Abstract
ABSTRACTObjective:To investigate trends in terms of number and cost of intravitreal injection, photocoagulation and panphotocoagulation procedures performed by the Brazilian Public Health System, from 2010 to 2019.Methods:The Brazilian Public Health System Database was used as the primary source of data. Intravitreal injection, photocoagulation and panphotocoagulation procedures performed from 2010 to 2019 were investigated. Procedure prevalence and cost trends were analyzed according to year and region. Annual trends were examined using generalized linear models, with a significance level of 5% (p=0.05).Results:There was a significant increase in the prevalence of intravitreal injections (1,088%), panphotocoagulation (51%) and photocoagulation (37%) procedures from 2010 to 2019. Intravitreal injections accounted for the most significant increase. However, costs were not significantly readjusted over the years.Conclusion:Over a 10-year period, there was a significant increase in the number of procedures associated with retinal disorders. Procedure costs saw little readjustments over time. In spite of limitations, inaccuracies and lack of details, the Brazilian Public Health System Database is the primary source of data for the Public Health System related research in Brazil, and can contribute with information on ocular health and costs of ophthalmic procedures.
Highlights
Intravitreal injections, indicated for age-related macular degeneration (AMD) and macular edema; photocoagulation, indicated for retinal tears; and retinal panphotocoagulation, indicated in cases of proliferative diabetic retinopathy, macular edema and retinal vein occlusion, among other diseases, are the most common procedures used by vitreoretinal specialists to treat retinal disorders.[1,2]
Therapeutic retinal photocoagulation has been used for more than 50 years[3] and is prescribed for all cases of microaneurysms and other focal leakage sites in the macula area.[4]. A recent meta-analysis revealed that photocoagulation as a single therapy can reduce the chances of visual loss within one to three years compared to no intervention.[3]. Panphotocoagulation is defined as total retinal laser ablation combined with small scattered focal ablations, spots aimed to prevent further vessel growth and leakage, due to secretion of vascular endothelial growth factor (VEGF) by the ischemic retina.[2]
National data derived from SUS are stored in the Public Health System Database (Departamento de Informática do Sistema Único de Saúde - DATASUS).(6) Originally intended for administrative procedures, this database contains data on all hospital admissions and procedures covered by SUS in Brazil
Summary
Intravitreal injections, indicated for age-related macular degeneration (AMD) and macular edema; photocoagulation, indicated for retinal tears; and retinal panphotocoagulation, indicated in cases of proliferative diabetic retinopathy, macular edema and retinal vein occlusion, among other diseases, are the most common procedures used by vitreoretinal specialists to treat retinal disorders.[1,2]Therapeutic retinal photocoagulation has been used for more than 50 years[3] and is prescribed for all cases of microaneurysms and other focal leakage sites in the macula area.[4]. Recent reviews have shown the success of therapeutic intravitreal injections for visual function improvement in patients with macular edema. In these studies, higher injection frequency and younger age were the main variables for better visual prognosis and superior treatment outcomes.[5]. Brazil is one of the few countries worldwide to offer universal, free health coverage financed by the federal government Public Health System (Sistema Único de Saúde - SUS). This system provides medical attention to the Brazilian population in every medical specialty, from primary healthcare to complex procedures delivered by tertiary hospitals, including eye care. The online version protects personal information, but provides access to data associated with specific procedure codes, general demographic information, place and date of admission and procedure costs.[7]
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