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Resource utilization and cost of rheumatic fever
M T Terreri1, M B Ferraz, J Goldenberg
1Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Clinical Epidemiology Unit/Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil.
Insights
Rheumatic fever (RF) significantly impacts Brazil
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- Socioeconomic effects of rheumatic fever (RF) in Brazil are not well-documented.
- Rheumatic heart disease is a significant concern in low-income populations.
Purpose of the Study:
- To evaluate resource utilization and associated costs of RF in a tertiary care center in São Paulo, Brazil.
- To assess direct and indirect costs to patients, families, and society.
Main Methods:
- 100 pediatric RF patients with at least one year follow-up were studied.
- Data collected via questionnaires and patient charts.
- Costs analyzed across public health, health plan, and private systems.
Main Results:
- Mean monthly family income was $625.20; mean disease duration was 3.9 years.
- Significant parental work absenteeism (22.9%) and patient school failure (22%).
- Total societal costs estimated at $124,663 per 100 patients (public system reference).
Conclusions:
- RF and rheumatic heart disease impose a substantial socioeconomic burden in Brazil.
- RF costs represent approximately 1.3% of affected families' annual income.
- Estimated annual societal cost of RF in Brazil exceeds $51 million USD.
Objective:
The socioeconomic effects of rheumatic fever (RF) in Brazil, including direct and indirect costs to patients and their families and to society, are largely unknown. We evaluated the utilization of resources and costs related to RF in a tertiary center caring for low income patients in the city of São Paulo, Brazil.
Methods:
One hundred patients with RF, younger than 18 yrs, with followup of at least one year, were sequentially selected to provide complete information on a questionnaire. Additional data were collected from patients' charts. The utilization of resources was evaluated for each patient throughout the entire disease course. Costs were determined for patients and their families as well as for the society, using variables from 3 different systems: the national public health system, used by most lower income groups; the Brazilian Medical Association, which regulates charges and fees utilized by health plans and insurance companies; and costs charged by private practitioners, paid directly by patients.
Results:
The RF population studied belonged to a low socioeconomic level. The mean monthly family income was $625.20 US. The mean disease duration was 3.9 yrs (range 1-10). Patients had a total of 1657 medical consultations, 22 hospital admissions, and 4 admissions to intensive care unit. Work absenteeism among parents was calculated as 22.9%, equivalent to 901 days of missed work; about 5% of the parents lost their jobs. Patients showed a high rate of school failure (22%). Considering the public system as a reference, direct, indirect, and total costs to society per 100 patients throughout the entire disease duration were $105,860 US ($271/patient/yr), $18,803 US ($48/patient/yr), and $124,663 US (US $319/patient/yr), respectively. When health care plan and private systems were taken as reference, the total costs were $423,550 US and $684,351 US, respectively.
Conclusion:
RF and rheumatic heart disease have an important socioeconomic impact in Brazil; costs of RF made up roughly 1.3% of annual family income. The estimated annual cost of RF for society in Brazil is $51,144,347.00 US.
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