Farmacovigilância na prática clínica : impacto sobre reações adversas e custos hospitalares

Abstract

Objetivo: A segurança no uso de medicamentos tem constituído importante indicador na assistência prestada em nível hospitalar. Para tanto, este estudo propõe avaliar o impacto clínico e econômico da implantação de um programa de farmacovigilância (PFV) intensiva em um hospital geral, através do monitoramento de reações adversas à vancomicina. Delineamento: Coorte. Amostra: 689 pacientes constituíram a amostra, sendo 151 acompanhados antes do PFV e 538 depois PFV. Principais Medidas: Ocorrência de reação adversa a medicamento (RAM) baseado no algoritmo de Naranjo e estimativa de custos hospitalares. Resultados: Houve redução na ocorrência de RAM após a implementação do PFV (19,9% vs. 13,4%; P < 0,05). O PFV foi um fator independente relacionado a uma diminuição da RAM, especialmente naqueles pacientes em uso de vancomicina inferior a 12 dias e em pacientes pediátricos, com um NNT de 15. Não houve diferença nos custos antes e após o programa, entretanto aqueles pacientes com RAM apresentaram um custo adicional de R$ 12.676,47, sendo que a atividade de vigilância representou um custo estimado de R$ 19,23 por caso acompanhado. Conclusão: Um PFV implementado ativamente, com busca e monitoramento de RAM, e com estratégias pró-ativas para minimizá-las, tem impacto positivo nos resultados clínicos e econômicos hospitalares.

Proper drug safety monitoring is a central aspect and an important quality indicator of hospital care. This study was carried to evaluate the clinical and economic impact of the implementation of an Intensive Phamacovigilance Program (IPP) in a general hospital. We selected the occurrence of Adverse Drug Reactions (ADR) related to the antimicrobial drug vancomycin to evaluate the program. Study design: Cohort. Methods: 689 patients were included, 151 of them were followed before the implementation of the IPP and 538 patients were followed after this. Main determinants: The occurrence of ADR was measured and classified based in the ‘Naranjo’ algorithm. All the hospital costs were estimated using the register of the financial department of the hospital. Results: There was a significant reduction in the ADR rates after the implementation of the IPP (19.9% versus 13.4%; P-value<0.05). The IPP was an independent factor for the reduction of the ADR rates; it was more important in those that used vancomycin for a period of time ≤ 12 days, and in pediatric patients, in this case the number needed to treat (NNT) estimated was 15. There was no difference between the costs comparing the period before and after the IPP implementation, but those patients that has ADR represented an additional cost of R$ 12,676.47. The cost of the IPP program was R$ 19.23 per individual case followed. Conclusion: The implementation of an IPP that monitored ADR and the strategies that were simultaneously developed to minimize them, had a positive impact in the clinical and economic aspects analized.