Análise de sobrevida de pacientes com Doença Pulmonar Obstrutiva Crônica no SUS, Brasil: uma coorte de 2003 a 2015.

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) has large socioeconomical impacts in low- and middle-income countries, but most epidemiological data regarding this health problem originate from high-income countries. It is especially important to understand survival and factors associated to treatment failure in COPD patients. Objective: To assess survival of COPD patients in Brazil, to identify risk factors associated with survival, and to assess effectiveness of treatment funded by Brazilian national health system (SUS). Methods: This was a retrospective cohort study of patients dispensed COPD treatment in SUS, from 2003 to 2015 using a National Database. The Kaplan-Meier method was used to estimate survival of patients, and Cox's model of proportional risks was used to assess risk factors. Results: 39,014 patients were included in the cohort. The fixed-dose combination (FDC) of budesonide/formoterol was the most frequent treatment (86% of cases), followed by long-acting beta-2-agonists (LABA) medicines in monotherapy (10.8%). Patient’s survival rates at 1, 5, and 10 years were 97.7%, 92.9%, and 83.7%, respectively. The multivariate analysis showed that male patients, over 65 years old, underweight or obese had an increased risk of treatment failure. The final model also showed that the mixed-dose or free-dose regimens seem to be a protective factor when compared to the FDC formoterol/budesonide. Conclusion: This study constitutes a large cohort of patients with COPD, especially important for understanding survival and factors associated with the use of medications. The results here provide a contribution to the knowledge of the profile of patients with COPD, in addition to providing new evidence to support the debate on the care and pharmacotherapy of these patients in SUS. Male patients, with age above the 65 years, with obesity or underweight showed worse survival rates. Additionally, this study presents real-world evidence of better results for patients who received free dose regimen or mixed dose regimen, especially due to concerns about inhaled corticosteroids in patients with COPD.