OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Resumo Fundamento: A fibrilação atrial (FA) é a arritmia mais comum em todo o mundo, com hospitalizações significativamente associadas. Considerando sua crescente incidência, a carga econômica relacionada à FA para os sistemas de saúde está aumentando. Os gastos com saúde podem ser substancialmente reduzidos após a ablação por radiofrequência (ARF). Objetivo: Comparar a utilização de recursos e os custos anteriores e posteriores à ARF em uma coorte de pacientes do sistema de saúde privado brasileiro. Métodos: Foi realizado um estudo de coorte retrospectivo, com base nas informações de cobrança dos pacientes de um banco de dados administrativo. Foram incluídos oitenta e três pacientes adultos que passaram pelo procedimento de ARF entre 2014 e 2015. A utilização de recursos de saúde relacionados às causas cardiovasculares, incluindo atendimento ambulatorial e hospitalar, assim como seus custos, foram analisados. Um valor de p inferior a 0,05 foi considerado estatisticamente significativo. Resultados: O seguimento médio foi de 14,7 ± 7,1 e 10,7 ± 5,4 meses antes e após a ARF, respectivamente. A taxa de FA livre de recidiva em 1 ano foi de 83,6%. Antes da ARF, a mediana dos custos totais mensais foi de R$286,00 (intervalo interquartil [IIQ]: 137-766), com redução de 63,5% (p = 0,001) após o procedimento, para um valor de R$104 (IIQ: 57-232). Os custos foram reduzidos tanto na emergência (em 58,6%, p < 0,001) como no ambiente ambulatorial (em 56%, p < 0,001); não houve diferenças significativas nas consultas ambulatoriais, internações eletivas e custos de internação eletiva antes e depois da ARF. As medianas das consultas mensais no setor de emergência foram reduzidas (p < 0,001). Conclusão: Nesta coorte, os custos gerais com saúde foram reduzidos em 63,5%. Um seguimento mais longo pode ser útil para avaliar se a redução de custos em longo prazo é mantida.

Abstract Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide, with significantly associated hospitalizations. Considering its growing incidence, the AF related economic burden to healthcare systems is increasing. Healthcare expenditures might be substantially reduced after AF radiofrequency ablation (AFRA). Objective: To compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system. Methods: We conducted a retrospective cohort study, based on patients’ billing information from an administrative database. Eighty-three adult patients who had an AFRA procedure between 2014 and 2015 were included. Healthcare resource utilization related to cardiovascular causes, including ambulatory and hospital care, as well as its costs, were analyzed. A p-value of less than 0.05 was considered statistically significant. Results: Mean follow-up was 14.7 ± 7.1 and 10.7 ± 5.4 months before and after AFRA, respectively. The 1-year AF recurrence-free rate was 83.6%. Before AFRA, median monthly total costs were Brazilian Reais (BRL) 286 (interquartile range [IQR]: 137-766), which decreased by 63.5% (p = 0.001) after the procedure, to BRL 104 (IQR: 57-232). Costs were reduced both in the emergency (by 58.6%, p < 0.001) and outpatient settings (by 56%, p < 0.001); there were no significant differences in the outpatient visits, inpatient elective admissions and elective admission costs before and after AFRA. The monthly median emergency department visits were reduced (p < 0.001). Conclusion: In this cohort, overall healthcare costs were reduced by 63.5%. A longer follow-up could be useful to evaluate if long-term cost reduction is maintained.