Avaliação da qualidade de vida e análise de custo-utilidades das terapias renais substitutivas no Brasil

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

07/12/2011

RESUMO

Introduction: chronic renal disease is now a public health problem, which brings great harm to the patient, under the social, economic and quality of life (QOL) and has shown increasing spending for the National Health System (SUS ). Objectives: To assess the quality of life and cost utility analysis of renal replacement therapies. Perform comparison of quality of life of patients on hemodialysis (HD), peritoneal dialysis (PD) and renal transplant (RT) using an instrument to measure QOL SF-36 [Article 1]; describe QOL measure directly and indirectly by visual analogue scale (VAS) and the EQ-5D, respectively, and thereby obtain the utility scores for the TRS modalities, supporting the economic evaluation of cost-utility [Article 2], performing cost-utility analysis in SUS perspective, comparing HD to SD, and whether or not stratified by TR [Article 3]. Methods: we selected a representative sample of dialysis units and transplant centers. Structured questionnaires were used to interview 3,036 patients in one of three treatment modalities: hemodialysis, peritoneal dialysis and kidney transplantation. Data were collected on the socio-economic and demographic indicators and quality of life measured by SF-36 and Eq5D. Cost-utility in view of the SUS, HD compared with PD among patients who did or not TR. Markov model was developed for the TRS with 10 years of follow-up. Costs and benefits were discounted at 5%. The transition probabilities between the modalities and costs of SUS with the patients were obtained from the National Database on RRT. The utility measures were obtained from the national study. We used the EQ-5D instrument for assessing quality of life. The comparison between the alternatives of treatment was measured by the ratio of incremental cost-effectiveness (ICER). One-way sensitivity analysis and probabilistic uncertainty evaluated. Results: There were significant differences between renal transplantation and both forms of dialysis for all dimensions of the SF-36. Renal transplant patients had the best average score of the physical component of quality of life. There were no significant differences between treatment groups in relation to the mental component of quality of life. As for Eq5D, there were significant differences between all modes. The correlation between EVA and Eq5D was moderate and 5 Eq5D dimensions explain 43% of the variability of the EVA. In costutility, HD resulted in a difference of 0.47 and 1.79 adjusted life years (QALYs) compared with SD for non-transplanted and transplanted, respectively. In the comparison between transplanted and not transplanted, there is a difference of 5.24 and 3.93 among patients who started treatment in HD and SD, respectively. Conclusions: Patients transplanted have a better quality of life at a cost that fits the standards set by the NHS and therefore should be encouraged.

ASSUNTO(S)

falência renal crônica decs qualidade de vida decs diálise decs transplante de rim decs custos de cuidados de saúde decs análise custo-benefício/utilização decs sistema Único de saúde decs dissertações acadêmicas decs tese da faculdade de medicina da ufmg

ACESSO AO ARTIGO

Documentos Relacionados