Cortada Aline Pinheiro dos Santos, Silva Telma Gomes da, Silva André Campos da, Golmia Ricardo Prado, Guerra Renata Leborato, Takemoto Maíra Libertad Soligo, Monteiro Roberta Dyonisio Canaveira, Scheinberg Morton Aaron
Associação de Assistência à Criança Deficiente, São Paulo, SP, Brazil.
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2015 Jul-Sep;13(3):410-6. doi: 10.1590/S1679-45082015GS3057. Epub 2015 Aug 25.
To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system.
A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization).
A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively.
Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.
在巴西卫生系统背景下，比较全膝关节和髋关节置换患者静脉血栓栓塞症的预防治疗方法及住院相关费用。
通过病历回顾对2010年在圣保罗州一家公立医院和两家私立医院接受关节成形术的患者进行回顾性研究。根据住院期间医疗资源的使用情况估算费用。根据提供护理的类型（公立或私立机构），使用频率和均值（标准差）进行描述性分析。
共评估了215例患者，其中56.3%接受了膝关节手术，43.7%接受了髋关节置换。公立和私立卫生服务机构中分别约有88%和98%的患者接受了某种形式的静脉血栓栓塞症预防，依诺肝素是两个系统中使用最广泛的药物。公立服务机构预防的总费用为1,873.01雷亚尔（每位患者26.38雷亚尔），私立服务机构为21,559.73雷亚尔（每位患者163.33雷亚尔）。对于出现血栓栓塞症的患者，公立和私立卫生服务机构每位患者的平均住院费用分别为6,210.80雷亚尔和43,792.59雷亚尔。
尽管关节成形术患者的血栓栓塞症预防在公立和私立服务机构中成本都很高，但在私立卫生服务机构中比在公立机构中使用更为普遍。住院期间血栓形成患者的人均费用高于预防的总费用，这表明预防具有更好的成本效益比。
