OBJECTIVES: In this patient-level analysis we explored HCRU, and medical costs of patients submitted to kidney transplant at SUS (Unified Health System) who were simultaneously covered by SH (Supplementary Health System).

METHODS: This is patient-level retrospective analysis conducted over a 5-year period, from Jan-2015 to Dec-2019, used publicly available administrative claims data from the SUS and SH. The cohort included patients ≥ 18 years, submitted to kidney transplant at SUS and to dialysis or other RRT-related procedure at SH, ≥ 6 months of follow-up prior and after transplantation. Costs were in Brazilian real (BRL) and converted to US dollar (USD); 1 USD = 4.0943 BRL, in mid-December 2019.

RESULTS: Cohort included 290 patients; mean age was 50.9 years (SD 12.9). Of total patients, 81.3% used ambulatorial care in SH pre-transplant with median of 1.33 times (Per Patient Per Month – PPPM) and 26.5% after kidney-transplant (0.45 times PPPM). In SUS, most patients used ambulatorial services before (81.3%) and after (93.1%) kidney-transplant, accounting for 0.74 times PPPM and 0.95 times PPPM, respectively. Of total patients, 44.7% received hemodialysis at SH before kidney-transplant (2.22 times PPPM). More than 70% of patients received drugs at SUS. Before transplantation, median costs of ambulatorial services were USD 127 PPPM in SH and USD 267 PPPM in SUS.

CONCLUSIONS: Insured patients undergoing kidney transplant in SUS impose a burden for both public and supplemental health sectors in Brazil. In SUS, besides the transplant surgery, patients used ambulatorial services before and after transplant, including dialysis, transplant follow-up, and drug acquisition. SH is mostly used for dialysis procedures before the transplant.