Analiza troškova akutnog nekompliciranog pijelonefritisa iz perspektive Hrvatskog zavoda za zdravstveno osiguranje

master's thesis

• Title (english): Cost of illness analysis for acute uncomplicated pyelonephritis from the perspective of Croatian health insurance fund
• Author: Marija Zoretić
• Mentor: Petra Turčić (mentor)
• Committee member: Petra Turčić (predsjednik povjerenstva)
• Committee member: Ana-Marija Domijan (član povjerenstva)
• Committee member: Živka Juričić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2016-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Akutni nekomplicirani pijelonefritis je akutna infekcija bubrega i bubrežne zdjelice. Radi se od najčešćoj ozbiljnoj infekciji inače zdravih pojedinaca. Dijagnostika pijelonefritisa zasniva se na laboratorijskim nalazima i kliničkim simptomima. Vrlo je važno definirati radi li se o pijelonefritisu da bi se mogao donijeti točan zaključak oko stvarnog tereta ove bolesti za zdravstveni sustav te definirati uzročnika što nam može omogućiti razumijevanje obrazaca antibiotske rezistencije.
Pri liječenju pijelonefritisa pacijente često treba zbog težine općeg stanja hospitalizirati i infekciju staviti pod kontrolu visokim dozama parenteralnih antibiotika. Inicijalni režim terapije je empirijski, a referentne smjernice za liječenje u Hrvatskoj su ISKRA smjernice.
Kako su infekcije urinarnog trakta vrlo česte infekcije, a akutni pijelonefritis ozbiljna i rekurirajuća infekcija, pretpostavka je da je to bolest koja znatno „opterećuje“ hrvatski zdravstveni sustav. Zbog toga je trošak akutnog nekompliciranog pijelonefritisa analiziran u ovom diplomskom radu metodom analize troška bolesti. Obrađeni su troškovi hospitalizacije, trošak izdvojen za lijekove i troškovi izvanbolničkog liječenja. Trošak hospitalizacije određen je prema dijagnostičko-terapijskoj skupini. Unutar tog troška je i trošak izdvojen za lijekove koji se koriste tijekom hospitalizacije, no cilj je bio fokusirati se na trošak liječenja lijekovima koji se koriste u bolničkoj i ambulantnoj terapiji pa je iz cijene DTS-a izdvojena cijena parenteralnih antibiotika. Analizirane su i dodatne dijagnoze vezane za akutni nekomplicirani pijelonefritis i obrađena statistika ishoda liječenja. Trošak izvanbolničkog liječenja izračunat je na temelju podataka o cijenama peroralnih antibiotika koji se prema smjernicama koriste u ovoj indikaciji.
Sve ove komponente pružaju cjelokupni pogled na ekonomski teret ove bolesti. U analizu su uključeni svi realni izravni troškovi. Analize troška bolesti pružaju mogućnosti opisa zdravstvenih troškova s ciljem predviđanja budućih troškova. S obzirom na sve navedeno, ovakva analiza trebala bi se provesti za većinu bolesti ne bi li se postavili prioriteti zdravstvene politike, pametno rasporedio novac uložen u zdravstvo i opisali izvori izdvajanja za različite bolesti.

Abstract (english)

Acute uncomplicated pyelonephritis is an acute infection of the kidneys and renal pelvis. It is one of the most common infection among otherwise healthy adults. Diagnostics of pyelonephritis is based on laboratory findings and clinical symptoms. It is very important to determine if pyelonephritis is the suspected infectious disease in order to make a correct conclusion about the burden of pyelonepritis to our health system. It is also important to detect the causative pathogen which can help us understand the pattern of antibiotic resistance.
Patients with pyelonephritis are often hospitalized because of their condition and the infection must be placed under control with high doses of parenteral antibiotics. The inicial therapy regime is empiric. Guidelines for pyelonephritis treatment in Croatia are ISKRA guidelines.
Since urinary tract infections are very common and acute pyelonephritis is serious and recurrent infection, the assumption is that acute pyelonephritis places a heavy burden on the health system. That was the reason to analyse the cost of illness for acute uncomplicated pyelonephritis. Hospitalization costs and expenses for medicines were taken into account. The cost of hospitalization was determined by diagnostic-therapeutic group. This cost also includes the cost allocated to medicines during hospitalization, however, since the aim was to focus on medicines used for in-hospital and outpatient therapy, the cost allocated for parenteral antibiotics was separated. Additional diagnosis from this diagnostic-therapeutic group were also analyzed as well as treatment outcome statistics. The cost of outpatient treatment was calculated based on the prices of oral antibiotics which are used in the therapy according to ISKRA guidelines.
All of the cost components provide an overall view on the economic burden of this disease. This analysis included any real direct costs. Cost of illness analysis provides the opportunity to describe health costs with the aim of prediciting future costs. In view of all the above, this type of analysis should be conducted for majority of diseases in order to set health politics priorities, arrange money wisely and describe sources of cost for different diseases.

• Keywords: pijelonefritis; akutni pijelonefritis; troškovi bolesti
• Keywords (english): pyelonephritis; acute pyelonephritis; cost of illness
• Language: croatian
• URN:NBN: urn:nbn:hr:163:889087
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2016-12-02 09:50:14