Custo-efetividade da oxigenoterapia hiperbárica no tratamento do pé diabético

• Autor(a) principal: Noal, Helena Carolina
• Data de Publicação: 2023
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Manancial - Repositório Digital da UFSM
• dARK ID: ark:/26339/001300000w0wk
• Texto Completo: http://repositorio.ufsm.br/handle/1/32179
• topic: Enfermagem; Avaliação de tecnologia em saúde; Avaliação econômica em saúde; Diabetes mellitus; Nursing; Health technology assessment; Health economic evaluation; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

This study aimed to evaluate the cost-effectiveness of hyperbaric oxygen therapy (HBOT) as an adjuvant in the treatment of diabetic foot ulcers compared to the treatment with conventional bandaging alone from the perspective of the public healthcare system. It was conducted a complete economic study with data from scientific literature and a systematic review. In order to increase the transparency of the proposed study, the main aspects of the study were summarized according to the CHEERS Task Force Report checklist. The target public was patients with lower limb lesions caused by diabetic foot ulcers in Brazil, and the perspective of analysis was the Sistema Único de Saúde/Unified Health System (SUS). Treatments with conventional bandaging and HBO in a period of 12 months were compared. The measures of effectiveness were wound healing and decrease in amputation. The costs were assessed in Brazilian real (R$). The chosen model was the decision tree and both a univariate deterministic sensitivity analysis (presented in Tornado diagram) and a multivariate probabilistic sensitivity analysis (Monte Carlo) were performed. The analyses followed the premises that patients would not be submitted to other adjuvant treatments, the probabilities of access to the treatments would be identical, and changes in the treatment would not be considered. The cost-effectiveness analysis demonstrated that HBOT has greater effectiveness associated with higher costs in the treatment of diabetic foot. Considering the average of costs and effectiveness observed in the model, an incremental cost of R$12,408.80 and an incremental effectiveness of 0.11 were obtained. The Monte Carlo simulation indicated that, after 10,000 alterations in the variables, the conventional bandage was the best therapy of choice up to the threshold of paying R$ 40,000. The variables that most impacted the model were the cost of HBOT and its frequency, allowing for modification in the incremental cost-effectiveness ratio. HBOT is an effective adjuvant alternative to treat diabetic foot when compared to conventional bandaging, but it is not cost-effective. A higher governmental investment in initiatives that promote the prevention of chronic diseases such as Diabetes Mellitus (DM) and the reduction of its impacts or complications would result in better quality of life for the user and most effective costs for the government.