Estudo farmacoeconômico de um programa de gerenciamento antimicrobiano e as consequências da pandemia de COVID-19

Abstract

Antimicrobials are widely used in the hospital environment and rational use can bring benefits related to the cost and resistance of antimicrobial therapy, which is already a global threat. The Antimicrobial Management Program (PGA) stands out as a strategy for this problem. The coronavirus 2019 (COVID-19) pandemic, without known guidelines at the beginning of the fight, emphasized the need for measures for the rational use of antimicrobials. Pharmacoeconomic studies can be a tool for optimizing resources in therapeutic choice. This study evaluated a PGA in a hospital, using process and result indicators from the beginning to the end of implementation. Furthermore, it analyzed the pharmacoeconomic influence of the COVID-19 pandemic on the consumption of antimicrobials. The study was divided into two stages, the first being the analysis of indicators and pharmacoeconomic study of the PGA and the second the pharmacoeconomic study of the influence of COVID-19 on hospital costs. In the PGA indicator analysis stage, an exploratory, descriptive and quantitative study was carried out, bringing the proposed intervention based on the prospective audit of antimicrobial therapy, revealing its data in the form of monitored indicators. The data collected referred to 30 months, between July/2019 and December/2021 and were used for pharmacoeconomic

evaluation of the proposed recommendations through the application of cost- minimization analysis. Among the results, in the PGA, 2993 patients were monitored,

covering the total number of beds at the end of the study. An average accessibility of 97% (n= 5,870) of the strategies carried out with a financial repercussion in the minimized direct cost of 32% (n= R$ 68,407.21) of the expected cost of antimicrobials. When compared to the period between the beginning and completion of the implementation, a rate of 17.2% (n= R$ 353,220.61) of projected savings was revealed, which could have been increased in the final result if the PGA was already a reality in the unit study hospital. In the pharmacoeconomic study stage of COVID-19, a cross-sectional and retrospective observational study was carried out, based on the evaluation of reports from a system, in three periods relating to the COVID-19 pandemic: pre-pandemic, first and second pandemic wave . The study evaluated the influence of the cost of COVID-19 on the consumption of antimicrobial therapy, with a partial analysis of the utility cost type. An 84% increase (n= R$ 161,734.90) in direct costs with injectable antimicrobials was revealed in the third trained period. When comparing the consumption of antimicrobial bottles with the cost in reais, the results reveal that the increase in costs is due to the increase in consumption of the items and, in some cases, also due to the increase in the price of the item on the market. Our findings demonstrated the effectiveness of PGA in reducing direct antimicrobial costs through multidisciplinary strategies. In the context of the COVID-19 pandemic, there was an increase in the consumption and cost of antimicrobials, especially during the third period studied. Measures for the rational use of antimicrobials are taken and must be increased in order to make it possible to face human tragedies.