Gastos públicos no tratamento da doença de Crohn: uma coorte de quinze anos no Brasil

Abstract

Crohn's disease (CD) is a recurrent, chronic inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, from the anus to the mouth, and most often affect the ileum, colon and perianal region. Treatment consists of induction of remission that can be obtained with medication or surgical procedures, followed by maintenance therapy. In Brazil, high-cost drugs (aminosalicylates, immunosuppressants and anti-TNF- agents) for the treatment of CD are available in (Unified Health System) SUS by the Specialized Component of Pharmaceutical Assistance (CEAF). Considering the high expenses with the treatment of CD reported in other countries and the reports of increased incidence in Brazil, it is of great relevance to evaluate the expenditures with CD in SUS. A retrospective cohort was developed with the deterministic-probabilistic relationship of the SUS databases: Outpatient Information System (SIH), Hospital Information System (SIH) and Mortality Information System (SIM). It was considering the period from 2000 to 2014 and patients were identified by the use of the CEAF drugs for CD combined with the respective ICD-10. We calculated the mean annual expenditure per patient which was stratified by demographic and clinical characteristics. A total of 46886 patients were included in the study, most of them female, with ages ranging from 26 to 35 and 36 to 45, living in the Southeast region, who started treatment between 2005 and 2009, with mesalazine being the initial medication in the majority of the patients. Total spending was US $ 844.24 million, of which US $ 762.43 million (90.3%) corresponded to medications for DC. Biological anti-TNF- medications accounted for 71.4% of total health care expenditure and 79.1% of drug amount for CD, increasing from 76.0% to 85.9% in the period. Medications for CD represented the most proportion of expenditures with the disease, with anti- TNF- agents accounting for the highest proportion of drug spending and total treatment costs, as has been reported in other recent studies. The results may be useful to support future costeffectiveness studies in CD, as well as provide reference data for health authorities in Brazil and other countries.