Analisis Efektivitas Biaya Terapi Kombinasi Amlodipin-Kandesartan dan Amlodipin-Ramipril pada Pasien Hipertensi dengan Komplikasi Diabetes Melitus Tipe 2 Rawat Jalan di RSUPN Dr. Cipto Mangunkusumo
Abstract
Hipertensi dan diabetes melitus (DM) menjadi salah satu faktor risiko kejadian kardiovaskuler. Tidak terkontrolnya hipertensi dapat menyebabkan perburukan kesehatan dan ekonomi pada penderitanya. Kombinasi terapi antihipertensi dinilai adekuat untuk mencapai target tekanan darah <140/90 mmHg pada pasien dengan DM. Obat antihipertensi golongan Angiotensin Converting Enzyme Inhibitor (ACEI), Angiotensin Receptor Blocker (ARB), dan Calcium Channel Blocker (CCB) merupakan terapi yang sesuai untuk pasien dengan DM tipe 2 dan harganya yang bervariasi memengaruhi besar biaya yang dikeluarkan sehingga menjadi pertimbangan dalam pemilihan pengobatan di rumah sakit. Penelitian sebelumnya menunjukkan bahwa ARB lebih cost-effective dibandingkan antihipertensi golongan lainnya. Tujuan penelitian ini adalah untuk menganalisis efektivitas biaya dari kombinasi terapi amlodipin-kandesartan dibandingkan amlodipin-ramipril pada pasien hipertensi dengan DM tipe 2. Penelitian cross-sectional ini dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan menggunakan rekam medis pasien tahun 2017–2019 dan metode studi farmakoekonomi yang digunakan adalah analisis efektifitas biaya. Subjek penelitian yang memenuhi kriteria inklusi sebanyak 87 pasien. Pasien dibagi menjadi dua kelompok: kelompok yang mendapat terapi amlodipin-kandesartan dan kelompok yang mendapat terapi amlodipin-ramipril. Analisis efektivitas biaya diperoleh dari perhitungan biaya medik langsung, menentukan efektivitas terapi berdasarkan jumlah pasien yang mencapai target tekanan darah <140/90 mmHg, serta menghitung nilai Average Cost-Effectiveness Ratio (ACER). Kombinasi amlodipin-kandesartan memiliki efektivitas terapi 48,9%, sedangkan efektivitas terapi amlodipin-ramipril 45,2%. Nilai ACER kelompok amlodipin-kandesartan dan kelompok amlodipin-ramipril adalah Rp1.604.736,2 per efektivitas dan Rp1.811.278,8 per efektivitas. Dapat disimpulkan bahwa amlodipin-kandesartan lebih cost-effective dibandingkan amlodipin-ramipril.
Kata kunci: Amlodipin-kandesartan, amlodipin-ramipril, diabetes melitus, efektivitas biaya, hipertensi
Cost-effectiveness Analysis of Amlodipine-Candesartan and Amlodipine-Ramipril Combination Therapy in Hypertensive Outpatient with Type 2 Diabetes Mellitus at Dr. Cipto Mangunkusumo Hospital
Abstract
Hypertension and diabetes mellitus (DM) are risk factors for cardiovascular events, and poor management has been implicated in patient health and economic deterioration. The use of combined antihypertensive therapy is considered adequate to achieve <140/90 mmHg as the targeted blood pressure. These include Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blockers (ARBs), and Calcium Channel Blockers (CCBs), estimated to be appropriate for patients with type 2 DM. In addition, the price variation influences the costs incurred, which is further considered during therapy selection in hospital. Previous studies have identified ARBs as the more cost-effective compared to others. The aim of this study was to analyze the cost-effectiveness of amlodipine-candesartan combination therapy, compared to amlodipine-ramipril during the hypertensive treatment of patients with type 2 DM. This cross-sectional study was conducted at Dr. Cipto Mangunkusumo Hospital by evaluating patient’s medical records between 2017–2019, while pharmacoeconomic study methods was adopted for cost-effectiveness analysis. A total of 87 research subjects were estimated to have met the inclusion criteria. These patients were divided into two groups, including those receiving amlodipine-candesartan and amlodipine-ramipril. The cost-effectiveness analysis obtained from the calculation of direct medical costs, determined the therapy efficacy based on the number of patients assumed to reach the target blood pressure of <140/90 mmHg, and the Average Cost-Effectiveness Ratio (ACER) value was calculated. The result showed a therapeutic effectiveness of 48.9% and 45.2%, respectively, with corresponding ACER value of 1,604,736.2 IDR and 1,811,278.8 IDR. The amlodipine-candesartan combination was, therefore, concluded to be more cost-effective in contrast with amlodipine-ramipril.
Keywords: Amlodipine-candesartan, amlodipine-ramipril, cost-effectiveness, diabetes mellitus, hypertension
Keywords
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DOI: https://doi.org/10.15416/ijcp.2020.9.4.271
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