Analisis Efektivitas Biaya Penggunaan Eritropoietin Pasien Rawat Jalan Penyakit Ginjal Kronis Stadium 5 di Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Penyakit Ginjal Kronis (PGK) menjadi masalah kesehatan global karena morbiditas, mortalitas, dan biaya perawatan yang tinggi. Tujuan dari penelitian ini adalah untuk menentukan jenis terapi eritropoietin (EPO) yang lebih cost effective digunakan pada pasien PGK stadium 5, sehingga perlu dilakukan analisis efektivitas biaya (CEA) dan utilitas biaya (CUA) penggunaan EPO berdasarkan nilai hemoglobin (Hb) dan skor kualitas hidup (QoL) pasien PGK stadium 5. Penelitian kohort ini dilakukan secara propektif dan retrospektif periode Agustus - Oktober 2017 terdiagnosis PGK stadium 5 dengan komorbiditas penyakit yang dirawat di Rumah Sakit Haji Adam Malik Medan. Kualitas hidup pasien PGK stadium 5 dianalisis menggunakan instrumen SF-36 dengan skor dikategorikan sebagai berikut: sangat baik, ≥ 80; bagus, 75 - <80; sedang, 60 - <75; buruk, <60. Data yang diperoleh dianalisis menggunakan uji statistik Microsoft-office Exel dan Chi-square. Hasil penelitian ini menunjukkan karakteristik pasien laki-laki (n = 52; 59%), p = 0,562. Usia rata-rata pasien (n = 88) adalah 48,74 ± 14,08 tahun. Hasil statistik menunjukkan tidak ada hubungan antara peningkatan kadar Hb dengan Qol, p = 0,916. Nilai Hb pasien diperoleh 9,28 ± 1,25 (g/dl). Kualitas hidup pasien adalah 47,01 ± 18,41 persen. Kualitas hidup pasien masih relatif buruk (n = 63; 71,7%). Nilai ICER dari kelompok diagnosis hypertension nephropathy dan diabetic nephrophaty menggunakan terapi hemapo tunggal diperoleh minus (- Rp 18.420) dengan total biaya medis langsung per pasien (Rp 17.182.170 ; efektivitas = 50%). Terapi hemapo tunggal memberikan hasil yang lebih cost effective dibandingkan pemberian terapi eprex dan recormon atau kombinasinya dengan hemapo.

Chronic kidney disease (CKD) remaind as a global health problem due to its high morbidity, mortality and costs treatment. The aim of this study was to determine the type of erythropoetin therapy which is more cost-effective in used with CKD patients stage 5, so necessary to perform cost effectiveness analysis (CEA) and cost utility (CUA) should be used EPO based on hemoglobin (Hb) value and score of Quality of Life (QoL) with CKD patients stage 5. This study was cohort with a prospective and retrospective approach form August to October 2017 which was diagnosed with CKD stage 5 a diagnosis of comorbidities who were treated at Haji Adam Malik Hospital Medan. The QoL of stage 5 CKD was analyzed using SF-36 instruments with scores categorized as follows: very good, ≥ 80; good, 75 - < 80; medium, 60 - < 75; bad, < 60. Data obtained were analyzed used Microsoft Excel and Chi Square statistical tests. The results of this study showed that generally the characteristics of patients were male (n = 52; 59%), p = 0.562. The average age of patients (n = 88) was 48.74 ± 14.08 years. Statistical results showed no correlation between increasing Hb levels with QoL, p = 0.916. The patient's Hb value was obtained 9.28 ± 1.25 (g/dl). The QoL of patients was 47.01 ± 18.41 percent. The QoL of patients is still relatively poor (n = 63; 71.7%). The ICER value on the diagnosis group complication nephropathy hypertension and diabetic nephropathy with single hemapo therapy obtained minus (- Rp 18,420) with the total direct medical costs per patient (Rp 17,182,170; effectiveness = 50%). The single hemapo therapy gives results that more cost effective than other EPO therapy with CKD patients stage 5 (eprex and recormon or combination with hemapo).