Analisis Cost Effectiveness dan Cost Utility Penggunaan Antiagregasi Trombosit pada Pasien Rawat Inap Stroke Iskemik di Rumah Sakit Universitas Sumatera Utara Medan

Abstract

Stroke is a condition in which poor blood flow to the brain with the highest incidence, disability and death in Indonesia each year and included into catastrophic diseases with the highest treatment cost. Antiplatelets aggregation therapy has an important role to prevent the recurrence of strokes; therefore can reduce the treatment costs. This study aimed to analyze the effectiveness of antiplatelets aggregation of aspirin and clopidogrel and determine the correlation between the activated Partial Thromboplastin Time (aPTT) and Prothrombine Time (PT) of the ischemic stroke patients with comorbid conditions with their quality of life (QOL) and calculated the average cost of therapy then compared with Indonesian Case Based Groups (INA-CBGs) admitted to Universitas Sumatera Utara (USU) Hospital Medan period February-August2019. This prospective cohort study extracted data including (patients characteristics, drugs used, accommodation costs, and therapeutic outcomes aPTT and PT) from the patients medical records. The patients characteristics were descriptively analyze using microsoft excel program. The costs consumed were calculated by multiply the number of units by the unit cost. Cost effectiveness was analyzed by calculating Cost Effectiveness Ratio (CER), Incremental Cost Effectiveness Ratio (ICER), Cost Utility Ratio (CUR,) and Incremental Cost Utility Ratio (ICUR). The QOLs of the patients were measured by using Euro Qol 5 dimension three level (EQ5D3L) questionnaire. The correlation between the outcomes achieved with their QOLs was analyze applying pearson correlation in the program ofSPSS. Characteristics of the patients: the mean age of the patients, 62 ± 2.3 years; male, 51.5%; high school education, 55%. There were 5 groups of the ischemic patients. The highest effectiveness (E) of the therapy based on aPTT was the patients with hypercholesterol provided with aspirin: CER, Rp 545,838; E, 4.3; ICER, Rp 67,147. The effectiveness based on PT of the same patient group: CER, Rp 4,694,208; E, 0.5; ICER, Rp -1,187,010. Correlation between aPTT and PT with the QOL of the patients: aPTT, 0.026, p, 0.884; PT, 0.007, p,0.970. Thus, these values were smaller than r table 0.344. The average cost of therapy was Rp 2,514,515 ± Rp 778,153. The aspirin therapy model was more cost effective than clopidogrel, there was no correlation between aPTT and PT with the QOL of the ischemic stroke patients. The average treatment costs was below the claims of INA-CBGs.

Stroke merupakan kondisi medis aliran darah ke otak terganggu dengan penyebab kecacatan serta kematian tertinggi di Indonesia setiap tahunnya dan termasuk ke dalam penyakit katastropik yang menyerap biaya perwatan tertinggi. Terapi antiagregasi trombosit berperan penting untuk mencegah stroke berulang sehingga dapat mengurangi biaya perawatan. Penelitian ini bertujuan untuk menganalisis efektivitas antiagregasi trombosit dari aspirin dan clopidogrel dan menentukan korelasi activated Partial Thromboplastin Time (aPTT) dan Prothrombine Time (PT) pada pasien stroke iskemik dengan kondisi komorbiditas dengan kualitas hidup (QOL) serta menghitung biaya rerata terapi pasien kemudian dibandingkan dengan klaim Indonesian Case Based Groups (INA-CBGs) di Rumah Sakit USU Medan periode Februari-Agustus 2019. Penelitian kohort prospektif ini diperlukan data (karakteristik pasien, penggunaan obat, biaya akomodasi dan outcome terapi yaitu aPTT dan PT) diakses dari rekam medis pasien. Karakteristik pasien dianalisis secara deskriptif menggunakan microsoft excel. Biaya yang digunakan dihitung dengan mengalikan jumlah unit dengan unit cost. Efektivitas biaya dianalisis dengan menghitung Cost Effectiveness Ratio (CER), Incremental Cost Effectiveness Ratio (ICER), Cost Utility Ratio (CUR) dan Incremental Cost Utility Ratio (ICUR). Kualitas hidup diukur dengan kuisioner Euro Qol 5 dimension three level (EQ5D3L). Korelasi antara outcomes terapi dengan kualitas hidup dianalisis menggunakan pearson correlation pada programSPSS. Karakteristik pasien: usia rerata pasien 62 ± 2, 3 tahun, laki-laki 51,5%, pendidikan SMA 55%. Terdapat 5 kelompok pasien stroke iskemik. Efektivitas (E) terapi tertinggi berdasarkan aPTT yaitu pada kelompok diagnosis hyperkolesterol penggunaan terapi aspirin diperoleh CER, Rp 545.838; E, 4,3; ICER, Rp 67.147 dan efektivias berdasarkan PT dari kelompok pasien yang sama diperoleh CER, Rp 4.694.208; E, 0,5; ICER Rp -1.187.010. Korelasi antara aPTT dan PT dengan kualitas hidup pasien: aPTT, 0,026, p, 0,884; PT, 0,007, p, 0,970 nilai tersebut lebih kecil dari r tabel 0,344. Biaya rerata terapi sebesar Rp 2.514.515 ± Rp 778.153. Model terapi aspirin lebih cost effective dari clopidogrel, tidak terdapat korelasi aPTT dan PT dengan kualitas hidup pasien stroke iskemik dan biaya rerata terapi di bawah klaimINA-CBGs.