Análise do custo de pacientes com broncopneumonia comunitária de baixo, intermediário e alto risco em uma emergência hospitalar – uso do método TDABC

Abstract

Introduction: Economic evaluations play a crucial role in guiding healthcare decisions by allowing comparisons between clinical outcomes and the costs associated with implementing a new technology or intervention. Understanding the actual costs incurred throughout patient care pathways through microcosting studies is considered essential in healthcare decision-making. Objective: The objective of this study is to analyze the costs of patients admitted with community-acquired pneumonia to a public hospital emergency department before and after the implementation of a restrictive access measure, stratified by low (Pneumonia Severity Index - PSI - classes I, II), medium (PSI - III), and high risk (PSI - IV, V) cases. Methods: The study utilized time-driven activity-based costing (TDABC) methodology, following recommended steps from the literature. Median costs for human resources, infrastructure, laboratory tests, antibiotics, and total costs were compared between the years 2016 and 2017, representing the year before and after the initiation of the emergency access restriction. Costs were also assessed based on the appropriateness of empirical antibiotic therapy (appropriate vs. inappropriate). Statistical comparisons between cost groups were performed using Mann-Whitney test for continuous variables and chi-square or Fisher's exact test for categorical variables, with significance set at p < 0.05. Ethical approval was obtained from the Research Ethics Committee (HCPA - 170613). Results: Data from 848 cases of community-acquired pneumonia were evaluated, representing 4.6% of emergency department visits - 477 from 2016 and 371 from 2017. There were no statistically significant differences between the two years in terms of socio-demographic, clinical, or laboratory variables, nor in total emergency department length of stay when cases were compared across PSI classes. The distribution of costs between the two years was as follows: personnel - 32% vs. 27%, laboratory tests - 47% vs. 46%, infrastructure - 12% vs. 16%, and antibiotics - 9% vs. 11% for 2016 and 2017, respectively. The median total costs per patient in 2016 were: PSI I - R$ 854, PSI II - R$ 1183, PSI III - R$ 1540, PSI IV - R$ 1893, and PSI V - R$ 1904, and in 2017 were: R$ 1120, R$ 1268, R$ 1570, R$ 1603, and R$ 1506, respectively, with no statistically significant difference between the years. There were statistically significant differences in median costs between 2016 and 2017 for human resources in PSI I (R$ 162 vs. R$ 250, p = 0.022), infrastructure in PSI III and V (R$ 311 vs. R$ 257, p = 0.043 and R$ 370 vs. R$ 204, p = 0.009), and antibiotics in PSI III and IV (R$ 145 vs. R$ 273, p = 0.02 and R$ 274 vs. R$ 136, p = 0.001). There was no statistically significant difference in costs when comparing antibiotic therapy appropriateness across risk classes. Conclusion: The study did not observe a difference in costs for patients with community-acquired pneumonia after the implementation of an emergency access restriction measure.