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    O impacto econômico da dependência química no contexto brasileiro: custos diretos e indiretos de usuários moderados e graves de drogas
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-12) Becker, Paula [UNIFESP]; Razzouk, Denise [UNIFESP]; http://lattes.cnpq.br/2570757108117687; http://lattes.cnpq.br/2526225947636656; Universidade Federal de São Paulo (UNIFESP)
    The economic impact of substance-related disorders can be measured by the higher consumption of health services, lower productivity and spending on the purchase of drugs. In Brazil, there has been an increase in the prevalence of early onset of drug use. There is a lack of economic studies on the societal impact of the early onset of drug use in Brazil. Objectives: To evaluate the direct, indirect and total costs of people with moderate and severe drug use under society perspective and to verify what are their relationships with early and late onset of drug use and others psychosocial aspects such as quality of life, social participation, self-perception of family support and generalized anxiety, in the context of a Psychosocial Care Center for Alcohol and Drugs users (CAPS-ad). In addition, it was aimed to estimate the CAPS-ad total costs for the public health provider. Methods: It was a retrospective cross-sectional cost analysis from the societal perspective. The main hypothesis of the study was that the early onset of drug use contributes to a higher total cost of substance-related disorders in adulthood. It was interviewed 105 subjects with moderate and severe scores for at least one drug according to ASSIST. These subjects constituted a sample of the CAPS-ad users population. The groups were compared through the age of drug use onset: early exposure (younger than 15 years) and late exposure (15 years old or more). Direct and indirect costs were estimated with the application of the Client Socio demographic and Service Receipt Inventory- CSSRI. Direct costs were those related to health services use, medication and transportation to treatment. Indirect costs were those related to unemployment, absenteeism and amount spent in drugs purchase. Social participation, self-perception of family support, quality of life, sociodemographic profile and screening for generalized anxiety variables were analyzed to verify its possible interference on costs. Data analysis: For the descriptive analysis of the association between two categorical variables it was applied the Qui-square or the Fisher’s Exact tests, Student’s t-test was applied to compare treatment costs means with normal distribution and Mann-Whitney non-parametric teste for the other variables. After the descriptive analysis, an inferential analysis was conducted in which the effects of the predictor variables on the dependent variables, Direct Cost, Indirect Cost and Total Cost were studied through Generalized Linear Models. Results: Regarding CAPS-ad total costs for the public health system, the service’s mean monthly cost in 2015 was BRL 64,017.54, and federal government funded 62.1% of this cost, while municipal management absorbed the remaining 37.9%. The early exposure to drugs did not act as a predictive variable of the total costs of subjects with moderate or severe drug use in adulthood. The direct and indirect costs of moderate and severe drugs users did not showed variation according to early or late exposure to drugs. The monthly direct, indirect and total mean costs of subjects in the year 2015 were, ____________________________________________________________________________ - 10 - respectively, BRL 863.80, BRL 1,718.72 and BRL 2,349.61. Indirect costs represented 73.1% of substance-related disorders total costs. For each year later in which the onset of drugs use happens it was observed a 1.5% increase on direct costs of those users in adulthood. Marijuana, cocaine or crack dependents who were also alcohol abusers had a mean direct cost 2 times higher than alcohol addicts and 4.4 times higher than addicts that did not use alcohol. Subjects with early exposure to drugs developed greater severity of marijuana use in adulthood. The more severe the use of cocaine/crack, the greater the user's indirect costs to society. The indirect cost to society of each additional point in the final ASSIST-Cocaine score was R$18.90 in 2015. Cocaine/crack abuser’s total costs to society were 53% higher than subjects that did not use cocaine/crack. The younger the user, the higher the indirect costs. Users with generalized anxiety disorders symptoms presented higher indirect costs than those without the symptoms. Conclusions: Regarding the CAPS-ad II total costs, the results may support a better planning and management of both federal and municipal governments and point to the need for governmental agencies and the national academic community to focus mental health policies not only on expanding treatment coverage but on the best allocation of resources in terms of costs and outcomes. Adolescents aged 10 to 15 years may be the target population of public policies to prevent drugs dependence and other mental disorders in the country, especially regarding marijuana use. Public policies and action programs focused on the population orientation regarding the risks of problematic use of alcohol, marijuana and crack/cocaine, that acts in early diagnosis of anxiety disorders, and that help in the development of networks to support the treatment for drugs users can reduce the economic impact of mental and behavioral disorders related to drug use in Brazil.