The clinical importance of direct hospital costs in patients with arterial hypertension under treatment in an university hospital, Rio de Janeiro State, Brazil

Abstract

The authors analysed retrospectively 503 adult patients (< 20 years old) representing 9.6% of the population living in the XX Administrative Region of Rio de Janeiro and registered for treatment in the University Hospital - UFRJ in the year of 1978 (5,262 patients). Arterial blood pressure was recorded in 483 of these cases and 138 (28.6%) were considered to have primary arterial hypertension (BP >; 140/90 mmHg). The 96 cases initially analysed were studied for the determination of the direct hospital costs involved in the evaluation, follow-up and treatment of such cases. The initial diastolic BP was distributed as follows: 90 to 104 mmHg-67 cases (69.8%); 105 to 114 mmHg-17 cases (17.7%); >; 115 mmHg - 12 cases (12.5%). The mean follow-up period of this population was 653 days and at the last hospital visit only 1/3 had their BP under control ( < 140/90 mmHg). By 1982, 68.7% had abandoned their treatment. The total annual direct hospital costs per patient were $ 102.48 thus distributed: ambulatory consultations determined by the hypertension $ 33.44; emergency consultations $ 2.33; hospital admissions $ 29.92; laboratory tests $ 10.45; expenses with anti-hypertensive medications $ 26.34. The disease morbidity determined the great majority of the hospital consultations and admissions (64% of the costs). Disease morbidity also causes high indexes of temporary and permanent disability with major social costs. The analysis of the final costs determinants indicated the following measures for costs minimization: a) Development of programs within the health units with a view to better BP control and aiming at reducing the abandonment of treatment by the patients; b) Standardization of the laboratory evaluation and treatment, based on studies of cost-efficiency; c) The establishment of a hierarchy among the health units. The hypertensive patient must be treated in health units where indirect hospital costs do not much influence the final costs of hospital consultations and admissions.