Impacto Econômico das Unidades de Cuidados Paliativos Hospitalares: Revisão Sistemática

Thiago Catão de Vasconcelos; Ana Mabel Sulpino Felisberto; Marcia Adriana Dias Meirelles Moreira; Thiago Lins da Costa; Rilva Lopes de Sousa Muñoz

Thiago Catão de Vasconcelos Hospital Universitário Lauro Wanderley (HULW) (João Pessoa, Paraíba, Brasil)
Ana Mabel Sulpino Felisberto Hospital Universitário Lauro Wanderley (HULW) (João Pessoa, Paraíba, Brasil)
Marcia Adriana Dias Meirelles Moreira Universidade Federal da Paraíba (João Pessoa, Paraíba, Brasil)
Thiago Lins da Costa Hospital Universitário Lauro Wanderley (HULW) (João Pessoa, Paraíba, Brasil)
Rilva Lopes de Sousa Muñoz Universidade Federal da Paraíba (João Pessoa, Paraíba, Brasil)

Palabras clave: Cuidados Paliativos, Costos de Cuidados de Salud, Unidades Hospitalarias, Asistencia Terminal, Revisión sistemática

Key-words: Palliative Care, Health Care Costs, Hospital Units, Terminal Care, Systematic Review

Palavras chave: Cuidados Paliativos, Custos de Cuidados de Saúde, Unidades Hospitalares, Assistência Terminal, Revisão Sistemática

Resumen

Objetivo: Determinar se la práctica de cuidados paliativos (CP) en unidades específicas reduce los costos hospitalarios para pacientes con enfermedades terminales. Métodos: Se realizó una revisión sistemática de la literatura. Se investigó estudios primarios en las bases LILACS, SCOPUS, SciELO, MEDLINE y Biblioteca Cochrane publicados entre enero de 2014 y enero de 2019, involucrando pacientes adultos con enfermedad terminal hospitalizados. Resultados: Se seleccionaron 15 estudios publicados en inglés y conducidos en nueve países, todos de renta alta y media-alta. Se encontraron evidencias observacionales de que pacientes en Unidades de Cuidados Paliativos (UCP) presentaron comparativamente menores costos. Conclusión: Los estudios compararon la minimización de costos, pero muchos no relataron análisis económico relevante para UCP. Los resultados de esta revisión apuntan para la necesidad de investigaciones con análisis económico en salud, a fin de obtener subsidios más amplios de las interrelaciones entre cuidado y costos

Abstract

Objective: The study’s main goal has been to determine whether the practice of palliative care in specific units reduces hospital costs for terminally ill patients. Methods: It is a systematic review. There were searched primary studies based on LILACS, SCOPUS, SciELO, MEDLINE and Cochrane Library published over the period from January 2014 to January 2019, involving hospitalized adult terminally ill patients. Results: There were selected 15 studies published in English and performed in nine countries, all high and medium-high income. Observational evidence was found that patients in palliative care units had comparatively lower costs. Conclusion: The addressed studies have compared cost minimization, but many did not report relevant economic analysis for palliative care units. The results of this review point to the need for further investigations regarding economic analysis in health, aiming to obtain broader subsidies of the interrelations between care and costs

Resumo

Objetivo: Determinar se a prática de cuidados paliativos (CP) em unidades específicas reduz os custos hospitalares para pacientes com doenças terminais. Métodos: Realizou-se uma revisão sistemática da literatura. Pesquisaram-se estudos primários nas bases da LILACS, SCOPUS, SciELO, MEDLINE e Biblioteca Cochrane publicados entre janeiro de 2014 e janeiro de 2019, envolvendo pacientes adultos com doença terminal hospitalizados. Resultados: Selecionaram-se 15 estudos publicados em inglês e conduzidos em nove países, todos de renda alta e média-alta. Encontraram-se evidências observacionais de que pacientes em Unidades de Cuidados Paliativos (UCP) apresentaram comparativamente menores custos. Conclusão: Os estudos compararam a minimização de custos, porém muitos não relataram análise econômica relevante para UCP. Os resultados desta revisão apontam para a necessidade de pesquisas com análise econômica em saúde, a fim de obter subsídios mais amplos das interrelações entre cuidado e custos

Bibliografía

1. Goodman DC, Esty AR, Fisher ES, Chang CH. Trends and variation in end-of-life care for medicare beneficiaries with severe chronic illness. Health Policy and Clinical Practice Center for Health Policy Research [Internet]. 2011. [citado 2019 Maio 20]. Disponível em: https://www.rwjf.org/en/library/research/2011/04/ trends-and-variation-in-end-of-life-care-for-medicare-beneficiar. html.
2. International Association for Hospice and Palliative Care (IAHPC). Global consensus based palliative care definition. [2018]. Houston, TX: The International Association for Hospice and palliative care. Disponível em https://hospicecare.com/what-we-do/projects/ consensus-based-definition-of-palliative-care/definition/
3. Hui D, Nooruddin Z, Didwaniya N, Dev R, De La Cruz M, Kim SH et al. Concepts and definitions for "actively dying," "end of life," "terminally ill," "terminal care," and "transition of care": a systematic review. J Pain Symptom Manage [Internet]. 2014 [citado 2019 jul 20]; 47(1):77-89. Disponível em: https://www.sciencedirect. com/science/article/abs/pii/S0885392413002431.
4. Salins N, Gursahani R, Mathur R, Iyer S, Macaden S, Simha N et al. Definition of terms used in limitation of treatment and providing palliative care at the end of life: the Indian council of medical research commission report. Indian J Crit Care Med. [Internet]. 2018 [citado 2019 jun 20]; 22(4):249-262. Disponível em: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5930529/.
5. Coelho CBT, Yankaskas JR. New concepts in palliative care in the intensive care unit. Rev Bras Ter Intensiva [Internet]. 2017 [citado 2019 Jun 20]; 29(2):222-230. Disponível em: https://www.ncbi.nlm. nih.gov/pubmed/28977262.
6. Maio P, Normand C, Cassel JB, Del Fabbro E, Fine RL, Menz R et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med. [Internet]. 2018 [citado 2019 Jun 20]; 178(6):820-829. Disponível em: https://jamanetwork. com/journals/jamainternalmedicine/article-abstract/2678833.
7. Gardiner C, Ingleton C, Ryan T, Ward S, Gott M. What cost components are relevant for economic evaluations of palliative care, and what approaches are used to measure these costs? A systematic review. Palliat Med. [Internet]. 2017 [citado 2019 Maio 20]; 31(4):323-337. Disponível em: https://journals.sagepub.com/ doi/full/10.1177/0269216316670287.
8. Nickel L, Oliari LP, Vesco SNP, Padilha MI. Grupos de pesquisa em cuidados paliativos: a realidade brasileira de 1994 a 2014. Esc AnnaNery [Internet]. 2016 [citado 2019 Maio 29]; 20(1):706. Disponível em: http://www.scielo.br/scielo.php?pid=S1414- 452016000100070&script=sci_abstract&tlng=pt.
9. Gomes ALZ, Othero MB. Cuidados paliativos. Estud. av. [Internet]. 2016 [citado 2019 Jul 29]; 30 (88): 155-166. Disponível em: http://www.scielo.br/scielo.php?pid=S0103- 40142016000300155&script=sci_arttext
10. Polit DF, Beck CT. Using research in evidence-based nursing practice. In: Polit DF, Beck CT, editors. Essentials of nursing research. Methods, appraisal and utilization. Philadelphia (USA). Lippincott Williams & Wilkins; 2006.
11. Haddaway NR, Collins AM, Coughlin D, Kirk S. The role of google scholar in evidence reviews and its applicability to grey literature searching. PLoS ONE. [Internet]. 2015 [citado 2019 MAYo 29]; 10(9): e0138237. Disponível em: https://journals.plos.org/plosone/ article?id=10.1371/journal.pone.0138237.
12. Galvão CM. Níveis de evidência. Acta Paul Enferm. [Internet]. 2006; [citado 2019 Jun 10]; 19 (2). Disponível em: https://www.redalyc. org/pdf/3070/307023806001.pdf.
13. Binney ZO, Quest TE, Feingold PL, Buchman T, Majesko AA. Feasibility and economic impact of dedicated hospice inpatient units for terminally ill ICU patients. Critical care medicine [Internet]. 2014 [citado 2019 Jun 10]; 42(5):1074-1080. Disponível em: https://cdn.journals.lww.com/ccmjournal/ Abstract/2014/05000/Feasibility_and_Economic_Impact_of_ Dedicated.7.aspx
14. Kim SJ, Han KT, Kim, TH, Park EC. Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: a retrospective cohort design of 2002–2012. Palliative medicine [Internet]. 2015 [citado 2019 Jun 10]; 29(9):808-816. Disponível em: https://journals.sagepub.com/ doi/abs/10.1177/0269216315582123.
15. McCarthy IM, Robinson C, Huq S, Philastre M, Fine RL. Cost savings from palliative care teams and guidance for a financially viable palliative care program. Health services research [Internet]. 2015 [citado 2019 Jun 23]; 50(1): 217-236. Disponível em: https:// onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12203.
16. Robinson J, Boyd M, O'Callaghan A, Laking G, Frey R, Raphael D et al. The extent and cost of potentially avoidable admissions in hospital inpatients with palliative care needs: a cross-sectional study. BMJ supportive & palliative care [Internet]. 2015 [citado 2019 Jun 13]; 5(3):266-272. Disponível em: https://spcare.bmj.com/ content/5/3/266.short.
17. Wang L, Piet L, Kenworthy CM, Dy SM. Association between palliative case management and utilization of inpatient, intensive care unit, emergency department, and hospice in medicaid beneficiaries. Am J Hosp Palliat Care [Internet]. 2015 [citado 2019 Jun 10]; 32(2):216-20. Disponível em: https://www.ncbi.nlm.nih. gov/pubmed/24445151.
18. Ciałkowska-Rysz AD, Pokropska W, Łuczak J, Kaptacz A, Stachowiak A, Hurich K et al. How much does care in palliative care wards cost in Poland? Archives of medical science: AMS. [Internet]. 2016 [citado 2019 Jun 13]; 12(2):457. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848375/.
19. Wang JP, Wu CY, Hwang IH., Kao CH, Hung YP, Hwang SJ, Li CP. How different is the care of terminal pancreatic cancer patients in inpatient palliative care units and acute hospital wards? A nationwide population-based study. BMC palliative care [Internet]. 2016 [citado 2019 Jun 13]; 15(1). Disponível em: https:// bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-016- 0075-x.
20. Chaudhuri D, Tanuseputro P, Herritt B, D’Egidio G, Chalifoux M, Kyeremanteng K. Critical care at the end of life: a population-level cohort study of cost and outcomes. Critical Care [Internet]. 2017 [citado 2019 Jun 10]; 21(1), 124. Disponível em: https://ccforum. biomedcentral.com/articles/10.1186/s13054-017-1711-4.
21. Ireland AW. Access to palliative care services during a terminal hospital episode reduces intervention rates and hospital costs: a database study of 19 707 elderly patients dying in hospital, 2011–2015. Internal medicine journal [Internet] 2017 [citado 2008 Jun 23]; 47(5): 549-556. Disponível em: https://onlinelibrary.wiley. com/doi/full/10.1111/imj.13400.
22. Isenberg SR, Lu C, McQuade J, Razzak R, Weir BW, Gill N et al. Economic evaluation of a hospital-based palliative care program. Journal of oncology practice [Internet] 2017 [citado 2019 Jun 23]; 13(5):e408-e420.Disponível em: https://ascopubs.org/doi/ full/10.1200/JOP.2016.018036.
23. Patel AA, Walling AM, Ricks-Oddie J, May FP, Saab S, Wenger N. Palliative care and health care utilization for patients with endstage liver disease at the end of life. Clinical Gastroenterology and Hepatology [Internet]. 2017 [citado 2019 Jun 13]; 15(10):1612-1619. Disponível em: https://www.sciencedirect.com/science/article/abs/ pii/S154235651730143X.
24. Maio P, Garrido MM, Cassel JB, Kelley AS, Meier DE, Normand C et al. Palliative care teams’ cost-saving effect is larger for cancer patients with higher numbers of comorbidities. Health Affairs [Internet] 2016 [citado 2019 Jul 03]; 35(1):44-53. Disponível em: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0752.
25. Scibetta C, Kerr K, Mcguire J, Rabow MW. The costs of waiting: implications of the timing of palliative care consultation among a cohort of decedents at a comprehensive cancer center. Journal of palliative medicine [Internet] 2016 [citado 2019 Jul 03]; 19(1):69- 75. Disponível em: https://www.liebertpub.com/doi/abs/10.1089/ jpm.2015.0119.
26. Nevadunsky NS, Gordon S, Spoozak L, Van Arsdale A, Hou Y, Klobocista M. The role and timing of palliative medicine consultation for women with gynecologic malignancies: association with end of life interventions and direct hospital costs. Gynecologic oncology [Internet] 2014 [citado 2019 Jul 03] 132(1):3-7. Disponível em: https://www.sciencedirect.com/science/article/pii/ S0090825813012742.
27. Morishima T, Lee J, Otsubo T, Imanaka Y. Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life: a cross-sectional study using claims data in Japan. Int J Qual Health Care. [Internet] 2013 [citado 2019 Jul 03]. 26(1):79-86. Disponível em: https://academic.oup.com/intqhc/ article/26/1/79/2849743.
28. Smith S, Brick A, O’Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliative Medic. [Internet]. 2014; [citado 2019 Jul 11]; 28(2) 130–150.
29. Brasil. Ministério da Saúde. Avaliação econômica em Saúde: desafios para gestão no Sistema Único de Saúde. Brasília: Editora do Ministério da Saúde, 2008.
30. Silva EN, Galvão TF, Pereira MG, Silva MT. Estudos de avaliação econômica de tecnologias em saúde: roteiro para análise crítica. Rev Panam Salud Publica [Internet]. 2014; [citado 2019 Jul 11]. 35(3):219-27. Disponível em: https://www.scielosp.org/article/ ssm/content/raw/?resource_ssm_path=/media/assets/rpsp/v35n3/ a09v35n3.pdf.
31. Azoulay E, Pochard F, Chevret S, Jourdain M, Bornstain C, Wernet A. et al. Impact of a family information leaflet on effectiveness of information provided to family members ofintensive care unit patients: A multicenter, prospective, randomized, controlled trial. Am J Respir Crit Care Med. [Internet]. 2002; [citado 2019 Jul 20]. 165:438–442. Disponível em: https://www.ncbi.nlm.nih.gov/ pubmed/11850333.
32. Pochard F, Darmon M, Fassier T, Bollaert PE, Cheval C, Coloigner M et al. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care [Internet]. 2005; [citado 2008 Jul 20]. 20:90–96. Disponível em: https://www.ncbi.nlm.nih.gov/ pubmed/16015522.
33. Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD et al. American academy of critical care medicine: recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of critical care medicine. Crit Care Med. [Internet]. 2008; [citado 2019 Jul 20]. 36:953–963. Disponível em: https://www.ncbi.nlm.nih.gov/ pubmed/18431285.
34. Silva EN, Silva MT, Pereira MG. Estudos de avaliação econômica em saúde: definição e aplicabilidade aos sistemas e serviços de saúde. Epidemiol Serv Saude [Internet]. 2016; [citado 2019 Jul 23]. 25(1):205-7.Disponível em: http://scielo.iec.gov.br/scielo. php?script=sci_arttext&pid=S1679-49742016000100023

Impacto Econômico das Unidades de Cuidados Paliativos Hospitalares: Revisão Sistemática

Economic Impact Of Hospital Paliative Care Units: A Systematic Review

Impacto Económico de las Unidades de Atención Paliativa Hospitalaria: Revisión Sistemática

Resumen

Abstract

Resumo

Bibliografía