Cost-benefit of hospitalization compared with outpatient
care for pregnant women with pregestational and
gestational diabetes or with mild hyperglycemia, in Brazil
Custo-benefício da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes pré-gestacional e gestacional ou com hiperglicemia leve, no Brasil
Ana Claudia Molina CavassiniI, Silvana Andréa Molina LimaII, Iracema Mattos Paranhos CalderonIII, Marilza Vieira Cunha RudgeIV Hospital das Clínicas (HC), Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
Nurse, Municipal Authority of Botucatu,
Botucatu, São Paulo, Brazil.
MD, PhD. Assistant Professor, Department of
Nursing, Hospital das Clínicas (HC), Faculdade
de Medicina de Botucatu (FMB), Universidade
Estadual Paulista (Unesp), Botucatu, São Paulo,
MD, PhD. Adjunct Professor, Department of
Gynecology and Obstetrics, Hospital das Clínicas
(HC), Faculdade de Medicina de Botucatu
(FMB), Universidade Estadual Paulista (Unesp),
Botucatu, São Paulo, Brazil.
MD, PhD. Titular Professor, Department of
Gynecology and Obstetrics and Pro-Rector of
Postgraduate Programs, Universidade Estadual
Paulista (Unesp), Botucatu, São Paulo, Brazil.
Health care costs.
Costs and cost analysis.
Custos de cuidados de saúde.
Custos e análise de custo.
CONTEXT AND OBJECTIVE: Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. STUDY DESIGN: This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp).
METHODS: Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients’ records and the hospital’s absorption costing system. The cost-benefit was then calculated. RESULTS: Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively.
CONCLUSION: Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits. resUMO
CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO DO ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em...
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Date of first submission: February 23, 2011
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