Assuntos
Complexo de Eisenmenger/complicações , Comunicação Interatrial/complicações , Hipertensão Pulmonar/complicações , Diagnóstico Tardio , Complexo de Eisenmenger/diagnóstico , Complexo de Eisenmenger/tratamento farmacológico , Complexo de Eisenmenger/patologia , Eletrocardiografia , Evolução Fatal , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/tratamento farmacológico , Comunicação Interatrial/patologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/patologia , Masculino , Pessoa de Meia-Idade , Vasodilatadores/uso terapêuticoRESUMO
INTRODUCTION: Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. METHODS: A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. DISCUSSION: PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.