Costos de atención y rehabilitación de pacientes con lesiones por accidentes de tránsito en el mundo

Abstract

ABSTRACT: To know the direct (dc) and indirect costs (ic) generated by the treatment of patients with moderate or severe injuries caused by traffic accidents (ta) in the world. Methodology: a systematic review of studies assessing the costs of treating victims of traffic accidents older than 16 between 2008 and 2013 was conducted using the PubMed, Embase, Centre for Reviews and Dissemination, Journal Storage and Scielo databases. The quality of the studies was assessed using criteria from Drummond and col, as well as the "Consolidated Health Economic Evaluation Reporting Standards statement (cheers)" and other mechanisms defined by the authors. DCs and ICs were assessed. The burden of disease (bd) was obtained with the disability-adjusted life year (daly), and the quality-adjusted life-year (qaly). The costs generated by disability / rehabilitation and traumatic brain injury (tbi) were analyzed. The monetary costs were expressed in 2010 us dollars (usd) adjusted for inflation. Results: 14 studies were analyzed, 6 of which had a good quality. We found studies with up to 567.000 patients and a duration of 10 years. Direct costs were up to usd 48.082 and indirect costs up to usd 29.706 per patient; the direct costs were exceeded by the indirect costs. The burden of disease showed high variability. In one study, 60% of the patients with severe tbi and 20% with moderate tbi had short term disability; in another study 4.6% of the patients sustained long-term disability. Conclusions: there is great heterogeneity in the cost studies. There is no consensus for assessing the quality of these studies. The indirect costs incurred in traffic accidents are greater than direct costs. The costs of disability and rehabilitation are poorly assessed.

RESUMEN: Conocer los costos directos (cd) e indirectos (ci) de la atención de pacientes con lesiones por accidentes de tránsito (at) en el mundo. Metodología: Se realizó una revisión sistemática en PubMed, Embase, Centre for Reviews and Dissemination, Journal Storage y Scielo de estudios de costos de atención de víctimas de at mayores de 16 años, entre 2008 y 2013. La calidad de los estudios se evaluó con criterios extraídos de Drummond y col, y del “Consolidated Health Economic Evaluation Reporting Standards statement (CHEERS)” y otros definidos por los autores. Se evaluaron los cd, los CI. La carga de la enfermedad (ce), se hizo con los Años de Vida Ajustados por Discapacidad (avad), y Años de Vida ajustados por Calidad (avac). Se analizaron los costos generados por discapacidad/rehabilitación y Trauma craneoencefálico (tec). Los costos monetarios en dólares americanos (usd) de 2010 ajustados por inflación. Resultados: se analizaron 14 estudios, seis de buena calidad. Se encontraron estudios con 567.000 pacientes y 10 años de duración, costos directos de 48.082 e indirectos de 29.706 usd por paciente; los costos indirectos superaron los directos. La carga de la enfermedad mostró amplia variabilidad; en un estudio el 60% de los pacientes con tec grave y 20% moderado quedaron con discapacidad corto plazo y en otro el 4,6% quedó con discapacidad a largo plazo. Conclusiones: existe gran heterogeneidad en los estudios, no hay consenso para evaluar la calidad de estos estudios. Los costos indirectos de accidentes de tránsito superan los directos. Los costos derivados de discapacidad y rehabilitación son poco evaluados.