O custo de prevenção e tratamento de úlceras de pressão: revisão da literatura

Introduction: Pressure ulcers (PU) are considered a public health problem, common in many care settings and an indicator of the quality care (1). This problem has been getting great political and economic concern, due to the financial burden on health system, loss and weakening of life quality, both for the PU patients, their caregivers and society (2). The need for high quality health care with in limited budget, has aroused interest in the preparation of studies in order to calculate the cost of prevention and treatment of PU as well as the impact on patients and society (3). Objective: Analysing costs of prevention and treatment of PU in adult population in any care environment through the analysis of studies aimed at measuring the economic impact of this problem. Material and Methods: In this research a literature review of PU and cost was carried out, using articles published in the databases of the BVS and EBSCOhost between January 2005 and December 2015, written in Portuguese, English and Spanish. MSH descriptors "cost of pressure ulcer or treatment and cost estimates and cost per patient or cost per patient per day" were used. The data collection and analysis was carried out from January to February 2016. Results / Discussion: In this research 84 publications were identified, after examining title and abstract 12 were selected to integrate this analysis. At a time when we witness an organizational change in health care, and that health institutions have a strategic goal to provide care more efficiently, both in costs and clinical terms, quantifying the cost of PU´s becomes increasingly more relevant because it allows to highlight the magnitude of this problem. It is important that doctors, nurses and managers understand the economic costs that are associated with the PU´s, so that they can ensure that the most effective means are used to prevent and treat the damage caused by pressure (4). The analysis of published articles revealed a large discrepancy in reported results. The average cost of prevention of PU´s patients at risk was estimated at 2.15 € per day in nursing homes and 7.88 € in hospitals and patients without risk ranged between 0.50 Euro per day in nursing homes and 1,44 € in hospitals (5). The estimated cost of treating a PU in hospitals ranged from 24 € (category I) (4) and 11,355 € (category IV) (3) and in primary health care between 108 € (category I) and 2868 € (category IV) (4). The main factor for the costs was the expense associated with preventive care due to regular repositioning and risk assessment, which ranged from 19% to 90% (3) (4). For managers it is important to know the potential cost of the PU´s because the resource costs for the hospital are likely to be substantial (3) (6). Dealey, Posnett and Walker (2012) found that 5 to 8 days of additional hospitalization in patients who developed PU´S, caused an increase of 4.35 million € per year, and a reduction of only 20% of the PU´s could generate savings about 868,762 € per year (3). These data highlight the importance of prevention, the implementation of effective identification and treatment measures in order to prevent the increase in PU’s severity and patients becoming more prone to infections and other complications that may lead to hospitalization and thus increase substantially the costs of treatments. Conclusion: At a time marked by a deep economic crisis, it is essential to understand the costs related to the prevention and treatment of PU’S. The results of these studies can help politicians and health services managers to identify the cost factors of prevention and treatment of PU´s and in making decisions on planning, resource allocation and prioritization of health spending to improve implementation of preventive measures.