Análise de custo-efetividade do programa de navegação de pacientes oncológicos em um centro oncológico de referência para tratamento de tumor colorretal

Abstract

OBJECTIVE: To evaluate the financial impact and effectiveness of a navigation program in patients with colorectal tumors undergoing videolaryngoscopic rectosigmoidectomy. MATERIAL AND METHODS: Retrospective, case-control type study from May 2019 to December 2020 with patients 18 years-old or older; with sigmoid, retosigmoid junction or upper rectal tumors, submitted to elective laparoscopic sigmoidectomy or high anterior resection with high colorectal anastomosis. The main endpoints were: costs during the patients pathway; interval between first appointment and surgery; use of unit of intensive care (ICU) or not; use of emergency room after discharge. Categorical variables were compared by chi-square test, Fisher's exact test, and Mann-Whitney. RESULTS: 71 patients, with 49 (69%) not navigated and 22 (31%) navigated. In the diagnostic stage, navigated patients were more referred to physical therapy (81.8% vs. 46.9%, p=0.013) and nutrition specialist (81.8% vs. 57, p=0.081) and performed more diagnostic tests according to the institutional protocol (86.4% vs. 75.5%), contributing with an average revenue per patient 90% higher, p=0.01). The mean time from first visit to surgery, although shorter, had no statistical difference (26 vs. 28 days, p=0.794), as well as the length of stay (5.3 vs. 8.2, p=0.082) and visits to the emergency room within 30 days after discharge (18% vs. 22%, p=1.0). However, the percentage of patients in ICU was 73.8% lower in navigated patients (34.7% vs. 9.1%, p=0.05). 4.5% of navigated patients were cost-outliers vs. 36.5% of non-navigated patients, p=0.05. This resulted in a 18.5% lower cost of surgery and a 16% cheaper journey compared to the non-navigated patients. CONCLUSION: Navigated patients on oncology treatment have lower costs along the journey and better outcomes with shorter ICU stays, as well as more compliant with institutional protocols.