Análise do custo-efetividade da implantação de uma unidade de prática integrada no cuidado de idosos com fratura do quadril

Abstract

INTRODUCTION: Hip fractures in the elderly are related to high rates of morbidity and mortality. The increased need for hospitalization, surgery and intensive care in the postoperative period require significant costs for the health system. The implementation of multidisciplinary units has the objective of providing continuous care to prevent complications in hospital and improve functional recovery of these patients. OBJECTIVE: To evaluate the cost-effectiveness, from a health provider perspective, considering the direct medical costs of hospitalization of elderly patients with hip fracture before and after the implementation of Integrated Practice Unit (IPU) at the orthopedics service of the Hospital Santa Casa de Misericórdia de Juiz de Fora/MG. The outcome was the cost-effectiveness ratios for length of hospital stay and mortality among patients 60 years of age or older with hip fracture. METHODS: Non-concurrent cohort-type observational study, with quantitative retrospective data collection. It included 272 medical records of elderly diagnosed with femoral neck fracture and pertrochanteric fracture hospitalized from January, 2010 to December, 2016, with the exception of the year 2012, when IPU was implemented. The sample was divided into two groups, one group submitted to the usual treatment (n = 53) and another group of patients assisted by the multidisciplinary team (n = 219). Data were represented by mean and standard deviation or relative and absolute frequency. The t-student test and the chi-squared test were used to assess factors associated with cost variation and effectiveness, with a significance level of 0.05. For the costeffectiveness analysis of the IPU implantation of orthopedics, the statistical model of the Decision Tree was used. The comparison between the two alternatives was measured by the Incremental Cost-Effectiveness Ratio (ICER). RESULTS: The mean age was 78.51 years + 8.68 in the group prior to the introduction of the multidisciplinary unit and 79.83 years + 9.39 in patients operated after IPU insertion, with a prevalence of females in both groups. After IPU, the time between trauma and surgery decreased from 4.21 days + 2.94 to 2.47 days + 2.48 (p <0.001), the length of stay from 8.78 days + 5.08 to 6.58 days + 7.35 (p = 0.041) and the mortality rate from 22.6% to 8.2% (p <0.001). The cost of the treatment of patients before the implantation of the IPU was, on average, R$ 7,378.58 and that of the group assisted by the multidisciplinary team was, on average, R$ 7,172.20 (p = 0.838). The introduction of the multidisciplinary unit proved to be dominant, and it was not necessary to calculate the Incremental Cost-Effectiveness Ratio (ICER). CONCLUSION: The introduction of the IPU in the orthopedics service of the Hospital Santa Casa de Misericórdia de Juiz de Fora/MG for the treatment of elderly patients with hip fracture was cost-effective, since this intervention resulted in shorter hospitalization time, lower in-hospital mortality and lower costs.