Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

Abstract

BackgroundHeart surgery has developed with increasing patient complexity.ObjectiveTo assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).MethodAll cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.ResultsPostoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.ConclusionHigher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS)

“…When comparing the average coverage of the funds transferred per patient in the present study with that of a study published in 2013 [ 17 ] , the coverage was around 45 to 52%. In the present study, the coverage was 48.66% of the costs.…”

“…However, the study sample was from isolated and elective CABGs. This shows that these transferred funds may have increased according to the patient's severity, as demonstrated by authors in 2015 [ 17 ] .…”

“…Most Brazilian studies only address the direct cost of the procedure, with almost no studies addressing the total cost or transferred funds from SUS for CABGs. In 2015, a study was published on average total cost and transfers from SUS for cardiac surgeries performed in 2013, with 48.8% of the evaluated surgeries being CABGs [ 17 ] . This study showed that transfers increased according to the severity of the EuroSCORE [ 11 ] , while the funds transferred for low-risk patients was R$14,306.00, for medium-risk R$16,217.00, and R$19,548.00 for high-risk patients ( P <0.001) [ 17 ] , corresponding to coverages of 52.75%, 46.53% and 45.21%, respectively.…”

“…In 2015, a study was published on average total cost and transfers from SUS for cardiac surgeries performed in 2013, with 48.8% of the evaluated surgeries being CABGs [ 17 ] . This study showed that transfers increased according to the severity of the EuroSCORE [ 11 ] , while the funds transferred for low-risk patients was R$14,306.00, for medium-risk R$16,217.00, and R$19,548.00 for high-risk patients ( P <0.001) [ 17 ] , corresponding to coverages of 52.75%, 46.53% and 45.21%, respectively. The authors demonstrated that the transferred funds were not proportional to the total cost, presenting a lower coverage percentage as the severity, cost and LOS increased.…”

“…In the present study, the coverage was 48.66% of the costs. In the cited study [ 17 ] , the coverage in increasing order of mortality risk by the additive EuroSCORE (low, medium and high) [ 11 ] was 52.75%, 46.53% and 45.21%, respectively. In both works, an increase in hospitalization increased the cost and the value of funds transferred from SUS; however, the increase in the transferred funds did not proportionately follow the increase in total cost, with the coverage percentage decreasing at each increase in LOS and cost.…”