Health Economic Evaluation As a Tool for Sustainable Financing of the Unified Health System: The Case of Hemodialysis

OBJECTIVES: To analyze the impact of an economic evaluation on the revision of the value of payment per production in the financing of the hemodialysis (HD) procedure in the Unified Health System (acronym in portuguese, SUS).

METHODS: The Ministry of Health team carried out a micro-costing analysis with bottom-up distribution of an HD clinic, in two comparative scenarios: 20 or 30 machines. The average values of these costs were compared with the value of the readjustment requested by the institutions providing services to SUS. Subsequently, the Budgetary Impact (BI) was calculated.

RESULTS: The total cost of the hemodialysis session per patient presented by the institutions of the clinics affiliated with SUS was R$273.44, which would represent an increase of 25.2% on the current value (R$218.47). Micro-costing measured the average cost at between R$223.72 and R$261.16, allowing for an incremental adjustment of between 2.4% and 19.5%. In the decision-making process, it was decided to adjust to 10.1%, which is above the accumulated inflation variation (9.73%). The difference in the BI between the index requested and that granted represents a saving of R$510.5 million per year, representing almost 1% of the specialized care budget.

CONCLUSIONS: The annual exemption of the public health system by half a million reais boosts efficiency in the line of care in this area, which in 2022 represented the largest outpatient expenditure of SUS. These results highlight the continued need to adopt data- and evidence-based approaches to ensure the effectiveness and financial viability of policies, especially in high-cost sectors such as hemodialysis, thus contributing to the financial sustainability of SUS.