Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals
Avaliação econômica do uso de albumina humana em pacientes com síndrome nefrótica em quatro hospitais públicos brasileiros
Keywords:
Economics, pharmaceutical, Economics, medical, Nephrotic syndrome, Cost-benefit analysis, AlbuminsAbstract
CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.
Downloads
References
Brasil. Ministério da Saúde. Secretaria Executiva. Área de Economia da Saúde e Desenvolvimento. Avaliação econômica em saúde: desafios para gestão no Sistema Único de Saúde. Brasília: Editora do Ministério da Saúde; 2008. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/avaliacao_economica_desafios_gestao_sus.pdf Accessed in 2016 (Jun 3).
Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes Metodológicas: estudos de avaliação econômica de tecnologias em saúde. Brasília: Editora do Ministério da Saúde; 2009. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/avaliacao_economica_tecnologias_saude_2009.pdf Accessed in 2016 (Jun 3).
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 1997.
Rascati KL. Introdução à farmacoeconomia. Porto Alegre: Artmed; 2010.
Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost effectiveness in health and medicine. New York: Oxford University Press; 1996.
Brasil. Ministério da Saúde. Secretaria de Atenção a Saúde. Protocolos clínicos e diretrizes terapêuticas. Brasília: Editora do Ministério da Saúde; 2010. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/protocolos_clinicos_diretrizes_terapeuticas_v1.pdf Accessed in 2016 (Jun 3).
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução RDC no 115, de 10 de março de 2004. Aprova as Diretrizes para o uso de Albumina. D. O. U. - Diário Oficial da União 11 de maio 2004. Available from: http://redsang.ial.sp.gov.br/site/docs_leis/rs/rs12.pdf Accessed in 2016 (Jun 3).
Tullis JL. Albumin. 1. Background and use. JAMA. 1977;237(5):355-9.
Tullis JL. Albumin. 2. Guidelines for critical use. JAMA. 1977;237(5):460-3.
Matos GC. Estudo de utilização da albumina humana em hospitais do Rio de Janeiro, Brasil [thesis]. Rio de Janeiro: Fundação Oswaldo Cruz - Escola Nacional de Saúde Pública Sergio Arouca; 2006.
Brasil. Ministério da Saúde. Empresa Brasileira de Hemoderivados e Biotecnologia. Hemobrás Auditoria Interna. Plano anual de atividades de auditoria interna exercício de 2012. Recife: Hemobrás; 2012. Available from: http://docplayer.com.br/4796239-Ministerio-da-saude-empresa-brasileira-de-hemoderivados-e-biotecnologia-hemobras-auditoria-interna.html Accessed in 2016 (Jun 3).
Veronese FV, Morales DD, Barros EJG, Morales JV. Síndrome nefrótica primaria em adultos [Primary nephrotic syndrome in adults]. Revista HCPA. 2010;30(2):131-9.
Ghafari A, Mehdizadeh A, Alavi-Darazam I, et al. Co-administration of albumin-furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl. 2011;22(3):471-5.
Sociedade Brasileira de Nefrologia. Tratamento da glomerulopatias primárias. Jornal Brasileiro de Nefrologia. 2005;27(2 Suppl 1):10-8. Available from: http://www.jbn.org.br/details/1396/pt-BR/tratamento-das-glomerulopatias-primarias Accessed in 2016 (Jun 3).
Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med. 1998;338(23):1202-11.
Cadnapaphornchai MA, Tkachenko O, Shchekochikhin D, Schrier RW. The nephrotic syndrome: pathogenesis and treatment of edema formation and secondary complications. Pediatr Nephrol. 2013;29(7):1159-67.
Elwell RJ, Spencer AP, Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema. Ann Pharmacother. 2003;37(5):695-700.
Fliser D, Zurbrüggen I, Mutschler E. Coadministration of albumin and furosemide in patients with the nephrotic syndrome. Kidney Int. 1999;55(2):629-34.
Bircan Z, Kervancioglu M, Katar S, Vitrinel A. Does albumin and furosemide therapy affect plasma volume in nephrotic children? Pediatr Nephrol. 2001;16(6):497-9.
Haynes GR, Navickis RJ, Wilkes MM. Albumin administration--what is the evidence of clinical benefit? A systematic review of randomized controlled trials. Eur J Anaesthesiol. 2003;20(10):771-93.
Dharmaraj R, Hari P, Bagga A. Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome. Pediatr Nephrol. 2009;24(4):775-82.
Akcicek F, Yalniz T, Basci A, Ok E, Mees EJ. Diuretic effect of frusemide in patients with nephrotic syndrome: is it potentiated by intravenous albumin? BMJ. 1995;310(6973):162-3.
Na KY, Han JS, Kim YS, et al. Does albumin preinfusion potentiate diuretic action of furosemide in patients with nephrotic syndrome? J Korean Med Sci. 2001;16(4):448-54.
Doungngern T, Huckleberry Y, Bloom JW, Erstad B. Effect of albumin on diuretic response to furosemide in patients with hypoalbuminemia. Am J Crit Care. 2012;21(4):280-6.
Kitsios GD, Mascari P, Ettunsi R, Gray AW. Co-administration of furosemide with albumin for overcoming diuretic resistance in patients with hypoalbuminemia: a meta-analysis. J Crit Care. 2014;29(2):253-9.
Haws RM, Baum M. Efficacy of albumin and diuretic therapy in children with nephrotic syndrome. Pediatrics. 1993;91(6):1142-6.
Rego Filho E de A, Casoni W. [The effect of albumin and furosemide administration in children with primary nephrotic syndrome (author's transl)]. Rev Bras Pesqui Med Biol. 1977;10(5):299-304.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36) [Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure]. Rev Bras Reumatol. 1999;39(3):143-50.
Landgraf JM, Abetz L, Ware JE. The Child Health Questionnaire: s user's manual. Boston: The Health Act; 1999.
Machado CS, Ruperto N, Silva CH, et al. The Brazilian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). Clin Exp Rheumatol. 2001;19(4 Suppl 23):S25-9.
Gomes DC. Adaptação e validação para a língua portuguesa do questionário genérico de avaliação de qualidade de vida - "50-item, parent complete short form, Child Health Questionnaire" (CHQ-PF50) [dissertation]. Uberlândia: Universidade Federal de Uberlândia; 2001.
Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;21(2):271-92.
Caraceni P, Domenicali M, Tovoli A, et al. Clinical indications for the albumin use: still a controversial issue. Eur J Intern Med. 2013;24(8):721-8.
Hari P, Bagga A. Co-administration of albumin and furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl. 2012;23(2):371-2; author reply 372-3.
Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001;135(9):825-34.
Mahmud SDP. Protocolos clínicos: adesão e aplicabilidade numa instituição hospitalar. Rio Grande do Sul [monograph]. Rio Grande do Sul: Universidade Federal do Rio Grande do Sul. Escola de Administração. Curso de Especialização em Gestão em Saúde; 2002.
Brasil. Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2010. Características gerais da população, religião e pessoas com deficiência. Brasília: IBGE; 2010.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Consulta Pública no 6, de 12 de março de 2014. Submete à Consulta Pública os critérios e parâmetros assistenciais de planejamento e programação de ações e serviços de saúde no âmbito do Sistema Único de Saúde. Seção A - Atenção Hospitalar (leitos e internações). Brasília: Ministério da Saúde; 2014. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/sas/2014/cop0006_12_03_2014.html Accessed in 2016 (Jun 3).
