Análise de custo-minimização por estratégias de otimização terapêutica aplicadas pelo programa de gerenciamento da terapia antimicrobiana de um hospital universitário no Ceará.

Abstract

The ecstasy that permeated the discovery of antimicrobials at a time of high rates of morbidity and mortality from infections, even in an epidemic scenario, caused an increase in the consumption of these drugs worldwide. Its frequent and inappropriate use has led to the spread of microbial resistance, now considered a global threat. Several strategies have been recommended so that the use of antimicrobials is done in a rational manner, among them, the antimicrobial therapy management program (PGTA/Stewardship), which in addition to presenting positive clinical care outcomes, also draws the attention of managers for its important economic impact. Studies that demonstrate this impact are still scarce in Brazil, since the area of research in pharmacoeconomics is recent in the country, as well as the guideline for implementing the program. Thus, the present study aims to carry out cost-minimization analysis promoted by applying the therapeutic optimization strategies of PGTA since its implementation in a university hospital in Ceará. Therefore, from 2017 to 2019, monitoring of patients using therapeutic and/or strategic antimicrobials was carried out, with subsequent import of data into the Program's database, which provides, among others, the process and result indicators evaluated in this work: pharmacotherapeutic profile, profile of applied therapeutic optimization strategies, antimicrobial consumption metrics as Defined Daily Dose (DDD), Days of Therapy (DOT), Length of Therapy (LOT) and Antimicrobial-Free Days (DLA), and cost analysis. The 1382 patients followed used 3996 antimicrobials, of which, piperacillin + tazobactam was the most frequent, with 22.21% (815/3669). A total of 6,083 optimization strategies were applied, with escalation (21.55%), optimization / dose adjustment (20.06%) and completion of treatment (15.45%) the most prevalent. Regarding the consumption of these drugs, both DDD and DOT showed prevalence of broad-spectrum antimicrobials. However, DOT revealed a decline in their consumption, reaching up to 72.94% (91.20/125.03) of reduction in the use of teicoplanin. The overall reduction rate of the LOT, in turn, was 36.56% (421.04 / 1151.69). The financial impact of the Program based on the main cost minimization strategies represented a significant avoided cost rate of 32.14% (p <0.001), equivalent to R$ 1,042,387.88. The strategy of discontinuation was more representative, with 49.18% (589,758.02 / 1,199,278.07) of avoided costs. Thus, it was possible to identify the reduction in the consumption of antimicrobials monitored by the multidisciplinary team, the growing therapeutic management by applied optimization strategies and its important economic impact in minimizing the costs associated with these agents.