Terreri M T, Ferraz M B, Goldenberg J, Len C, Hilário M O
Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Clinical Epidemiology Unit/Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil.
J Rheumatol. 2001 Jun;28(6):1394-7.
The socioeconomic effects of rheumatic fever (RF) in Brazil, including direct and indirect costs to patients and their families and to society, are largely unknown. We evaluated the utilization of resources and costs related to RF in a tertiary center caring for low income patients in the city of São Paulo, Brazil.
One hundred patients with RF, younger than 18 yrs, with followup of at least one year, were sequentially selected to provide complete information on a questionnaire. Additional data were collected from patients' charts. The utilization of resources was evaluated for each patient throughout the entire disease course. Costs were determined for patients and their families as well as for the society, using variables from 3 different systems: the national public health system, used by most lower income groups; the Brazilian Medical Association, which regulates charges and fees utilized by health plans and insurance companies; and costs charged by private practitioners, paid directly by patients.
The RF population studied belonged to a low socioeconomic level. The mean monthly family income was $625.20 US. The mean disease duration was 3.9 yrs (range 1-10). Patients had a total of 1657 medical consultations, 22 hospital admissions, and 4 admissions to intensive care unit. Work absenteeism among parents was calculated as 22.9%, equivalent to 901 days of missed work; about 5% of the parents lost their jobs. Patients showed a high rate of school failure (22%). Considering the public system as a reference, direct, indirect, and total costs to society per 100 patients throughout the entire disease duration were $105,860 US ($271/patient/yr), $18,803 US ($48/patient/yr), and $124,663 US (US $319/patient/yr), respectively. When health care plan and private systems were taken as reference, the total costs were $423,550 US and $684,351 US, respectively.
RF and rheumatic heart disease have an important socioeconomic impact in Brazil; costs of RF made up roughly 1.3% of annual family income. The estimated annual cost of RF for society in Brazil is $51,144,347.00 US.
风湿热（RF）在巴西产生的社会经济影响，包括对患者及其家庭以及社会造成的直接和间接成本，在很大程度上尚不明确。我们在巴西圣保罗市一家为低收入患者提供治疗的三级中心，评估了与RF相关的资源利用情况和成本。
连续选取100名年龄小于18岁、随访至少一年的RF患者，让他们在一份问卷上提供完整信息。另外还从患者病历中收集数据。在整个疾病过程中对每位患者的资源利用情况进行评估。使用来自3种不同体系的变量来确定患者及其家庭以及社会的成本：大多数低收入群体使用的国家公共卫生系统；规范健康计划和保险公司收费的巴西医学协会；以及患者直接支付的私人执业医生收取的费用。
所研究的RF患者群体社会经济水平较低。家庭月平均收入为625.20美元。疾病平均持续时间为3.9年（范围1 - 10年）。患者总共进行了1657次医疗咨询、22次住院治疗以及4次重症监护病房住院。父母的旷工率经计算为22.9%，相当于901个工作日的缺勤；约5%的父母失去了工作。患者的学业失败率较高（22%）。以公共系统作为参照，在整个疾病持续期间，每100名患者对社会造成的直接、间接和总成本分别为105,860美元（每位患者每年271美元）、18,803美元（每位患者每年48美元）和124,663美元（每位患者每年319美元）。当以医疗保健计划和私人系统作为参照时，总成本分别为423,550美元和684,351美元。
RF和风湿性心脏病在巴西具有重要的社会经济影响；RF的成本约占家庭年收入的1.3%。巴西社会每年估计的RF成本为51,144,347.00美元。
