Bigal Marcelo E, Rapoport Alan M, Bordini Carlos A, Tepper Stewart J, Sheftell Fred D, Speciali José G
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
Headache. 2003 Jul-Aug;43(7):742-54. doi: 10.1046/j.1526-4610.2003.03132.x.
The search for rationality in health expenses in developing countries collides with the lack of effectively conducted epidemiologic studies.
To present an estimate of the impact and costs of migraine in the Brazilian public health system and to estimate the impact on these costs and the effectiveness of a model of stratified care in the management of migraine.
An analytical model of utilization of the Brazilian public health system was constructed. Data refer to 1999 and were obtained in accordance with the following steps: (1) Brazilian demographic characteristics; (2) characteristics of the public health system related to its 3 hierarchical levels-primary, secondary, and tertiary care, the last being subdivided into emergency department and hospital care; and (3) estimation of the number of migraine consultations at each complexity level. In Brazil, migraineurs seen in the public health system are most often discharged with an acute treatment, usually a nonspecific medication. We compared this treatment with a proposed stratified care model that uses a triptan as an acute care medication. We have made the following assumptions: (1) 15% of the patients would fall into the Migraine Disability Assessment (MIDAS) grade I category, 25% would fall into the MIDAS grade II category, 30% into the grade III category, and 30% into the MIDAS grade IV category; (2) the mean number of migraine attacks per year are: MIDAS I, 7.49; MIDAS II, 8.02; MIDAS III, 12.22; and MIDAS IV, 27.01. The annual costs of the treatment were calculated according to the following equation: AC = P x N x C + P x Cp + P x Cat x AMA, where P is the number of patients; N, the number of consultations per patient; C, the cost of consultation per level; Cp, the cost of preventive drugs; Cat, the cost of acute therapy drugs; and AMA is the number of migraine attacks per year. Results.-The public health system resources included 55 735 ambulatory units (primary and secondary) and 6453 emergency department and public hospital units, with a corresponding budget of US $2 820 899 621.26. The estimated cost of a consultation on the primary care level was US $11.53; on the secondary care level, US $22.18; in the emergency department, $34.82; and for hospitalization, US $217.93. The total estimated public health system expenses for migraine were US $140 388 469.60. The proposed model would imply a cost reduction of 6.2% (US $7 514 604.40) with an improvement in the quality of the public health system from the actual 18.2% to an estimated 84.5%.
Migraine seems to pose a huge burden on the Brazilian public health system. The implementation of a stratified care model of treatment that would include specific acute migraine therapies could result in a dramatic increase in the quality of migraine care and a significant reduction in cost.
在发展中国家，寻求合理的医疗费用与缺乏有效开展的流行病学研究相冲突。
评估偏头痛在巴西公共卫生系统中的影响和成本，并估计分层护理模式对这些成本的影响以及在偏头痛管理中的有效性。
构建了巴西公共卫生系统利用情况的分析模型。数据来自1999年，通过以下步骤获得：（1）巴西人口特征；（2）公共卫生系统与其三个层级——初级、二级和三级护理相关的特征，最后一级又细分为急诊科和医院护理；（3）估计每个复杂程度层级的偏头痛会诊次数。在巴西，在公共卫生系统就诊的偏头痛患者通常以急性治疗出院，通常是使用非特异性药物。我们将这种治疗与一种提议的分层护理模式进行了比较，该模式使用曲坦类药物作为急性护理药物。我们做了以下假设：（1）15%的患者属于偏头痛残疾评估（MIDAS）I级，25%属于MIDAS II级，30%属于III级，30%属于MIDAS IV级；（2）每年偏头痛发作的平均次数为：MIDAS I级，7.49次；MIDAS II级，8.02次；MIDAS III级，12.22次；MIDAS IV级，27.01次。治疗的年度成本根据以下公式计算：AC = P×N×C + P×Cp + P×Cat×AMA，其中P是患者数量；N是每位患者的会诊次数；C是每个层级的会诊成本；Cp是预防性药物的成本；Cat是急性治疗药物的成本；AMA是每年偏头痛发作的次数。结果：公共卫生系统资源包括55735个门诊单位（初级和二级）以及6453个急诊科和公立医院单位，相应预算为2820899621.26美元。初级护理层级的会诊估计成本为11.53美元；二级护理层级为22.18美元；急诊科为34.82美元；住院为217.93美元。偏头痛的公共卫生系统总估计费用为140388469.60美元。提议的模式将意味着成本降低6.2%（7514604.40美元），同时公共卫生系统的质量从实际的18.2%提高到估计的84.5%。
偏头痛似乎给巴西公共卫生系统带来了巨大负担。实施包括特定急性偏头痛治疗的分层护理治疗模式可能会显著提高偏头痛护理质量并大幅降低成本。
