Estudo de custos dos acidentes isquémicos transitórios tratados em ambulatório.

Abstract

Patients with transient ischemic attacks (TIA) may be studied on a hospital admission or an outpatient clinic basis. There are few studies evaluating the costs of TIA treating on outpatient basis. Our aims were to determine the total cost per patient with TIA evaluated in a weekly TIA Clinic and to compare the costs of treating as ambulatory with the ones of inpatient treatment.Direct costs to the health care services (primary and secondary care), direct costs outside the health care services and indirect costs were assessed in consecutive patients with TIA evaluated in the TIA Clinic of Hospital de Santa Maria, between October 2006 and May 2007. The time horizon was one month, estimated from the date of TIA. The study perspective was the society. The main instrument for data collection was a questionnaire applied in an interview immediately after the first TIA Clinic visit. The TIA clinic database was consulted to extract information subsequent to the first visit. The monetary valuation of the different items was done in accordance with the officially fixed values.Thirty-two patients were evaluated, with a mean of 65 years (41-85), 23 (71.9%) males. Mean total costs (direct and indirect) was 802.71 €/patient. Mean total direct costs for the health care services was 691.16 €/patient, corresponding to 89.7% of the total direct costs. Primary care costs represented 1.7% and secondary care 98.3%. Mean total direct costs outside the health care services was 79.49 €/patient. Mean total direct costs (of the health care services and outside the health care services) was 770.65 €/patient. Mean total indirect costs was 32.06 €/patient. Diagnostic tests and exams represented 45.2% of the direct costs per category, hospital emergency 19.8%, TIA clinic 8.4% and drugs 4.0%. The estimated cost for inpatient treatment was 1.214.29 €/patient (DRG 832).Most of the direct costs were supported by the health care services. Cost of treatment in ambulatory basis was lower than that estimated in inpatient basis. This study suggests that immediate evaluation of TIA patients is possible in a outpatient TIA Clinic and may reduce hospital admission and costs in low risk patients.