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Analysis of the Direct Costs of Neuromyelitis Optica in a Brazilian Hospital
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09 May 2024
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10 May 2024
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15 November 2024
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Abstract
Objective: To evaluate the direct costs of treating patients with neuromyelitis optica spectrum disorders (NMOSD) in outpatient care, from a hospital and Unified Health System (SUS) perspective. Methods: Observational study with data collection by microfunding, carried out with patients diagnosed with neuromyelitis optics, treated at a university hospital, in the city of Rio de Janeiro. Mann-Whitney tests were performed to measure cost differences between patient groups by disease severity and analysis perspective. Results: Nine individuals with a median age of 48 years (IQR 30 - 59 years) were included. The median total costs for patients with greater severity from the perspective of the SUS and the hospital were R$ 21,638.22 (IIQ: R$ 15,614.63; R$ 25,985.32) and R$ 32,094.11 (IIQ: R$ 25,610 .60; R$ 38,617.25) respectively. For patients with moderate severity the median was R$ 7,339.85 (IIQ: R$ 6,235.45; R$ 11,912.05) from the SUS perspective and R$ 11,505.80 (IIQ: R$ 7,339.85; R$ 22,424.76) from the perspective of the hospital, where the use of medications had a major impact. Conclusion: The main cost drivers were medicines, especially those used off-label, and procedures.
Keywords:
Subject: Public Health and Healthcare - Public Health and Health Services
1. Introduction
In the search for the economic and financial sustainability of health systems, especially universal models such as the Brazilian Unified Health System (SUS), in the treatment of neuromyelitis optica spectrum disorder (NMOSD), the adoption of practices that prioritize resource efficiency and waste minimization is crucial. Sustainable strategies can include the development of continuing education programs for healthcare professionals, aimed at improving the diagnosis and management of the disease, reducing the need for costly and ineffective interventions. In addition, the integration of health systems that allow for more effective follow-up of patients can help avoid frequent and prolonged hospitalizations, which substantially increase the costs associated with treatment.
NMOSD is a rare and severe autoimmune and inflammatory demyelinating disease of the central nervous system, strongly associated with the anti-aquaporin 4 antibody (AQP4-IgG), which causes episodes of optic neuritis, transverse myelitis, and less frequently other neurological manifestations that can mimic multiple sclerosis (MS), such as brainstem syndromes, diencephalic syndrome and cerebral symptoms [1]. Until a few years ago, there was no differential diagnosis with MS, and NMOSD was considered a variant [2,3].
In the context of public health, the implementation of policies aimed at economic and financial sustainability in the treatment of NMOSD also involves the need to review the clinical protocols and lists of drugs provided by the SUS. This would ensure that the most effective treatments are available and accessible, reducing variability in care and disparities in access to appropriate treatments. Efficient management of available resources, based on evidence and good governance, can optimize the use of public funds and improve health outcomes.
It is estimated that the disease affects around 0.5 - 4 per 100,000 individuals worldwide and can reach 10/100,000 in certain racial groups [3]. In Latin America, it is believed that the prevalence of the disease can vary from 0.37/100,000 inhabitants in the city of Volta Redonda/Rio de Janeiro to 4.2/100,000 inhabitants in the Caribbean Islands [4].
Studies have estimated a prevalence of NMSD of 4.5/100,000 in the city of Belo Horizonte/Minas Gerais. In the city of São Paulo/São Paulo, a rate of 2.1/100,000 cases of NMSD with serologically positive AQP4-IgG and 0.4/100,000 with serologically negative AQP4-IgG (anti-MOG) was estimated [5,6].
From a clinical point of view, the typical optic neuritis of NMOSD presents with pain when moving the eye, which is quickly followed by loss of visual acuity, which can be unilateral or bilateral. Typical transverse myelitis sets in within hours to days, usually with the presence of pain in the spine or limbs, accompanied by motor deficits in the lower limbs (paraparesis) or even all four limbs (tetraparesis), which usually progress with severity and loss of bowel and bladder control. Some individuals may present with persistent or intractable hiccups or nausea and vomiting [7,8,9], characterizing the area postrema syndrome.
The recurrent clinical course is the most common form of the disease, characterized by recurrent crises, also called attacks. Recurrent attacks of optic neuritis and/or myelitis, which affect women four times more often than men and whose recovery is often incomplete, result in residual and accumulated sequelae such as amaurosis and paraplegia. Difficulty breathing due to spinal cord involvement threatens the lives of these patients [7,8,9,10].
Scientific evidence shows that new attacks with greater damage to vision and the spinal cord predominate in the first few months after the onset of the disease, making early diagnosis and treatment factors of great importance for preserving patients' health [1,3,9].
Although there is still no cure, available treatments reduce the duration, severity and intensity of attacks and the chances of their recurrence, and can reduce the risk of short-term disability and the burden of the disease, not only for patients, but also for their caregivers [3,8,9,10].
In Brazil, the Unified Health System (SUS) does not offer tests for Anti-AQP4-IgG and Anti-MOG. Only magnetic resonance imaging of the neuroaxis and some electrophysiological tests, such as evoked potentials and electroneuromyography, are available on the SUS for diagnosing the disease. With regard to drug treatment, although three monoclonal antibodies have already been registered with the National Health Surveillance Agency (ANVISA) for the treatment of the disease, to date, none are offered by SUS.
Treatment of attacks in the acute phase is normally carried out using corticosteroids and, in some cases, plasmapheresis [3,9,10,11]. In the SUS, extraordinarily, some patients are treated either with immunosuppressive drugs, such as Azathioprine and Mycophenolate Mofetil, or with immunobiologicals such as Rituximab. These drugs are not available on the SUS for patients with NMOSD, which is why they are eventually used off-label through judicialization, or by justifying their indication using the ICD of other diseases.
Difficulties in accessing means of diagnosing NMOSD (especially the Anti-AQP4-IgG and anti-MOG tests, which are not offered by the SUS) have a negative impact on the quality and survival of patients, and result in heterogeneous treatment, even in the same health unit. Finally, all these implications contribute to the rising costs of treating the disease in the health system.
The economic and financial sustainability of the SUS depends crucially on the ability to make accurate budget forecasts and the implementation of resource management practices that guarantee maximum efficiency. In this context, a detailed understanding of the direct medical costs associated with NMOSD becomes a valuable tool for strategic planning, allowing managers to allocate funds more effectively and direct investments to areas that maximize the impact on public health.
Thus, it is of the utmost importance to know the direct medical costs of NMOSD for health services and the SUS, so that it is possible to understand the economic impact and possible funding gaps of these instances, providing information to managers that can be useful in planning and allocating resources, especially at the local level (health services).
Therefore, the aim of this study was to evaluate the direct medical costs and their components from a hospital and SUS perspective, of patients with a confirmed diagnosis of NMOSD, cared for in a secondary hospital in the Brazilian public network.
2. Materials and Methods
This is an observational study of the cost of the disease, which produced data retrospectively. The study report took into account the recommendations of The Strengthening the Reporting of Observational Studies in Epidemiology - STROBE [12] and Consolidated Health Economic Evaluation Reporting Standards - CHEERS [13]. To identify costs, the perspectives (i.e. payers) of the SUS and the hospital where the study was carried out were considered.
Patients with a diagnosis of NMO according to the International Panel for Diagnosis of NMO - IPND [14] were included in the study, who were being followed up by a specialist service for demyelinating diseases at a University Hospital in Rio de Janeiro. The time frame was from November 2018 to December 2023. With authorization from the hospital, easy access to the patients' medical records, as well as other administrative documents, was decisive in defining the time frame.
The inclusion criterion for defining NMOSD was compliance with the 2015 IPND criteria, defined by clinical characteristics, examinations, neuroimaging, and detection of the specific antibody (AQP4-IgG). Exclusion criteria were patients with less than 30 days of follow-up in hospital or with only clinical suspicion but no defined diagnosis, as well as the impossibility of accessing the patient's medical records.
The patients included in the study were classified as moderate severity when the motor sequela was monoparesis or monoplegia or paraparesis or tetraparesis, and the visual sequela ≥ 20/200 and ≤ 20/400; and higher severity when the motor sequela was paraplegia or tetraplegia and the visual sequela equal to or greater than ≥ 20/400 or total amaurosis with or without light perception.
The data for each patient was collected secondarily at the demyelinating diseases outpatient clinic, from sources of clinical information (sectorial medical records) and hospital management, considering the previously defined time frame.
Sociodemographic data (i.e., age, gender, education, ethnicity, employment and profession), clinical data (i.e., number of attacks, sequelae, comorbidities, proposed treatments), and resource use data (i.e., hospitalizations, medical specialty consultations, physiotherapy, psychologist, plasmapheresis) were extracted from the medical records. The variables number of hospitalizations and length of stay in the day hospital, ward and intensive care unit (ICU) were obtained from hospital reports.
To collect cost data from the SUS perspective, the bottom-up individual data micro-costing approach [15] was used, based on the Hospital Admission Authorization (HAA) reports for each patient.
To collect data from the perspective of the health service (hospital), the micro-costing approach was also used to identify the costs of medicines, laboratory and imaging tests, consumables, procedures and hospitalizations.
Personnel costs (staff salaries and social charges), apportionments (hygiene and cleaning service, porterage and security, maintenance, nutrition and dietetics service), materials (cleaning and hygiene material, LPG gas for hospital use) and general costs (building maintenance service and services provided by third parties) were not taken into account in the study.
No sampling technique was used, and all the individuals regularly followed up by the hospital's demyelinating disease service in the previously defined time frame who met the eligibility criteria were considered.
The purpose of the analysis was to identify and measure costs related to the treatment of NMOSD, the cost drivers (i.e. drugs, consumables, tests and procedures and hospitalizations), as well as the cost predictor severity of the disease.
In order to identify the cost of each patient, the costs obtained by bottom-up were added up over the entire period of the patient's follow-up in the hospital, taking into account the following cost components: medicines (including saline and glucose), materials (i.e. syringes, needles, infusion pump equipment...), tests (i.e. biochemistry, blood tests, antibody tests, imaging tests...) and hospital services (i.e. hospitalizations, consultations, procedures). Only direct medical costs were considered.
Access to Rituximab for patients who used the drug was through a court decision. The costs of this drug were only considered for the analysis from the perspective of the hospital, which was responsible for purchasing the drug with its own resources. The drugs Mycophenolate Mofetil and Azathioprine, although also not offered by the SUS for patients with NMOSD, had their costs considered for analysis from the perspective of the SUS, as they were dispensed using ICDs of other diseases for which the drugs are provided for in the Clinical Protocol and Therapeutic Guidelines (CPTG) established by the Ministry of Health, such as multiple sclerosis, for example.
Both the plasmapheresis treatment and the MRI scan are not carried out at the hospital, but at other units in the public network. Therefore, their costs were only taken into account when calculating them from the perspective of the SUS, since they are offered by the Brazilian health system.
As the Anti-AQP4-IgG antibody test is not offered by the SUS and was funded by the hospital, it was only taken into account when calculating costs from the hospital's perspective. All other costs for medicines, materials and procedures were calculated from both perspectives.
The Procedure Table Management System (PTMS) was used as a price reference for items covered by the SUS. For items not priced in PTMS, the reference used was the Price Panel [2,3,4]. All costs were recorded in Reais (R$).
As the study participants' follow-up time in hospital varied between 2 and 62 months, in order to make cost comparisons between individuals possible, all costs were adjusted per month by dividing the total cost of each patient in the period by the number of months corresponding to the period in which they were being followed up in hospital during the study period. Therefore, costs were expressed as total costs and monthly costs.
The variables were presented using absolute frequency and relative frequency and, for continuous variables, the medians and interquartile range (IQR) were reported.
The Mann-Whitney U test for non-parametric data was used to compare costs between patients, disease severity subgroup (greater severity and moderate severity) and cost components, considering the hospital and SUS perspectives. The p-values reported are two-tailed, adopting statistical significance when the p-value < 0.05. Therefore, p-values < 0.05 indicate that there is a statistically significant difference in the parameters of the variables compared.
The study was approved by the Research Ethics Committee of the Gaffrée Guinle University Hospital - HUGG/UNIRIO (CAAE: 76874723.7.0000.5258), as defined in Resolution 466/2012 of the National Health Council - Ministry of Health.
3. Results
Between November 2018 and December 2023 (62 months), 10 patients were identified with a diagnosis of NMOSD who were being regularly followed up by the neurology service at HUGG. Of these, one had been admitted to the outpatient clinic less than 30 days before the start of the study; it was decided to exclude him as he did not meet the eligibility criterion of length of follow-up. The sociodemographic and clinical characteristics of the study participants are described in Table 1.
It was possible to access the medical records of all 9 patients included in the study. The majority were female (88.8%), self-declared brown (55.5%), living in the municipality of Rio de Janeiro (66.6%), with a complete high school degree (55.5%), at the time of enrollment in the hospital.
The median follow-up time during the study period was 42 months (IQR: 36; 51.5) in the group of patients with greater severity and 10 months (IQR: 2; 24) in the group of patients with moderate severity (p= 0.02). The median age of the participants in the group of patients with greater severity was 53 years (IQR: 41; 59 years) and among the patients with moderate severity, 47 years (IQR: 28; 59 years), with no statistically significant difference (p>0.05).
With regard to the severity of the disease, four patients were classified as severe and five as moderate. This classification took into account the intensity of the sequelae left by the outbreaks.
Among the five patients classified as moderate severity, all had moderate visual sequelae and none had motor sequelae. Among the four patients classified as more severe, two had visual sequelae and three had motor sequelae, one of whom also had visual sequelae. Three patients remained with major sequelae with a single outbreak.
In all, two patients with major severity and two with moderate severity (44.4%) had a confirmed diagnosis of the disease at least 5 years previously (between 2012 and 2018). All the patients tested positive for Anti-AQP4 antibodies. One patient also tested positive for Anti-MOG antibodies (patient 7).
Among the patients classified as more severe, three required bladder catheterization and one used a delayed bladder catheter. Among the patients with higher severity, two used diapers due to loss of anal sphincter control. No patients classified as moderate severity used diapers or required bladder catheterization.
Two patients with higher severity and one with moderate severity used Rituximab. With regard to the use of Azathioprine, one patient with greater severity and one with moderate severity did not use the drug. Only one patient used Mycophenolate mofetil (patient with greater severity). Two patients, one with moderate severity and one with greater severity, underwent at least one plasmapheresis session. Three patients with moderate severity and two with greater severity underwent pulse therapy.
All the individuals had results from at least one MRI scan of the neuroaxis, electroneuromyography, visual evoked responses and Anti-AQP-4IgG and MOG antibody tests, confirming the disease.
The costs associated with monitoring patients with NMOSD, from the perspective of the SUS, are described in Table 2. It should be emphasized that for this analysis, the acquisition costs of all the drugs were taken into account, with the exception of Rituximab.
In the group of four patients with greater severity, the median follow-up time was 42 months (IQR: 36; 51) and the total cost was R$79,846.91, with a median of R$21,638.22 (IQR: R$15,614.63; R$25,985.32). In the group of five patients with moderate severity, the median follow-up time was 10 months (IQR: 2; 24), and the total cost was R$ 52,710.75, with a median of R$ 7,339.85 (IQR: R$ 6,235.45; R$ 11,912.05). The difference in total costs between the groups was not statistically significant (p>0.05).
In both groups, costs due to medication had the greatest impact on total costs. In the group of patients with greater severity, drug costs had an impact of 57%, while in the group of patients with moderate severity the impact was 47%.
If the costs of off-label drugs (Azathioprine and Mycophenolate Mofetil) were not taken into account, the cost of drugs from the perspective of the SUS would be 69.1% lower in the group of patients with greater severity (R$ 14,030.78 vs R$ 45,530.28) and 93.67% lower in the group of patients with moderate severity (R$ 3,331.63 vs R$ 52,710.75).
The impact of material costs was 4.6 times greater in the group of patients with greater severity (14% vs 3% respectively). In the group of patients with moderate severity, the impact of exam costs was 2.5 times greater than in the group of patients with greater severity (23% vs 9%; respectively). The smallest difference was observed in the impact of costs for procedures, with 27% in the group of patients with moderate severity and 20% in the group of patients with greater severity. No statistically significant differences were observed in any of these comparisons (p>0.05).
The costs associated with monitoring NMOSD patients, from the hospital's perspective, are described in Table 3.
It should be noted that this analysis took into account the cost of purchasing the drug Rituximab, which was purchased with the hospital's own funds, and disregarded the costs of the drugs Azathioprine and Mycophenolate Mofetil, which, although also off-label, are paid for by the SUS.
In the group of four patients with greater severity, the total cost was R$128,534.96, with a median of R$32,094.11 (IQR: R$25,610.60; R$38,617.25). In the group of five patients with moderate severity, the total cost was R$74,856.91, with a median of R$11,505.80 (IQR: R$7,339.85; R$22,424.76). There was no statistically significant difference (p> 0.05).
In both groups, as had already been observed from the SUS perspective, the costs from the hospital's perspective due to medicines were also the ones that had the greatest impact on the total cost. In the group of patients with greater severity, medication costs had an impact of 84.4%, while in the group of patients with moderate severity, the impact was 68.20%, with statistical significance (p= 0.04).
The impact of examination costs was twice as high in the group of patients with moderate severity than in the group of patients with higher severity (11.1% vs. 4.2%). In this group, the impact of costs with procedures and hospitalizations was also greater (moderate severity = 19% vs major severity = 9%), and with materials (moderate severity = 1.75% vs major severity = 1.5%). In these comparisons, there were no statistically significant differences (p>0.05).
4. Discussion
In the public health system, patients diagnosed with NMOSD are basically treated with corticosteroids and plasmapheresis (therapeutic apheresis) for optic neuritis, which are the only alternatives offered by the SUS. If initial high-dose corticoids do not promote effective improvement in vision, and the cause is demyelination, plasmapheresis can be considered. Some patients who have relapses of the disease can receive Azathioprine, Mycophenolate Mofetil and Rituximab [13,16].
In the SUS, the use of these drugs is considered off-label for patients with NMOSD. Azathioprine is included in the CPTG established by the Ministry of Health for multiple sclerosis and myasthenia gravis, among other diseases, as well as immunosuppression in transplants; Mycophenolate Mofetil is included in the CPTG for immunosuppression in transplants and Rituximab in the CPTG for rheumatoid arthritis [3].
The disease has been increasingly recognized as a non-monophasic disease; instead, it follows a relapsing condition with disease exacerbation events separated by years or decades and whose treatment will require the continuous use of drugs to prevent attacks [1].
As the disease is still incurable, the more frequent and severe the attacks, the greater the chances of serious sequelae that will require hospitalization and long-term care. Patients with highly active NMOSD have a hospitalization rate approximately 10 times higher than patients without the disease, showing how much attacks of the disease can burden health systems and services [7].
Thinking about the opportunity cost of purchasing off-label drugs for the treatment of patients with NMOSD, to the detriment of those indicated on the package leaflet, is of fundamental importance in decision-making processes regarding the planning and management of human, economic and technological resources for the care of these patients.
Clear and detailed knowledge of the costs related to monitoring patients with NMOSD can provide information for decision-makers and health managers, including at local level (health services), helping with the planning and allocation of resources for the care of individuals affected by the disease, for which there is still no CPTG established by the Ministry of Health (MoH).
In addition to the high economic burden on health systems and services, NMOSD also imposes a high social burden associated with reduced quality of life and loss of patient productivity. NMOSD patients report low utility scores on the EQ-5D-5L. Their average score of 0.54 compares to 0.57 for patients with amyotrophic lateral sclerosis [9] and 0.64 for patients with multiple sclerosis, revealing the enormous social impact that the disease can have [10,11].
In Brazil, this is supposedly the first study to quantify the economic burden of NMOSD on the SUS and the health service that provides care to these patients. It reveals the high costs of the disease, mainly due to the use of off-label drugs.
In this study, the median total cost of the entire cohort was R$28,978.07 (IQR: R$21,850.08; R$37,897.37) from the perspective of the SUS, and R$43,599.91 (IQR: R$33,010.45; R$61,042.01) from the perspective of the hospital (health service) where the study was carried out (p>0.05). This difference in costs is basically due to the cost of purchasing Rituximab, which is fully covered by the hospital, and shows the gap in budget coverage for the treatment of this disease at the hospital, for which the costs of purchasing this drug are not passed on by the SUS.
When the costs of Azathioprine and Mycophenolate Mofetil (off label) are excluded from the calculations, there is a reduction from R$ 45,530.28 to R$ 14,030.78 (69.1%) in the costs of drugs for treating patients with greater severity, and from R$ 52,710.70 to R$ 3,331.63 (93.67%) for treating patients with moderate severity. This shows how costly it is for the SUS not to have a CPTG for the disease, which includes drugs with better safety and efficacy profiles, such as immunobiologicals, for example.
A study carried out in the UK reported a reduction in quality of life with each new outbreak of the disease. Total costs over 3 months were estimated at £ 5,623 (monthly average of ~ R$ 11,727.32 at 2024 price), which can vary according to the severity of the disease, being higher the worse the score on the Expanded Disability Status Scale (EDSS). The authors concluded that NMOSD has significant impacts on health services, the NHS and the costs of care providers [5,6,7,8].
In the USA, a study reported an average monthly healthcare expenditure of US$5,049.00 (~$24,891.57 at 2024 prices) among patients with NMOSD. The authors concluded that relapses among NMOSD patients are common in US clinical practice, leading to substantial healthcare utilization and expenditure in the country [6,14].
Another study carried out in the USA found that patients with highly active NMOSD had a hospitalization rate approximately 10 times higher than patients without the disease, with average annual hospitalization costs for patients with NMOSD of US$ 29,054.00 (~R$ 143,236.22 at 2024 prices) [7,8].
Although there is little validity in making comparisons between the Brazilian health systems and those of other countries such as the USA and the UK, given the significant differences in financing models, coverage and costs of health technologies and services between these countries, the comparisons help to demonstrate how high the economic burden of NMOSD is in these countries, too.
The strength of this study is that it used the micro-costing approach at the patient level, which enabled us to identify the variability of diagnostic and therapeutic approaches in the cohort analyzed. Due to this variability, the results can therefore not be generalized to the entire SUS.
The study has some limitations which may reduce the internal validity and, especially, the external validity of the findings. Firstly, the data was collected from patients' medical records, whose professional records did not follow a standard of wording and information to be reported. This made it impossible to extract some fundamental data to build the patient's journey, from the onset of the first signs and symptoms to diagnosis and the start of treatment.
Another limitation was the great variability in follow-up time and the small sample size of the study, even though all patients with confirmed NMOSD seen at the hospital where the study was carried out and who met the eligibility criteria were included. This limitation may have contributed to biases in the predictive analyses and a reduction in their power.
The fact that the severity of the disease was not assessed and defined by the Expanded Disability Status Scale (EDSS), but by the number, severity and sequelae determined by the attacks of the disease, combined with the small sample size, made it impossible to analyze the relationship between costs and the severity of sensory-motor limitations resulting from the attacks in a more consistent way.
5. Conclusions
The results of this study showed that the component with the greatest impact on the total cost of NMOSD patients, regardless of severity and the perspective of the analysis, was the use of medication. The costs of Azathioprine and Mycophenolate Mofetil represented a significant increase in drug costs, especially from the hospital's perspective.
Information on the resources needed to care for patients with NMOSD, as well as the distinction between its components and their respective economic impacts, can help managers plan and manage resources dedicated to the disease, both in terms of management at the health unit and public policies involving the diagnosis and treatment of the disease.
Author Contributions
Project administration, R.C.L.S. and C.R.L.S.; Publication revision—H.A.F.; Writing—original draft, R.C.L.S.; Writing—review and editing, D.V.F.; D.A.M. and C.C.F.V.; Formal analysis, C.C.F.V. All authors have read and agreed to the published version of the manuscript.
References
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Table 1.
Sociodemographic and clinical characteristics of patients with NMOSD, followed up by the neurology service at HUGG during the period analyzed.
Table 1.
Sociodemographic and clinical characteristics of patients with NMOSD, followed up by the neurology service at HUGG during the period analyzed.
 |
Note: Esc= schooling; Res= place of residence; Diag= year of diagnosis; AQP4= anti-aquaporin 4; Grav= severity of the disease; Seq= number of sequelae; Seg= follow-up time in months; Sur= number of attacks of the disease; Int= number of daily hospitalizations; Afe= number of times plasmapheresis was performed; Pul= number of times pulse therapy was required; Rtx= use of rituximab; Mic= use of mycophenolate; Aza= use of azathioprine Fem= female; Mas= male; Gr= severe; Md= moderate; Mt= motor sequela; Vs= visual sequela; Bra= white; Pre= black; Par= brown; RJ= Rio de Janeiro; Nil=Nilópolis; BFR= Belford Roxo; gr= level of education; Sup= higher education.
Table 2.
Costs associated with treating patients, stratified by cost component and disease severity, from the perspective of the SUS.
Table 2.
Costs associated with treating patients, stratified by cost component and disease severity, from the perspective of the SUS.
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Note: Seg.= follow-up time in hospital in months; Med.= cost of medicines; Mat.= cost of materials; Exa.= cost of exams; Proc.= cost of procedures and hospitalizations; Month= monthly cost (proportional to the number of months of follow-up for each patient); %= impact of costs per component on the total cost per patient and in the group..
Table 3.
Costs associated with patient treatment, stratified by cost component, from the hospital's perspective.
Table 3.
Costs associated with patient treatment, stratified by cost component, from the hospital's perspective.
 |
Note: Seg.= follow-up time in hospital in months; Med.= cost of medicines; Mat.= cost of materials; Exa.= cost of exams; Proc.= cost of procedures and hospitalizations; Month= monthly cost (proportional to the number of months of follow-up for each patient); %= impact of costs per component on the total cost per patient and in the group.
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