Avaliação farmacoeconômica da prevenção e do tratamento tópico em pacientes com lesão por pressão.

Abstract

Pressure ulcer (PU) are a worldwide problem that compromises the quality of life and patient safety. They usually cause pain, change in body image and entail care and social costs for the health system and society. Difficult to manage and cure, their incidence varies from 3 to 39.3% and their prevalence from 11.5 to 32.7%. In Brazil, PU are the second most reported adverse event. The care provided to patients with PU involves preventive and therapeutic measures such as pressure relief, patient education, pain control, improvement in circulation/perfusion/nutrition, treatment of infection, debridement and use of dressings. The effectiveness, safety and costs of these technologies must be carefully evaluated to identify alternatives that present scientific evidence and are efficient as a way to ensure the sustainability of the health system. Technologies should add value to clinical practice, with a focus on reducing patient suffering and pain and making better use of health resources. In this sense, the objective of this thesis was to carry out a pharmacoeconomic evaluation of prevention and topical treatment of patients with Pressure Injury. To achieve this goal, the work comprises three studies: a systematic review of economic assessments of therapeutic alternatives available to treat patients with PU; a non-concurrent cohort carried out in a public hospital to assess the effectiveness of dressings used in the treatment of patients with PU; and an evaluation of the cost of Pressure Injury prevention considering two scenarios: the ideal (Ministry of Health protocol) and the real (hospital routine), from the perspective of a public hospital. In the systematic review, 10 economic studies were included, on the treatment of patients with PU from stages 2 to 4, referring to data from five countries, in different care settings. Overall, hydrocolloid and collagenase were the most cost-effective therapeutic alternatives. In the cohort, 107 patients who presented 538 PU were followed, with 11.1% of these recurrent wounds. The mean healing time of PU was 73±86 days. Of the dressings used in the treatment, conventional (39.9%) and hydrocolloid (21.9%) were the most used. There was no significant difference in effectiveness between antimicrobial coatings (foam and silver and hydrofiber and silver). As there was no difference in clinical effectiveness between the evaluated coverages, the cost of these technologies should be adopted as a criterion for choosing. In evaluating the cost of prevention, the difference in prevention costs between the two evaluated scenarios is observed. According to risk stratification, the maximum difference in the cost of prevention was R$17.72 per patient. The results of this thesis are important to support the choice of strategies to prevent PU and treat hospitalized patients affected by these wounds.