Economic analysis of intravenous immunoglobulin and plasma exchange therapies for the treatment of Guillain-Barré Syndrome in a university-based hospital in the South of Brazil

Introduction: Direct costs for treating Guillain-Barré Syndrome (GBS) represent a significant financial burden to public hospitals. Few studies compared the cost of plasma exchange (PE) treatment with human intravenous immunoglobulin (IVIg).Objectives: To compare the cost of two therapies for GBS: IVIg and PE. Secondary objective was to evaluate compliance to IVIg prescription guidelines of the Pharmacy and Therapeutics Committee (PTC).Methods: A cross-sectional study included 25 patients with GBS admitted in a university affiliated hospital from June, 2003 through June, 2008. The costs of IVIg (n=20) and PE (n=5) were evaluated through the cost minimization method, considering direct medical costs yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by medical records review. Clinical endpoint was disability on discharge, established by the 7-point scale of Hughes. Compliance to the PTC guidelines was evaluated considering the dose and prescription regime of IVIg.Results: Twenty-five participants, ranging from 2 to 70 years of age, were included. No difference occurred in any medical variables related to the treatment or in the main clinical outcome measured by the Hughes’ scale. The mean direct cost of PE treatment was US$6,059± 1,701 per patient, and the same expense for IVIg was US$ 18,344±12,259 (P = 0.035). Total inpatient cost was US$ 25,730± 18,714 in the PE group, and 34,768± 27,766 (p=0.530) in the IVIg group.Conclusions: In a university-based hospital, PE is equally effective and less expensive than IVIg to treat GBS

Avaliação econômica do uso de imunoglobulina intravenosa e de plasmaferese no tratamento da Síndrome de Guillain-Barré no Hospital de Clínicas de Porto Alegre

Background: direct costs for treating Guillain-Barré Syndrome (GBS) represent a significant financial burden to public hospitals. Few studies compared the cost of plasma exchange (PE) treatment with human intravenous immunoglobulin (IVIg). Aim: to compare the cost of two therapies for GBS: IVIg and PE. Secondary objective was to evaluate compliance to IVIg prescription guidelines of the Pharmacy and Therapeutics Committee (PTC). Methods: a cross-sectional study included 25 patients with GBS admitted in a university affiliated hospital from June, 2003 through June, 2008. The costs of IVIg (N=20) and PE (N=5) were evaluated through the cost minimization method, considering direct medical costs yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by medical records review. Clinical endpoint was disability on discharge, established by the 7-point scale of Hughes. Compliance to the PTC guidelines was evaluated considering the dose and prescription regime of IVIg. Results: twenty-five participants, ranging from 2 to 70 years of age, were included. No difference occurred in any medical variables related to the treatment or in the main clinical outcome measured by the Hughes’ scale. The mean direct cost of PE treatment was US$6,059± 1,701 per patient, and the same expense for IVIg was US$ 18,344±12,259 (P= 0.035). Total inpatient cost was US$25,730± 18,714 in the PE group, and 34,768± 27,766 (P=0.530) in the IVIg group. Conclusion: in a university-based hospital, PE is less expensive than IVIg to treat GBS.Background: direct costs for treating Guillain-Barré Syndrome (GBS) represent a significant financial burden to public hospitals. Few studies compared the cost of plasma exchange (PE) treatment with human intravenous immunoglobulin (IVIg). Aim: to compare the cost of two therapies for GBS: IVIg and PE. Secondary objective was to evaluate compliance to IVIg prescription guidelines of the Pharmacy and Therapeutics Committee (PTC). Methods: a cross-sectional study included 25 patients with GBS admitted in a university affiliated hospital from June, 2003 through June, 2008. The costs of IVIg (N=20) and PE (N=5) were evaluated through the cost minimization method, considering direct medical costs yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by medical records review. Clinical endpoint was disability on discharge, established by the 7-point scale of Hughes. Compliance to the PTC guidelines was evaluated considering the dose and prescription regime of IVIg. Results: twenty-five participants, ranging from 2 to 70 years of age, were included. No difference occurred in any medical variables related to the treatment or in the main clinical outcome measured by the Hughes’ scale. The mean direct cost of PE treatment was US$ 6,059± 1,701 per patient, and the same expense for IVIg was US$18,344±12,259 (P= 0.035). Total inpatient cost was US$ 25,730± 18,714 in the PE group, and 34,768± 27,766 (P=0.530) in the IVIg group. Conclusion: in a university-based hospital, PE is less expensive than IVIg to treat GBS

Los desafíos de la planificación municipal desde la perspectiva de enfermeras gestoras

Objetivos: analisar o planejamento municipal desenvolvido por enfermeiras coordenadoras da Atenção Primária à Saúde, voltado para o enfrentamento das Doenças Crônicas Não Transmissíveis, sob a perspectiva do Planejamento Estratégico Situacional. Métodos: estudo exploratório descritivo, com abordagem qualitativa, desenvolvido em municípios de uma Região de Saúde do Rio Grande do Sul. Foram realizadas entrevistas semiestruturadas junto às coordenações de Atenção Primária à Saúde dos municípios da área empírica, entre 2014 e 2015. A análise de conteúdo foi a temática e a perspectiva teórica de análise estratégica. Resultados: no desenvolvimento do planejamento municipal na atenção ao adoecimento crônico, o estudo evidenciou as fragilidades, colocando-se como desafio para a gestão. O Planejamento Municipal Regionalizado agrega como ferramenta para contribuir com a articulação entre atores implicados na organização do sistema de saúde. Considerações finais: a inserção estratégica da Enfermagem no campo da Saúde incita o debate acerca do papel deste profissional na gestão do SUS.Objectives: to analyze the municipal planning developed by nurses coordinating Primary Health Care, aimed at coping with Chronic Noncommunicable Diseases, from the perspective of the Situational Strategic Planning. Methods: a descriptive exploratory study with a qualitative approach developed in municipalities of a Health Region of Rio Grande do Sul State. Semi-structured interviews were carried out with the Primary Health Care coordination of the municipalities of the empirical area, between 2014 and 2015. Content analysis was the thematic and the theoretical perspective of strategic analysis. Results: in the development of municipal planning regarding care for chronic illness, the study highlighted fragilities, which are a challenge for management. The Regional Municipal Planning is a tool that contributes to the articulation between actors involved in the organization of the health system. Final considerations: strategic insertion of Nursing in the field of Health prompts the debate about the role of this professional in the management of SUSObjetivos: analizar la planificación municipal desarrollada por enfermeras coordinadoras de la Atención Primaria de Salud orientada al enfrentamiento de las enfermedades crónicas no transmisibles bajo la perspectiva de la Planificación Estratégica Situacional. Métodos: estudio exploratorio descriptivo con abordaje cualitativo, desarrollado en municipios de una Región de Salud de Rio Grande do Sul. Se realizaron entrevistas semiestructuradas junto a las coordinaciones de Atención Primaria de Salud de los municipios del área empírica, entre 2014 y 2015. El análisis de contenido fue temático y la perspectiva teórica de análisis, estratégica. Resultados: en el desarrollo de la planificación municipal en la atención al enfermo crónico el estudio evidencia las fragilidades, colocándose como desafío para la gestión. La Planificación Municipal Regionalizada agrega como herramienta para contribuir con la articulación entre actores implicados en la organización del sistema de salud. Consideraciones finales: la inserción estratégica de la Enfermería en el campo de la Salud incita el debate acerca del papel de este profesional en la gestión del SUS