Custo do teste Anti-HBs pós-vacinação primária em relação ao manejo para hepatite B pós-exposição à material biológico entre trabalhadores da área da saúde

• Autor(a) principal: Souza, Camila Lucas de
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• dARK ID: ark:/38995/00130000098wt
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/8669
• topic: Exposição ocupacional; Pessoal de saúde; Vacinas contra hepatite B; Anticorpos anti-hepatite B; Custos e análise de custos; Custos de cuidados de saúde; Occupational exposure; Health care workers; Hepatitis B vaccines; Hepatitis B antibodies; Costs and cost analysis; Health care costs; CIENCIAS DA SAUDE::ENFERMAGEM

INTRODUCTION: Hepatitis B virus (HBV) infection is a worldwide public health problem and the cost of treatment for hepatitis B is high. Work related accidents with biological material among health care workers present a risk of transmission of this virus. The primary preventive measure against HBV is vaccination, followed by an anti-HBs test one to two months after the final dose of the vaccine, however this test is not part of the pre-exposure routine in Brazilian public health. OBJECTIVES: To compare the direct medical cost, from the public health perspective, of the evaluation of pre-exposure serological status vs the post-exposure management of hepatitis B virus-related occupational exposure among exposed health care workers. The specific objectives were to describe sociodemographic and job characteristics, to classify the profile of accidents, to identify the vaccination history and serological status for hepatitis B, and to quantify the direct cost of post-exposure management and preventive measures for hepatitis B. METHODOLOGY: A cross-sectional, descriptive study with a partial economic evaluation of the cost analysis type, focusing on direct medical costs among health care workers exposed to biological material in the municipality of Goiania, accidents registered in the SINAN-NET database in the period 2006-2016. RESULTS: This study included 7,265 recorded accidents with biological material, being predominantly female health care workers (80.5%), nursing staff (55.2%) with secondary education (43.0%), with accidents involving blood (74.4%), those being percutaneous (72.4%). The mean age was 34 years, with the age group 21-30 years being the most predominant. Among those exposed, 85.1% received all three doses of the vaccine, and of those, 44.6% performed the anti-HBs test at the time of the accident. The prevalence of HBsAg among known source patients was 1.8% (95% CI 1.0- 3.2). The costs analyzed in this study were the anti-HBs test, HBsAg test, IGHAHB and a worker health office visit. Considering this history, the direct cost of occupational post- exposure management for hepatitis B among victims was evaluated in four different scenarios, and the direct cost ranged from R$ 3,615.52 (Int$ 6.573,67) to R$ 835,751.52 (Int$1.519.548,22). The post-exposure scenarios for HBV that presented the greatest direct medical cost impact for public health were the scenarios in which the porkers had anti-HBs <10 IU/ml and were exposed to an HBsAg-positive, unknown source patient. The direct cost of performing the anti-HBs test after primary vaccination among 7.265 workers was R$ 207,415.75 (Int$ 377,119.54). CONCLUSION: The direct per capita cost of post-exposure management was higher than the direct cost of performing the pre-exposure anti-HBs test, money that could be invested in policies that protect the health of the worker.