Análise de microcusteio do tratamento ambulatorial ao câncer de mama em um hospital público, credenciado como Unacon, em Minas Gerais.

Abstract

Cancer is the second leading cause of death in the world and its economic impact is significant and increasing. The total annual cost of the disease in 2010 was estimated at approximately $ 1.16 trillion. Breast cancer is the most common cause of death among women and the first most incident in 140 countries, with the exception of non-melanoma skin cancer. According to INCA estimates for the 2020-2022 period, 66.280 new cases of breast cancer will occur annually. Brazil is the only country in Latin America that has a health system entirely financed by general tax revenues, however, public spending on health still represents less than half of the total necessary expenditure. Therefore, it is important that the costs used in the execution of cancer treatment are raised in order to guarantee the maintenance of the economic and financial balance of service providers to SUS. The value of each chemotherapy procedure represented in the SUS Table is pre-fixed according to the description of specific tumor situations and is only reimbursed once a month. In view of this scenario, the present study intends to assess, from the perspective of the public provider, the costs incurred to perform breast chemotherapy procedures in a public hospital and its billing by SUS using the Microcusting method. Data collection from female patients diagnosed with malignant breast cancer was performed by searching the computerized database of the Hospital Cancer Registry (SisRHC) and the missing data were recovered through the Integrated Hospital Management System of the FHEMIG - SIGH (Electronic Health Record and Costs Modules) and through the Oncological Treatment Management System (ONCOSIS). The sample of 47 women undergoing outpatient chemotherapy, corresponded to a total cost of at least R$ 282.775,24 to a maximum of R$ 345.708,74. When assessing the monthly cost of each patient, it can be seen that it ranged from R$ 453,37 to R$ 2.074,00, with an average of R$ 1.220,33 and a median of R$ 1.252,38. Total turnover was R$ 377.930,00, varying monthly from a minimum of R$ 1.413,33 to a maximum of R$ 1.735,00; with an average value of R$ 1.493,85 and a median of R$ 1.425,00. There is also a difference in the average monthly costs when comparing the indicated therapeutic purposes. The average monthly cost for the neoadjuvant purpose was R$ 1.266,05, with an average revenue of R$ 1.424,19. In palliative protocols, the average monthly cost was R$ 1.070,71 and the average billing was R$ 1.721,85. When observing the difference between the cost dispensed by the provider for the execution of chemotherapy treatment and the billing according to the SUS Table, it is noted 90.9% of the cost of palliative treatment is covered by the billing amount, while in the previous one this coverage reduced to 66.7%. Thus, it is suggested to increase the value of the procedure "03.04.04.002-9: chemotherapy of breast carcinoma (previous)”.