Titre:	Panorama do tratamento da acromegalia em centro terciário de referência do Distrito Federal : desfechos clínicos, impacto orçamentário e acessibilidade à dispensação de medicamentos aplicando os sistemas de informações geográficas
Auteur(s):	Dantas, Lara Benigno Porto
Orientador(es)::	Naves, Luciana Ansaneli
Coorientador(es)::	Rosa, José Wilson Corrêa
Assunto::	Acromegalia Acompanhamento terapêutico Epidemiologia Impacto orçamentário Sistemas de informação geográfica Saúde - análise de valor (Controle de custo) Acesso aos serviços de saúde
Date de publication:	22-oct-2018
Data de defesa::	9-oct-2017
Référence bibliographique:	DANTAS, Lara Benigno Porto. Panorama do tratamento da acromegalia em centro terciário de referência do Distrito Federal: desfechos clínicos, impacto orçamentário e acessibilidade à dispensação de medicamentos aplicando os sistemas de informações geográficas. 2017. 131 f., il. Tese (Doutorado em Ciências da Saúde)—Universidade de Brasília, Brasília, 2017.
Abstract:	Introduction: Acromegaly is a rare disease with high morbidity and mortality, which is complex and expensive to manage. National epidemiological data on therapeutic outcomes in “real life” conditions are scarce, as are economic studies capable of assisting in the allocation of financial resources and in budget planning to better define strategies for treatment by the public health system. Information on geographical accessibility to the dispensation of medicines by the public health system is also little known. Objectives: To describe the main clinical outcomes of long-term therapy in patients with acromegaly accompanied at a referral center for treatment of the disease in Brazil; estimate the budget impact when comparing different treatment scenarios; to perform a spatial analysis of the patients submitted to pharmacological treatment regarding the distance from home to the drug dispensing centers and to evaluate if the geographical accessibility impacted on hormonal control. Methods: A retrospective data analysis of 111 patients followed-up at the Neuroendocrinology Unit of the Brasília Universitary Hospital (HUB) between January 1980 and March 2015 was accomplished; a budget impact study comparing the costs of performing transsphenoidal pituitary surgery in relation to continued treatment with octreotide LAR was developed; the application of the Geographic Information System (GIS) software ArcGIS, ESRI, Redlands, CA was used for spatial analysis. Results: 25.2% (n = 29) of the patients were cured, 40.6% (n = 44) presented disease under control and 34.2% (n = 38) were biochemically uncontrolled, after a period of follow-up of 8.9 ± 6.4 years. Higher age (PR = 1.03, p = 0.0196) and one single intervention (PR = 4.24, p <0.0001) were associated with cure in patients submitted to surgery. The hormonal control obtained in patients on pharmacological treatment (n= 76) was 58% (n = 44) after a period of 5.8 ± 3.8 years. The normalization rate was higher in adjuvant (67%) versus primary (45%) therapy (p = 0.0394). The budget impact study showed that the increase in surgery coverage for two procedures per month could bring savings of approximately R$ 2,781,026.35 over 3 years, when this scenario was compared to the continued use of octreotide LAR at a dose of 30mg every 28 days. In relation to spatial analysis, there was no statistically significant difference between the distance of the residence to the respective drug dispensing center and the achievement of control (p = 0.7616). Conclusions: Only one quarter of the patients presented cure criteria. The budget impact analysis showed that there could be significant cost savings if there was investment in performing pituitary surgery. The distance between home and drug dispensing center, when assessed in isolation, does not seem to have an impact on obtaining hormonal control.
metadata.dc.description.unidade:	Faculdade de Ciências da Saúde (FS)
Description:	Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2017.
metadata.dc.description.ppg:	Programa de Pós-Graduação em Ciências da Saúde
Licença::	A concessão da licença deste item refere-se ao termo de autorização impresso assinado pelo autor com as seguintes condições: Na qualidade de titular dos direitos de autor da publicação, autorizo a Universidade de Brasília e o IBICT a disponibilizar por meio dos sites www.bce.unb.br, www.ibict.br, http://hercules.vtls.com/cgi-bin/ndltd/chameleon?lng=pt&skin=ndltd sem ressarcimento dos direitos autorais, de acordo com a Lei nº 9610/98, o texto integral da obra disponibilizada, conforme permissões assinaladas, para fins de leitura, impressão e/ou download, a título de divulgação da produção científica brasileira, a partir desta data.
Collection(s) :	Teses, dissertações e produtos pós-doutorado

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