Avaliação do custo do transplante hepático em um Hospital de atendimento do Sistema Único de Saúde

Abstract

Introduction: Liver transplantation, despite its established efficacy in treating end stage liver disease, is considered a costly procedure due to its complexity and the fact that it is predominantly performed on critically ill patients. There is increasing attention to the management of hospital costs and the allocation of resources to public health. In this context, this study was designed to analyze the hospital costs associated with the procedure over a twelve-month postoperative follow-up period. This is a cross sectional study conducted at a large philanthropic hospital. Methods: Patients aged ≥18 years who underwent liver transplantation were included, excluding cases of combined organ transplants and retransplants. The sample consisted of 86 patients. Direct and indirect costs related to patient care were assessed using the full absorption costing method, and revenue was considered based on the amounts published in the Unified Health System's Procedures, Medications, and Special Materials Table Management System. The operational contribution margin was calculated considering the incentive levels of the Financial Increment for Performing Transplant Procedures and the Organ Donation Process. Results: Liver transplant recipients had a median age of 56 years, while donors had a median age of 49 years. The sample comprised 76% men, with hepatocellular cirrhosis as the indication in 79% of cases. The severity, measured by the Model for End-Stage Liver Disease score, was calculated at twenty points. At the end of one year, 71% of patients were alive. The median length of hospitalization was fifteen days. The total cost for the sample was R$13,049,707.72, with the most significant portion (58%) related to Intensive Care Unit and ward daily rates. Total revenue amounted to R$11,189,072.36. Considering the 60% incentive increase in the table, the operational contribution margin was negative in all scenarios. Total costs were influenced by the following factors: average length of stay (p<0.0001) and outcome (alive or deceased) (p=0.001). Discussion: The operational contribution margin results reveal a lack of sustainability in the context of liver transplantation funded by the Unified Health System. This finding challenges the long-term viability of this procedure in the analyzed setting. Nationally, the findings of this study have the potential to inform the creation of sustainable programs that promote patient access to effective treatment. Furthermore, these results can serve as a reference for financial analysis methodologies in other transplant centers, contributing to a more effective and equitable approach in health resource management. Recent official publications, subsequent to this study, have increased the incentive to 80% for transplant teams classified at level A, bringing revenue closer to the cost of transplantation. Conclusion: The cost of hospital treatment for liver transplantation over one year post-transplant exceeds the payment made by the Unified Health System, even at the highest incentive level as of September 2023.