianna Araújo, Universidade do Estado do Rio de Janeiro, Instituto de Medicina Social, 22450-000, Leblon, Brasil
Patrocinio y reconocimiento
El estudio fue financiado por la Indústria Roche Diagnóstico do Brasil.
Artículo completo
(portugués)
Extensión:
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COST-EFFECTIVENESS OF MONITORING HEART FAILURE USING PROBNP COMPARED TO CLINICAL MONITORING
Abstract
There is no practical guide to intensity of drug treatment for patients with chronic heart failure (HF). We tested the hypothesis whether pharmacotherapy directed by plasma concentrations of the aminoterminal portion of ProBNP (proBNP) would produce better clinical outcomes and lower costs with hospital admissions, compared to clinical monitoring alone, in chronic HF patients. A decision tree was developed to cost-effectiveness analysis to the Private Health System. We used effectiveness data described in a randomized, controlled clinical trial and data from ambulatory and hospital treatment costs coming from Brazilian studies on costs of HF. The effectiveness unit was "avoided hospital admissions". The decision tree and statistical analyses were performed by the software TreeAge Pro Healthcare. The proBNP monitored group showed a 63% reduction in hospital admissions when compared to the clinical group. The average cost of proBNP group was R$ 2884 versus R$ 3134 of clinical group. The effectiveness of proBNP group was 89% versus 72% of clinical group. The lower cost of hospital admissions reached by proBNP group yields a lower final burden, when compared to the clinical group costs. We concluded that use of proBNP can be cost saving strategy in treatment monitoring of chronic heart failure patients.
Key words
congestive heart failure, brain natriuretic peptide, cost efficiency analysis, health resources, cost analysis
Bibliografía del artículo
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