Estudos de custo sobre terapia dialítica no mundo: uma revisão sistemática e uma abordagem histórica
DOI:
https://doi.org/10.34019/1982-8047.2019.v45.28663Palavras-chave:
Custos e Análise de Custo, Gastos em Saúde, Diálise Peritoneal, Diálise RenalResumo
Introdução: A doença renal afeta 850 milhões de pessoas no mundo e é uma das principais contribuintes para a carga global de doenças não transmissíveis (DNT). Projeta-se que até 2040 seja a quinta causa de anos de vida perdidos. Objetivo: Avaliar onde (geograficamente) e como estão sendo feitos os estudos de custo em terapia dialítica no mundo. Material e métodos: Foi realizada nos dias 26/06/2017, 10/07/2017 e 30/09/2018 uma busca com os unitermos “cost and cost analysis”, ”health expenditures” and “peritoneal dialysis”, os mesmos unitermos e “renal dialysis” nas bases Pubmed, Scielo e EmBase e foram encontrados 1796 artigos, destes foram selecionados 124. Acrescentou-se análise no Google Acadêmico. Ao final, analisou-se 125 artigos. Os critérios de inclusão dos artigos foram terem como escopo do estudo o custo, utilizando metodologias diversas como custo, custo total, custo efetividade, custo utilidade, custo benefício, custo minimização, gasto, impacto econômico. A perspectiva poderia ser do pagador e do prestador de serviço. Resultados: Observou-se um maior número de publicações a partir do ano 2000. Com relação ao desenho dos estudos, a maioria apresentou metodologia de difícil reprodutibilidade, utilizando conceitos variados e métodos diversos. Há uma grande variabilidade do custo entre os países e até mesmo entre os centros de diálise. Em linhas gerais, em países de alta renda, a DPAC (diálise peritoneal ambulatorial contínua) e a DPA (diálise peritoneal automatizada) apresentam menor custo quando comparadas à HD (hemodiálise). No Brasil a maioria dos estudos mostra HD apresentando menor custo que DPAC e DPA. Os desenhos são diversos e mostram, em geral, a perspectiva do pagador. Conclusão: Estudos de custos são recentes na literatura, incluem métodos diversos e a descrição dos resultados não é padronizada. Esperamos progredir para uma discussão da saúde baseada em valor.
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