Análise de custo de transplante de células-tronco hematopoéticas em um hospital de ensino: gestão e perspectiva político-econômica

Abstract

Hematopoietic stem cell transplantations (TCTH) are highly complex technological procedures subsidized by the public health system with high expenses. Taking into account that health should be understood as human value as well an unquestionable right of the population, studies on health economics are necessary for adequate planning and sustainable management of health services. Objectives: To evaluate the amount of hospitalization costs for TCTH with estimated analysis of sufficiency of resources, comparing costs and values passed through SUS. To discuss the management of TCTH processes aiming at improvements in cost-effectiveness in the current political-economic context of public funding. Casuistics and Methods: Descriptive study of the cost estimate of 147 hospitalization procedures for TCTH at a teaching hospital, subsidized by SUS, from February 2014 to July 2017. The estimates were made by the responsible department of the institution with absorption costing methodology. Data were grouped by disease and the parameters analyzed were conditioning chemotherapy, immunosuppressants, antibiotic therapy, drugs for clinical support, exams, cost of ward, medical fees and hemotherapy. Results: In all of the groups analyzed, ward costs and medical fees were the ones that caused the greatest impact on the final cost. The total cost of the procedures was R$ 5,683,038.49, and the average cost per transplant ranged from R$ 20,107.81 to R$ 131,037.05, corresponding to Plasma Cell Neoplasms and Primary Myelofibrosis, respectively. Hodgkin's lymphoma and Myelofibrosis groups may have generated cost-related institutional imbalance. Conclusion: The procedures analyzed in this series resulted in an estimated positive balance of R$ 725,487.28. In the institution where this study was performed, the data suggest that it is possible to carry out sustainable management in TCTH with the public resources available, towards the goal of equity and integrality on public health care.