RESUMO
OBJECTIVES: This study aimed to determine the hospital service utilization patterns and direct healthcare hospital costs before and during peritoneal dialysis (PD) at home. METHODS: A retrospective cohort study of patients with kidney failure (KF) was conducted at a Mexican Social Security Institute hospital for the year 2014. Cost categories included inpatient emergency room stays, inpatient services at internal medicine or surgery, and hospital PD. The study groups were (1) patients with KF before initiating home PD, (2) patients with less than 1 year of home PD (incident), and (3) patients with more than 1 year of home PD (prevalent). Costs were actualized to international dollars (Int$) 2023. RESULTS: We found that 53% of patients with KF used home PD services, 42% had not received any type of PD, and 5% had hospital dialysis while waiting for home PD. The estimated costs adjusting for age and sex were Int$5339 (95% CI 4680-9746) for patients without home PD, Int$17 556 (95% CI 15 314-19 789) for incident patients, and Int$7872 (95% CI 5994-9749) for prevalent patients; with significantly different averages for the 3 groups (P < .001). CONCLUSIONS: Although the use of services and cost is highest at the time of initiating PD, over time, using home PD leads to a significant reduction in use of hospital services, which translates into institutional cost savings. Our findings, especially considering the high rates of KF in Mexico, suggest a pressing need for interventions that can reduce healthcare costs at the beginning of renal replacement therapy.
Assuntos
Hospitalização , Diálise Peritoneal , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Hospitalização/economia , Hospitalização/estatística & dados numéricos , México , Diálise Peritoneal/economia , Diálise Peritoneal/estatística & dados numéricos , Adulto , Idoso , Custos de Cuidados de Saúde/estatística & dados numéricos , Insuficiência Renal/terapia , Insuficiência Renal/economia , Insuficiência Renal/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Hemodiálise no Domicílio/economia , Hemodiálise no Domicílio/estatística & dados numéricos , Falência Renal Crônica/terapia , Falência Renal Crônica/economiaRESUMO
OBJECTIVES: Heart failure has a great impact on health budget, mainly due to the cost of hospitalizations. Our aim was to describe health resource use and costs of heart failure admissions in three important institutions in Argentina. METHODS: Multi-center retrospective cohort study, with descriptive and analytical analysis by subgroups of ejection fraction, blood pressure and renal function at admission. Generalized linear models were used to assess the association of independent variables to main outcomes. RESULTS: We included 301 subjects; age 75.3±11.8 years; 37% women; 57% with depressed ejection fraction; 46% of coronary etiology. Blood pressure at admission was 129.8±29.7 mmHg; renal function 57.9±26.2 ml/min/1.73 m2. Overall mortality was 7%. Average length of stay was 7.82±7.06 days (median 5.69), and was significantly longer in patients with renal impairment (8.9 vs. 8.18; p=0.03) and shorter in those with high initial blood pressure (6.08±4.03; p=0.009). Mean cost per patient was AR$68,861±96,066 (US$=8,071; 1US$=AR$8.532); 71% attributable to hospital stay, 20% to interventional procedures and 6.7% to diagnostic studies. Variables independently associated with higher costs were depressed ejection fraction, presence of valvular disease, and impaired renal function. CONCLUSIONS: Resource use and costs associated to hospitalizations for heart failure is high, and the highest proportion is attributable to the costs related to hospital stay.
Assuntos
Custos e Análise de Custo , Recursos em Saúde/estatística & dados numéricos , Insuficiência Cardíaca , Hospitalização/estatística & dados numéricos , Idoso , Argentina , Feminino , Recursos em Saúde/economia , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão , Tempo de Internação/economia , Masculino , Insuficiência Renal/complicações , Insuficiência Renal/economia , Estudos RetrospectivosRESUMO
BACKGROUND: Return to work is an objective parameter used worldwide to evaluate the success of organ transplantation and is especially feasible after renal transplantation. This study sought to describe the frequency of return to work after renal transplantation and related characteristics. METHODS: Retrospective cohort of 511 isolated kidney transplant recipients was recruited from a Brazilian referral center from January 2005 to December 2009; all were matched to the public social security database to determine inclusion and benefit awards, as well as the rate of resumption of contributions to the public social security system, a surrogate marker of work rehabilitation. Characteristics associated with work return were analyzed. RESULTS: No social security records were found for 28 subjects. The remaining 483 subjects had a mean age of 45±13 years; 62% were male; 401 (83%) received some public social security benefit; 298 were paying dues and could, therefore, receive temporary or permanent disability benefits. Of these, 78 subjects made social security payments after transplantation, resulting in a work return rate of 26% (95% confidence interval, 21-32). Younger age, living donor graft, and chronic glomerulonephritis were significantly associated with return to work. CONCLUSION: In Brazil, most renal transplant recipients are on social security benefits, but only a small proportion return to work after surgery. Clinical characteristics may help define work resumption trends.
Assuntos
Transplante de Rim/métodos , Insuficiência Renal/cirurgia , Retorno ao Trabalho , Adolescente , Adulto , Fatores Etários , Idoso , Brasil , Emprego , Feminino , Glomerulonefrite/complicações , Humanos , Transplante de Rim/economia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/economia , Estudos Retrospectivos , Previdência Social , Adulto JovemRESUMO
OBJETIVO: Descrever o perfil epidemiológico dos óbitos de pacientes em terapia renal substitutiva e o custo do tratamento. MÉTODOS: Estudo transversal e retrospectivo realizado com os dados da Base Nacional de Terapia Renal Substitutiva. Foram incluídos 2029 óbitos por insuficiência renal. Os dados foram analisados por inferência estatística e estatística não paramétrica. RESULTADOS: Houve maior número de óbitos entre os pacientes do sexo masculino e da raça branca. O custo do tratamento aumentou 6,7% nos gastos do estado e 45,3% no município. CONCLUSÃO: O maior número de óbitos ocorreu no sexo masculino, raça branca, variações bruscas nas taxas de mortalidade hospitalar e aumentou o custo do tratamento nos últimos três anos.
OBJECTIVE: Determine the epidemiological profile of patient deaths related to renal replacement therapy and the cost of treatment. METHODS: Cross-sectional retrospective study carried out with data from the National Renal Replacement Therapy Database. It included 2009 deaths due to renal failure. Data were analyzed using statistical inference and nonparametric statistics. RESULTS: A greater number of deaths was observed among white, male patients. The cost of treatment increased 6.7% in the state and 45.3% in the city. CONCLUSION: The highest number of deaths occurred among white males; there were marked variations in hospital mortality rates; and the cost of treatment increased over the past three years.