The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.1371/journal.pone.0199446 http://hdl.handle.net/1843/60987 |
Resumo: | Background: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. Methods and findings: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. Results: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). Conclusions: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed. |
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2023-11-16T12:33:19Z2023-11-16T12:33:19Z2018-06-21136114https://doi.org/10.1371/journal.pone.01994461932-6203http://hdl.handle.net/1843/60987Background: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. Methods and findings: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. Results: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). Conclusions: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.Antecedentes: A Esclerose Múltipla (EM) é uma doença que impacta sensivelmente na qualidade de vida dos pacientes e está associada a elevados gastos. A EM é uma doença crônica multifatorial, caracterizada por inflamação, desmielinização e perda axonal. O sistema público de saúde brasileiro oferece tratamento farmacológico, bem como atendimento hospitalar e ambulatorial para pacientes com esclerose múltipla recorrente-remitente e secundária progressiva. No entanto, não temos conhecimento de publicações anteriores que avaliem os custos médicos diretos totais em pacientes com longo seguimento no sistema de saúde brasileiro. Consequentemente, o objetivo é analisar os gastos públicos com pacientes com EM para orientar as partes interessadas em futuras decisões de investimento e desinvestimento. Métodos e resultados: Analisamos retrospectivamente os gastos públicos brasileiros com pacientes com EM entre 2000 e 2015 usando o registro centrado no paciente de todos os pacientes do sistema público de saúde (SUS) obtido por meio do linkage determinístico-probabilístico de registros do Sistema de Informações Ambulatoriais, Informações Hospitalares Sistema e Sistemas de Informações sobre Mortalidade no Brasil. Foi realizada análise descritiva dos dados e modelo de regressão linear múltipla para avaliar as associações entre o custo médio anual por paciente e as variáveis clínicas e demográficas. A adequação do modelo foi verificada a partir de análise de resíduos e o nível de significância adotado foi de 5%. Resultados: foram identificados 28.401 pacientes e posteriormente analisados 23.082 pacientes. A maioria dos pacientes era do sexo feminino (73,3%), residia na região Sudeste (58,9%), tinha idade média de 36,8 (± 12,2) anos e iniciou tratamento com um dos interferons beta (78,9%). O gasto total com custos médicos diretos nos dezesseis anos de acompanhamento foi de US$ 2.308.393.465,60, e o gasto médio anual por paciente foi de US$ 13.544,40 (± 4.607,05). No modelo de melhor ajuste (p<0,001), aproximadamente 40% da variabilidade do custo médio anual por paciente foi explicada pela região de residência; medicação utilizada (intenção de tratar); se o paciente era usuário não exclusivo de medicamentos, ou seja, utilizava o SUS para outros procedimentos que não medicamentos de alto custo; ano de início do tratamento; e presença de eventos (óbito; recidiva; mudança de tratamento e/ou comorbidade). Conclusões: No sistema público de saúde do Brasil, as terapias modificadoras da doença representam atualmente quase a totalidade dos custos diretos totais do tratamento da esclerose múltipla. Em todo o mundo, as tecnologias de saúde novas e emergentes para o tratamento da EM impõem um desafio aos orçamentos da saúde, destacando a necessidade de estudos de custo-eficácia que comparem estas tecnologias com as já disponíveis. Nosso modelo de regressão pode ajudar nesse processo e chama a atenção para a necessidade de acessar o desempenho real das novas terapias disponíveis no SUS, com potencial de desinvestimento e/ou redução de preços, se necessário.engUniversidade Federal de Minas GeraisUFMGBrasilFAR - DEPARTAMENTO DE FARMÁCIA SOCIALMED - DEPARTAMENTO DE MEDICINA PREVENTIVA SOCIALPLOS ONEEsclerose múltiplaCustos de cuidados de saúdeSistema Único de SaúdeQualidade de vidaBrasilMultiple sclerosisHealth care costsPublic spendingPublic health systemQuality of lifeBrazilThe long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleIsabela Maia DinizAugusto Afonso Guerra JúniorLívia Lovato Pires de LemosKathiaja Miranda SouzaBrian GodmanMarion BennieBjörn WettermarkFrancisco de Assis AcurcioJuliana Alvares TeodoroEli Iola Gurgel AndradeMariangela Leal CherchigliaVânia Eloisa de Araújo Silvaapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/60987/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALThe long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil.pdfThe long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil.pdfapplication/pdf3391733https://repositorio.ufmg.br/bitstream/1843/60987/2/The%20long-term%20costs%20for%20treating%20multiple%20sclerosis%20in%20a%2016-year%20retrospective%20cohort%20study%20in%20Brazil.pdf21136fa9e6de05c3d92e3bdf233f96b5MD521843/609872023-11-16 17:00:03.913oai:repositorio.ufmg.br:1843/60987Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-11-16T20:00:03Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
title |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
spellingShingle |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil Isabela Maia Diniz Multiple sclerosis Health care costs Public spending Public health system Quality of life Brazil Esclerose múltipla Custos de cuidados de saúde Sistema Único de Saúde Qualidade de vida Brasil |
title_short |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
title_full |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
title_fullStr |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
title_full_unstemmed |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
title_sort |
The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil |
author |
Isabela Maia Diniz |
author_facet |
Isabela Maia Diniz Augusto Afonso Guerra Júnior Lívia Lovato Pires de Lemos Kathiaja Miranda Souza Brian Godman Marion Bennie Björn Wettermark Francisco de Assis Acurcio Juliana Alvares Teodoro Eli Iola Gurgel Andrade Mariangela Leal Cherchiglia Vânia Eloisa de Araújo Silva |
author_role |
author |
author2 |
Augusto Afonso Guerra Júnior Lívia Lovato Pires de Lemos Kathiaja Miranda Souza Brian Godman Marion Bennie Björn Wettermark Francisco de Assis Acurcio Juliana Alvares Teodoro Eli Iola Gurgel Andrade Mariangela Leal Cherchiglia Vânia Eloisa de Araújo Silva |
author2_role |
author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Isabela Maia Diniz Augusto Afonso Guerra Júnior Lívia Lovato Pires de Lemos Kathiaja Miranda Souza Brian Godman Marion Bennie Björn Wettermark Francisco de Assis Acurcio Juliana Alvares Teodoro Eli Iola Gurgel Andrade Mariangela Leal Cherchiglia Vânia Eloisa de Araújo Silva |
dc.subject.por.fl_str_mv |
Multiple sclerosis Health care costs Public spending Public health system Quality of life Brazil |
topic |
Multiple sclerosis Health care costs Public spending Public health system Quality of life Brazil Esclerose múltipla Custos de cuidados de saúde Sistema Único de Saúde Qualidade de vida Brasil |
dc.subject.other.pt_BR.fl_str_mv |
Esclerose múltipla Custos de cuidados de saúde Sistema Único de Saúde Qualidade de vida Brasil |
description |
Background: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. Methods and findings: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. Results: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). Conclusions: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018-06-21 |
dc.date.accessioned.fl_str_mv |
2023-11-16T12:33:19Z |
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2023-11-16T12:33:19Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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https://doi.org/10.1371/journal.pone.0199446 |
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1932-6203 |
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https://doi.org/10.1371/journal.pone.0199446 http://hdl.handle.net/1843/60987 |
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1932-6203 |
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Universidade Federal de Minas Gerais |
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Brasil |
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FAR - DEPARTAMENTO DE FARMÁCIA SOCIAL MED - DEPARTAMENTO DE MEDICINA PREVENTIVA SOCIAL |
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Universidade Federal de Minas Gerais |
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