Evaluation of the Cost of Liver Transplantation in a Hospital Providing Care under the Brazilian Unified Health System
Keywords:
Liver transplantation, Hospital costs, Costs and Cost AnalysisAbstract
Introduction: Liver transplantation is considered an expensive procedure due to its complexity and the fact that it is predominantly performed on critically ill patients. In general, the management of hospital costs and the allocation of resources for public health have garnered increasing attention over the years. Objectives: This study aims to analyze the costs associated with liver transplantation to facilitate interventions that improve the cost-effectiveness of the procedure. Methods: This is a cross-sectional study conducted in a large philanthropic hospital. Patients aged 18 years or over who underwent liver transplantation in the service were included, yielding a sample of 86 patients. Direct and indirect costs related to care were analyzed, and potential factors associated with increased procedure costs were studied. Results: The sample comprised 76% male, with a median age of 56 years. The one-year survival rate was 71%, and the median length of hospitalization for transplantation was 15 days. The total cost calculated for this sample was BRL 13,049,707.72, with the largest portion (58%) attributable to the daily rates of the intensive care unit and inpatient ward. The total revenue was BRL 11,189,072.36. Even with a 60% incentive increase in the payment schedule, the operational contribution margin remained negative in all scenarios. Factors statistically associated with total costs were the average hospital stay (p 0.0001) and outcome (alive or deceased) (p 0.001). The results reveal a lack of financial sustainability in the context of liver transplantation funded by the Brazilian Unified Health System (SUS). Nationally, the findings of this study have the potential to inform the creation of sustainable programs that promote patient access to effective treatment. Furthermore, these results may serve as a reference for financial analysis methodology in other transplant centers, contributing to a more efficient and equitable approach to healthcare resource management. Conclusion: The cost of hospital care for liver transplantation, over one-year post-transplant, exceeds the payment made by the SUS, even at the highest incentive level, as of September 2023.
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