Abstract
Introduction
Total knee and hip arthroplasty were the main arthroplasty surgery performed in Brazil. In Brazil, around 50% of arthroplasty surgeries are performed by the public health system, knowing as SUS 1. SUS is the biggest public and universal health system in the world, attending 100% of the Brazilian population (220 million), with 2020's expected budget of US$ 31 billion 2,3.
The National Institute of Clinical Excellence utilizes the QALY system (Quality adjustment year life)to calculate the best cost-benefit between medical interventions 4. In compliance with the study, an operated person has a QALY index of £5000 while a non-operated person has an index of £7182.
In March 2020, due to the COVID-19 pandemics, the Brazilian Health Ministry oriented for the postponing of elective surgery, to prioritize combating the virus 5. This postponing, it was important but will cause an impact in the economy at the public health system from Brazil this year and in the next years. Therefore, this study aims to present the economic impact caused by COVID-19 pandemics in the public heal system, SUS, of Brazil.
Methods
Data about total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Brazil were collected from the TABNET portal of the Brazilian Health Ministry/Datasus 6. It was collected information per month about hospitalization authorization (AIH), and total cost per AIH. The information regards the period of January to June from years 2015 to 2020.
Results and Discussion
After the orientation in march 2020 to postpone elective surgery, there was a reduction of up to 91% in total knee arthroplasty (TKA) and 76% in total hip arthroplasty (THA), compared to the same period in the previous years (see Figure 1). This represents a reduction of more than 5000 surgeries in the first semester. According to Brazilian doctors, the retention of surgeries will result in excessive demand for the sector in the upcoming months 7.
Due to the reduction of the AIH, which occurs a reduction US$3,881,494 of the budget destined for arthroplasty surgeries in the first semester of 2020 (see Figure 2), being used to the combat of COVID-19. Consequently, the purchase of new hip and knee prostheses decreases, harming the implant sales sector in Brazil. Furthermore, by the QALY system, the cost of a non-operated patient is up to 43% bigger than that of an operated patient. Thus, this will generate an increase in the expenses of the SUS in the upcoming months or years.
Conclusion
The COVID-19 pandemics generate the need of postponing elective surgery of the SUS, such as total hip and knee arthroplasty. Because of this, there was a reduction of 67% of the number and expense of knee and hip arthroplasties in the first semester of 2020. This generates an economic loss for the implants companies and it will increase overly the demand for new surgeries in the upcoming months or years.
For any figures or tables, please contact the authors directly.
