[Annual cost of ischemic heart disease in Brazil. Public and private perspective].
OBJECTIVE
To estimate the annual cost of coronary artery disease (CAD) management in Public Health Care System (SUS) and HMOs values in Brazil.


METHODS
Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999) reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market.


RESULTS
The 147 patients (65 +/- 12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI) had an average follow-up of 24 +/- 8 months. The average estimated annual cost per patient was R$ 2,733.00, for the public sector, and R$ 6,788.00, for private and fee-for-service plans. Expenses with medications (R$ 1,154.00) represented 80% and 55% of outpatient costs, and 41% and 17% of total expenses, in public and non-public sectors, respectively. The occurrence of cardiovascular event had a great impact (R$ 4,626.00 vs. R$ 1,312.00, in SUS, and R$ 13,453.00 vs. R$ 1,789.00, for HMOs, p<0.01) on the results.


CONCLUSIONS
The average annual cost of CAD management was high, being the pharmacological treatment the main determinant of public costs. Such estimates may subsidize economical analyses in this area, and foster related healthcare policies.
Ribeiro
Rodrigo A
RA
Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS. raribeiro@via-rs.net
Mello
Renato G B
RG
Melchior
Raquel
R
Dill
Juliana C
JC
Hohmann
Clarissa B
CB
Lucchese
Angélica M
AM
Stein
Ricardo
R
Ribeiro
Jorge Pinto
JP
Polanczyk
Carisi A
CA
D001938:Brazil; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000191:economics* / Q000628:therapy; D009313:National Health Programs / Q000191:economics / Q000592:standards; D017149:Private Sector; D017150:Public Sector