Esclerose Múltipla: gastos em medicamentos do componente especializado, serviços ambulatoriais e hospitalares em uma coorte de dezesseis anos

Abstract

Multiple sclerosis is a chronic multifactorial disease, characterized by inflammation, demyelination and gliosis. The Brazilian public health system provides pharmacological treatment; hospital and outpatient care for treatment of this disease. Clinical and financial information regarding these procedures was recorded in the Outpatient Information System and the Hospital Information System. The integration between these and the Mortality Information System, through the probabilistic deterministic linkage method, as well as the construction of a patient-centered bank contributes to the improvement in the quality of the recorded data and allows the longitudinal follow-up of the assistance to the individual. Public expenditure on the treatment of Multiple Sclerosis in Brazil, between 2000 and 2015, was analyzed from a historical cohort. The descriptive analysis of the data, as well as the construction of a multiple linear regression model that aimed to evaluate the association between the average annual expenditure per patient and the clinical and demographic variables of the population, were conducted. The adequacy of the model was verified from a residue analysis and the level of significance adopted was 5%. A total of 28,401 patients were identified, of which 23,082 were analyzed. The majority of the patients were female (73.3%), lived in the southeast (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment with one of the interferons beta (78,9%). Total expenditure at sixteen years of follow-up was more than $ 2 billion, while the average annual expenditure per patient was $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), about 41% of the annual mean expenditure variability per patient was explained by the region of residence; medication used, non-exclusive use of medication, year of initiation of treatment, record of comorbidity and presence of events indicative of treatment failure, such as relapse, switching of medication and death. Multiple Sclerosis is a chronic disease that stands out because of the high cost associated with its treatment. In the context of an economic scenario of scarce resources, evident in the health sector, this study may contribute to the decision of investment or disinvestment of therapies used in the treatment of multiple sclerosis.