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Abstract Objective: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children’s hospital. Methods: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital’s finance department. Results: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R $1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5–18 years compared to children aged 2–5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2–5 and 5–18 years, respectively. Conclusion: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment. Objective childrens s hospital Methods (SUS 2221 2 221 2,22 approach 200 2019 Procedures Medications OrthosesProstheses Orthoses Prostheses Orthoses/Prostheses hospitals department Results 506 50 6 50.6 R$703,503.00 R70350300 R 703 503 00 (R$703,503.00 $1,388,449.40 138844940 1 388 449 40 investigated 118 11 8 11. 518 18 5–1 25 2– Additionally 4 0 4. 63 3 6. respectively Conclusion R13884500 138 845 R$138,845.00 effectiveness investment 222 22 2,2 20 201 50. R$703,503.0 R7035030 70 (R$703,503.0 $1,388,449.4 13884494 38 44 51 5– R1388450 13 84 R$138,845.0 2, R$703,503. R703503 7 (R$703,503. $1,388,449. 1388449 R138845 R$138,845. R$703,503 R70350 (R$703,503 $1,388,449 138844 R13884 R$138,845 R$703,50 R7035 (R$703,50 $1,388,44 13884 R1388 R$138,84 R$703,5 R703 (R$703,5 $1,388,4 1388 R138 R$138,8 R$703, R70 (R$703, $1,388, R13 R$138, R$703 R7 (R$703 $1,388 R1 R$138 R$70 (R$70 $1,38 R$13 R$7 (R$7 $1,3 R$1 R$ (R$ $1, $1 $