Análise dos custos diretos da assistência oncológica no Sistema Único de Saúde

• Ano de defesa: 2018
• Autor(a) principal: Agner Pereira Lana
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Neoplasias; Análise de Custos; Custo da Doença; Sistema Único de Saúde; Custos e Análise de Custo; Medicina
• Link de acesso: http://hdl.handle.net/1843/BUOS-B8MFGZ

Health expenditures can represent an important part of public investment, especially in countries where the health system is universal. As a result of the increasing expenses in recent years, especially in cancer care, grows the need of economic evaluations to guide decisionmaking and definition of public policy. The aim of this study was to evaluate the direct costs of cancer care in the Sistema Único de Saúde (SUS), between 2001 and 2014. This is a cost-ofillness study, based on the National Oncology Database, a historical cohort of oncological patients, constructed by deterministic-probabilistic linkage of healthcare system data from DataSUS. This study was composed of patients diagnosed with breast cancer, prostate cancer, stomach cancer, colorectal cancer, cervix cancer and lung cancer, who underwent oncological treatment by chemotherapy and/or radiotherapy, and who also could be treated by surgery together with those treatment forms. All direct costs related to diagnosis, chemotherapy, radiotherapy, surgery and inpatient care were included. The correction of the values occurred by IPCA index referred on December/2015. To evaluate the increase of direct costs in the study, were constructed historical series according to the interest variables. Results: 954,091 patients were included in the study, ranging from breast cancer (40.1%), prostate cancer (22.3%), colorectal cancer (13.2%), cervix cancer (11.5%), lung cancer (7.9%) and stomach cancer (5.0%). Over 14 years, the total of direct costs was R$14.9 billion, from which the highest median direct cost was attributed to the patient with colorectal cancer (R$15,467.9), followed by breast cancer (R$11,398.9) and cervix cancer (R$10,572.4). Referring to the types of procedures, the largest share of the direct costs in the period was allocated to chemotherapy (R$9.5 billion), radiotherapy (R$2.5 billion) and surgery (R$1.3 billion). On the other hand, the estimated direct cost for diagnostic exams was R$ 0.6 billion, which represented 4% of the total direct cost resulted by oncological care of the study's population. We observed that, between 2001 and 2014, the direct costs of cancer care increased about 419%. However, in the same period, the number of patients treated annually grew up by a higher proportion (503%). Evaluating the average annual cost per patient in the period, it was observed a considerable reduction of the values until 2008, resuming the growth until the year 2014, but not equal as registered at the beginning of the follow-up, suggesting that invested resources may not have been increased in fact, only reacted the cancer incidence growth. Considering that part of the cancer care financing occurred by the Strategic Actions and Compensation Fund, whose values were not included in the estimates of this study, it should be evaluated, in other perspectives, whether there was in fact a reduction of the amounts directed per person to cancer care in the scope of SUS. Finally, despite its limitations, this study can be able to guide the construction of more detailed research on this subject, not exhausting future investigations about the economic burden of cancer in Brazil.