Custos de hospitalização por infecções respiratórias causadas por três coronaviroses, vírus sincicial respiratório e vírus parainfluenza tipo 3 em países emergentes: uma revisão sistemática
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Data
2024-05-09
Autores
Rocha Filho, César Ramos [UNIFESP]
Orientadores
Trevisani, Virginia Fernandes Moça [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
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Objetivo: Identificar e avaliar as evidências disponíveis sobre os custos relacionados aos cuidados hospitalares da COVID-19a, SARSb, MERSc e as infecções respiratórias agudas relacionadas ao VSRd e VPIH-3e em populações de países emergentes. Métodos: Revisão sistemática padrão Cochrane, com alterações metodológicas para recuperação e análise da qualidade de estudos econômicos. Os custos extraídos foram convertidos em dólares internacionais (U$ 2021), a partir da paridade do poder de compra ajustada. Resultados: Não foram identificadas evidências para SARS, MERS e VPIH-3. No total, foram incluídos nove estudos, sendo cinco avaliações econômicas para COVID-19 e quatro para VSR. Em relação a COVID-19, os custos menor e maior por paciente em enfermaria foram observados na Turquia (U$ 900,08) e no Brasil (U$ 5.093,38), respectivamente; enquanto em cuidados críticos (UTIf) foram observados na Turquia (U$ 2.984,78) e na China (U$ 52.432,87), respectivamente. “Serviços hospitalares” foram os maiores direcionadores de custos na enfermaria (58%-88%) e em cuidados críticos (54%-87%), apesar de “tratamento” (72%-81%) ter sido outro componente importante para esse último grupo. Para o VSR, entre pacientes na enfermaria pediátrica um menor e maior custo total foram estimados em hospitais da Malásia (U$ 347,60) e Colômbia (U$ 709,66), respectivamente. Na UTI pediátrica, um menor e maior custo foram estimados em hospitais da China (U$ 1.068,26) e México (U$ 3.815,56), respectivamente. Não houve consenso sobre o principal direcionador de custo. No entanto, as evidências descreveram que os medicamentos (tratamento) foram responsáveis por mais de 30% do custo total. Em todos os estudos, foi observada uma alta heterogeneidade nos métodos de análise, impedindo o agrupamento por país ou região. Conclusão: A COVID-19 e infecção pelo VSR apresentam um impacto econômico substancial para os sistemas de saúde e para a sociedade. O reporte adequado de características de participantes e do contexto em estudos futuros poderão otimizar a análise de validade externa dos achados, bem como de influenciadores de custo.
Objective: To identify and assess the available evidence on costs related to hospital care of COVID19a, SARSb, MERSc, and acute respiratory infections related to RSVd and HPIV3e in populations of developing countries. Methods: Standard Cochrane systematic review, with methodological modifications for the retrieval and analysis of the quality of economic studies. The extracted costs were converted into international dollars (USD 2021) based on adjusted purchasing power parity. Results: No evidence was found for SARS, MERS, and HPIV3. In total, nine studies were included, comprising five economic evaluations for COVID19 and four for RSV. Regarding COVID19, the lowest and highest costs per patient in a ward were observed in Turkey (USD 900.08) and Brazil (USD 5,093.38), respectively, while in critical care (ICUf), they were observed in Turkey (USD 2,984.78) and China (USD 52,432.87), respectively. "Medical services" were the primary cost drivers in the ward (58%88%) and critical care (54%87%) settings, although "treatment" (72%81%) was another significant component for the latter group. For RSV, among pediatric ward patients, the lowest and highest total costs were estimated in hospitals in Malaysia (USD 347.60) and Colombia (USD 709.66), respectively. In the pediatric ICU, the lowest and highest costs were estimated in hospitals in China (USD 1,068.26) and Mexico (USD 3,815.56), respectively. There was no consensus on the primary cost driver. However, the evidence indicated that medications (treatment) accounted for more than 30% of the total cost. In all studies, a high heterogeneity in the analysis methods was observed, preventing grouping by country or region. Conclusion: COVID19 and VSR infection have a substantial economic impact on healthcare systems and society. Proper reporting of participant characteristics and context in future studies can optimize the analysis of external validity of findings as well as cost influencers.
Objective: To identify and assess the available evidence on costs related to hospital care of COVID19a, SARSb, MERSc, and acute respiratory infections related to RSVd and HPIV3e in populations of developing countries. Methods: Standard Cochrane systematic review, with methodological modifications for the retrieval and analysis of the quality of economic studies. The extracted costs were converted into international dollars (USD 2021) based on adjusted purchasing power parity. Results: No evidence was found for SARS, MERS, and HPIV3. In total, nine studies were included, comprising five economic evaluations for COVID19 and four for RSV. Regarding COVID19, the lowest and highest costs per patient in a ward were observed in Turkey (USD 900.08) and Brazil (USD 5,093.38), respectively, while in critical care (ICUf), they were observed in Turkey (USD 2,984.78) and China (USD 52,432.87), respectively. "Medical services" were the primary cost drivers in the ward (58%88%) and critical care (54%87%) settings, although "treatment" (72%81%) was another significant component for the latter group. For RSV, among pediatric ward patients, the lowest and highest total costs were estimated in hospitals in Malaysia (USD 347.60) and Colombia (USD 709.66), respectively. In the pediatric ICU, the lowest and highest costs were estimated in hospitals in China (USD 1,068.26) and Mexico (USD 3,815.56), respectively. There was no consensus on the primary cost driver. However, the evidence indicated that medications (treatment) accounted for more than 30% of the total cost. In all studies, a high heterogeneity in the analysis methods was observed, preventing grouping by country or region. Conclusion: COVID19 and VSR infection have a substantial economic impact on healthcare systems and society. Proper reporting of participant characteristics and context in future studies can optimize the analysis of external validity of findings as well as cost influencers.
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Citação
ROCHA FILHO, César Ramos. Custos de hospitalização por infecções respiratórias causadas por três coronaviroses, vírus sincicial respiratório e vírus parainfluenza tipo 3 em países emergentes: uma revisão sistemática. 2024. 79 f. Tese (Doutorado em Saúde Baseada em Evidências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.