Regional variation and factors associated with average expenditure per headache disorder hospitalization in Brazil: a macrocosting analysis in the SUS (2008-2023).

OBJECTIVE

To quantify the total expenditure on hospitalizations due to headache disorders within the Brazilian Unified Health System (SUS) and to identify the sociodemographic, clinical, and regional factors associated with the average expenditure per hospitalization.

METHODS

This observational study used SIH-SUS data from 2008 to 2023. Expenditures were inflation-adjusted and categorized by sex, age, and ICD-10 diagnosis. Given the extreme positive asymmetry of the expenditure data, a Generalized Linear Model with a Gamma family and log link function was used to identify adjusted expenditure multipliers.

RESULTS

Total expenditure reached BRL 77,643,809.55. The highest volume was concentrated among females (65.7%) and the 19-59 age group (66.1%). The Generalized Linear Model revealed that patients aged 60 years or older had a 21% higher expenditure multiplier (multiplier = 1.21) per event. The South Region showed a structurally 73.7% higher expenditure multiplier (Multiplier = 1.737) per event, even after adjustment for complexity. Vascular headache not elsewhere classified (247.2% higher) and status migrainosus (124.8% higher) were the costliest diagnoses. Crude rate analysis showed the South Region with the highest utilization rate (108.0 hospitalizations per 100,000 inhabitants).

CONCLUSION

The high adjusted expenditure multipliers in the South/Southeast and the long median stays in the North/Northeast point to structural inequalities in the cost and timeliness of care provision. Public policies must reinforce specialized outpatient management to reduce high-cost hospitalizations and promote equitable resource allocation.