MENSURAÇÃO DOS CUSTOS HOSPITALARES DO AVC ISQUÊMICO NO BRASIL POR GRUPOS RELACIONADOS AO DIAGNÓSTICO (DRG)

Abstract

Background Measuring hospital costs adjusted by clinical complexity is a global challenge. The Refined Brazilian DRG methodology (DRG Brasil Refinado) has the ability to dimension cost differences among patients hospitalized at different severity levels, providing a more accurate and transparent assessment of resource utilization. Ischemic stroke (IS), due to its high clinical and economic relevance, represents an ideal scenario to evaluate this capability.

Methods We conducted an observational, retrospective study including adult patients (≥18 years) hospitalized with ischemic stroke (ICD-10 I63, I66) discharged between 2019 and 2024. A total of 2,744 inpatient admissions were included in the analysis. We used the Refined Brazilian DRG methodology. Variables included demographics, comorbidities, length of stay, ICU use, and corrected direct hospital costs. Comparisons across severity levels used the Kruskal–Wallis test with Dunn’s post-hoc test with Bonferroni adjustment. Adjusted models employed GLM Gamma regression with log link, yielding cost ratios (CR) by severity.

Findings Of 2,744 patients, 41.8% were severity level 1, 36.9% severity level 2, 18.0% severity level 3, and 3.3% severity level 4. Median age was 70 years, with balanced sex distribution and a median of three comorbidities. Median hospitalization costs ranged from BRL 8,500 (severity level 1) to BRL 32,000 (severity level 4). Kruskal–Wallis indicated global differences (H=367.6; p<0.001). Dunn’s test confirmed that severity level 1 differed from all others, while severity level 2 and severity level 3 were not significantly different (p=0.30). The adjusted GLM model confirmed that only N4 remained robustly associated with higher costs (CR=2.17; 95% CI: 1.66–2.82; p<0.001), whereas N2 (CR=1.11; 95% CI: 0.94–1.31; p=0.24) and N3 (CR=1.06; 95% CI: 0.78–1.44; p=0.70) did not differ significantly from N1.

Interpretation Ischemic stroke imposes a substantial economic burden on the Brazilian healthcare system, primarily driven by clinical severity as stratified by the Refined DRG methodology. DRG-based cost analysis enhances transparency and comparability, supporting value-based payment models and efficiency-oriented policies.

Keywords: Hospital costs. Epidemiology. Diagnosis related groups. Health economics. Ischemic stroke.