Pengaruh Asuhan Kefarmasian terhadap Biaya dan Outcomes Klinis Terapi Pasien Hipertensi Primer Rawat Jalan di Rumah Sakit Umum Daerah Cut Meutia Lhokseumawe

Abstract

Hypertension (HTN) remains as a global health problem and contributes to 62% of cerebrovascular cases,49% of ischemic heart disease, and 49% of heart failure. In Indonesia, the prevalence of HTN tends to increase, resulting in increased cost of therapy and a serious economic burden. This problem needs effors to improve the quality of services provided, one of which is in the form of pharmaceutical care counseling. The objective of this study was to determine the impact of counseling on the outcomes of HTN therapy including reduction in blood pressure and improvement of quality of life as well as the cost-effectiveness of therapy. This study was a quasi experimental non-equivalent control group used a prospective approach and evaluation of each month during the period from May to November 2016 in Cut Meutia Lhokseumawe general hospital. The study sample consisted of 22 patients in each group. Analysis of the cost was conducted from the perspective of Badan Penyelenggara Jaminan Sosial (BPJS). The total direct medical costs for each group was calculated by multiplying the number of resources their to unit costs. The quality of life measured in quality adjusted life years (QALY) was calculated using the SF-36 questionnaire as an instrument. The cost effectiveness was analyzed by calculating the cost effectiveness ratio (CER), incremental cost effectiveness ratio (ICER), cost utility ratio (CUR), and the incremental cost utility ratio (ICUR). The results of this study showed that most of the patients with HTN (54.55%) were male with ages ranging from 35 - 64 years old (77.27%). HTN treatment with counseling could lower systolic and diastolic blood pressure significantly (p = 0.000 and p = 0.000). There were significant differences in decreased in systolic and diastolic blood pressures between the counseling and non counseling groups (p = 0.000 and p = 0.001) and increased quality of life (p = 0.039). CER for groups: without counseling, Rp 6,704,248; counseling, Rp 1,756,118. ICER was Rp 233,145. CUR for-groups. without counseling, Rp 2,188,208; counseling, Rp 2,181,595 CUR. ICUR was Rp 2,124,923. It could be concluded that hypertension treatment with counseling was more cost effective than those without counseling.