Custeio em saúde baseado em atividade e tempo (TDABC) de um programa de reabilitação pulmonar para pessoas com COVID longa

Abstract

Objectives: To estimate the cost of the Pulmonary Rehabilitation Program for patients with long-term COVID at the Hospital Regional da Asa Norte (HRAN) and to evaluate its financial performance, comparing the cost to the financial transfer of resources from the Unified Health System. Methods: This is a post-hoc analysis study applying the activity and time-based costing method (TDABC) based on data prospectively collected in a randomized clinical trial on inspiratory muscle training in 110 post-COVID-19 patients who were over 18 years old and required at least 48 hours of invasive ventilatory support. The sample was collected for convenience by referring patients to rehabilitation at the HRAN. The study took place from November 2020 to February 2022. Patients who did not complete the 24 proposed rehabilitation sessions were excluded from the analysis; patients with pre-existing neuromuscular diseases; pregnant women; patients with inability to understand simple verbal commands, characterized by a value greater than or equal to 24 on the Mini-Mental scale; and who did not sign the Free and Informed Consent Form (TCLE). Results: The total monthly cost of the program is R$ 65,508.75, with a per capita cost of R$ 655.09 (equivalent to €3,681.60 or US$ 3,426.12). The items that most impact the cost are the material resources used (R$ 61,419.80), equivalent to 93.7% of the total value. There was a large deficit in the amount transferred (R$ 63,741.23 – 97.3%) by the SUS. Conclusion: The TDABC methodology proved to be efficient for measuring the proposed financial performance. The rehabilitation program generates a significant deficit, consuming a significant portion of the health system's resources, which justifies the need to review government transfers, so that the conditions for health promotion, protection and recovery are maintained. In the same sense, aiming at improving the efficiency of the service, it is suggested to evaluate the increase in the program's service capacity.