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- Os custos da aterosclerose em PortugalPublication . Costa, João; Alarcão, Joana; Amaral‐Silva, Alexandre; Araújo, Francisco; Ascenção, Raquel; Caldeira, Daniel; Cardoso, Marta Ferreira; Correia, Manuel; Fiorentino, Francesca; Gavina, Cristina; Gil, Victor; Gouveia, Miguel; Lourenço, Francisco; Silva, Alberto Mello e; Pedro, Luís Mendes; Morais, João; Vaz‐Carneiro, António; Veríssimo, Manuel Teixeira; Borges, MargaridaIntroduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease‐related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real‐world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.
- Os custos da insuficiência cardíaca em Portugal e a sua evolução previsível com o envelhecimento da populaçãoPublication . Gouveia, Miguel Rebordão de Almeida; Ascenção, Raquel Maria Sousa e Silva; Fiorentino, Francesca; Costa, João Nuno Marques Parracho Guerra da; Broeiro‐Gonçalves, Paula Maria; Fonseca, Maria Cândida Faustino Gamito da; Borges, Margarida de Fátima Palma FeriaIntrodução e objetivos: A insuficiência cardíaca (IC) é um problema crescente de saúde pública. Este estudo estima os custos atuais e futuros da IC em Portugal Continental. Métodos: A estimativa dos custos foi realizada na ótica da prevalência e na perspetiva da sociedade. Os custos anuais da IC incluíram os custos diretos (consumos de recursos) e indiretos (impacto na produtividade da população). Utilizaram‐se maioritariamente dados da Base de Dados de Morbilidade Hospitalar, dados da prática clínica real relativamente aos consumos nos cuidados primários e opiniões de peritos. Estimaram‐se os custos para 2014 e, tendo em conta o envelhecimento da população, a evolução dos mesmos até 2036. Resultados: Os custos diretos em 2014 totalizaram €299 milhões (39% por internamentos, 24% por medicamentos, 17% por meios complementares de diagnóstico e terapêutica, 16% por consultas e o restante por outras rubricas como urgências e cuidados continuados). Os custos indiretos totalizaram €106 milhões (16% por absenteísmo e 84% por redução de emprego). Entre 2014 e 2036, por efeitos demográficos, os custos totais passarão de €405 para €503 milhões. O aumento nos custos por habitante será de 34%, um aumento superior ao dos custos totais (+ 24%) dada a redução prevista da população residente. Conclusões: A IC tem um importante impacto económico atual (2,6% do total das despesas públicas em saúde) e previsivelmente maior no futuro, o qual deve ser tido em consideração pelos responsáveis pelas políticas de saúde por forma a adequar a gestão de recursos atual e futura e minimizar o impacto desta doença.
- Indirect costs of myocardial infarction in PortugalPublication . Timóteo, Ana Teresa; Gouveia, Miguel; Soares, Cristina; Ferreira, Rui CruzIntroduction: Cardiovascular disease, and particularly myocardial infarction (MI), carries a significant economic burden, through productivity losses (indirect costs) associated with temporary absence from work, that has not yet been adequately studied in Portugal. Our objective was to quantify the indirect costs of MI in the first year after admission. Methods: Consecutive patients admitted to a single center aged <66 years who survived to discharge during a one-year period were included. Employment status on admission was assessed and for every employed patient, their monthly wage was estimated from market wage rates taken from the Ministry of Labor database according to gender and age. The duration of temporary absence from work was assessed in follow-up contacts for up to one year. Indirect costs were calculated in this sample and the results were applied to the number of MIs in Portugal during 2016 and separately to ST-elevation MI (STEMI) and non-ST-elevation acute coronary syndrome. Results: A total of 219 patients were included, of whom 66.2% were working. The mean monthly labor cost was 1802 euros. A total cost of 760 521.55 euros was obtained. At national level there were 4133 patients aged <66 years admitted with acute MI who survived to discharge. Costs were higher in STEMI patients and the total indirect cost was estimated at 10.12 million euros. Conclusions: In Portugal, the costs to society of disability-generated productivity losses exceed ten million euros in the first year after MI. Strategies to promote an earlier return to work are needed to lower these costs.