Healthcare Utilization

Healthcare costing studies have expressive methodologic variability and, thus, need to be carefully interpreted. In the present document, most of the cost data were gathered from reimbursement tables from the Public Health System from 2008 to 2018. During this period, adjustment for inflation was performed neither regularly nor homogeneously across the CVD groups or procedures. The Brazilian inflation rate (based on the IPCA) from 2008 to 2018 was 76.3%, and the mean inflation for cardiovascular procedures was 43.5%. For some procedure codes, the adjustment was minimal; for coronary stenting, for example, it was 8.7%. Other procedures, however, were adjusted above the inflation rate, such as the treatment of arrhythmias (83.4%).

To minimize biases in reporting and interpreting cost data, a systematic approach was applied to all chapters. Overall costing studies were described in original currency (Reais or US dollars in a specific year) and international dollars. International dollars were converted to PPP adjusted to 2018 US dollars (2018 Int$) using the Campbell and Cochrane Economics Methods Group Evidence for Policy and Practice Information and Coordination Centre cost converter. A two-stage approach is applied in this method. First, it adjusts the original estimate of cost from the original price-year to a target priceyear, using a GDP deflator index (GDPD values). Second, it converts the price-year adjusted cost estimate in the original currency to a target currency, using conversion rates based on PPP for GDP (PPP values). For original economic studies, when the base year of the currency was not reported or could not be inferred from the manuscript (e.g., the last year of data collection), the recommendation was to assume the year before the publication of the paper.

More details can be found in the article by Oliveira et al.