Analisis Efektivitas Biaya Escitalopram dan Fluoksetin Dibandingkan dengan Sertralin untuk Gangguan Depresi Mayor di Salah Satu Klinik di Kota Bandung
Abstract
Gangguan depresi mayor menjadi kontributor utama beban penyakit global yang memengaruhi jutaan masyarakat dari segala usia di seluruh dunia. Di berbagai negara, escitalopram dinilai lebih efektif secara biaya dibandingkan dengan selective serotonin reuptake inhibitor (SSRI) lain yang menjadi terapi lini pertama. Di Indonesia, escitalopram tidak termasuk dalam Formularium Nasional (Fornas). Penelitian ini bertujuan untuk menganalisis efektivitas biaya dari escitalopram dan fluoksetin dibandingkan dengan sertralin, SSRI yang masuk ke dalam Fornas, dalam pengobatan gangguan depresi mayor di salah satu klinik di Kota Bandung. Pengumpulan data dilakukan secara retrospektif dari rekam medis pasien di salah satu klinik di Kota Bandung pada periode 2020–2021. Total biaya meliputi komponen biaya langsung berdasarkan healthcare perspective (klinik) yakni biaya jasa dokter, biaya administrasi, dan biaya obat. Efektivitas dihitung berdasarkan per penurunan 1 skor Hamilton Depression Rating Scale (HDRS). Hasil menunjukkan nilai Incremental Cost-effectiveness Ratio (ICER) antara sertralin dengan escitalopram dan sertralin dengan fluoksetin berturut-turut Rp772.076,00 dan (Rp467.326,00) per penurunan 1 skor HDRS. Hasil uji sensitivitas pada nilai ICER antara sertralin dengan escitalopram menunjukkan penurunan skor HDRS dan biaya antidepresan memiliki rentang yang paling panjang. Penurunan skor HDRS dan biaya jasa dokter memiliki rentang terpanjang pada nilai ICER antara sertralin dengan fluoksetin. Escitalopram memiliki efektivitas dan biaya yang lebih tinggi daripada sertralin, sedangkan sertralin lebih cost-saving dibanding fluoksetin. Efektivitas terapi antidepresan merupakan faktor yang memengaruhi dan memiliki peran penting dalam penentuan nilai ICER.
Kata kunci: Antidepresan, cost-effective analysis, escitalopram, fluoksetin, gangguan depresi mayor, sertralin
Cost-effectiveness Analysis of Escitalopram and Fluoxetine Compared with Sertraline for Major Depressive Disorder in One of Clinics in Bandung
Abstract
Major depressive disorder is a substantial contributor to the global burden of disease affecting millions of people of all ages around the world. In many countries, escitalopram is more cost-effective than other selective serotonin reuptake inhibitors (SSRIs) as first-line therapy. Escitalopram has never listed in the National Formulary (Fornas). This study aims to analyze the cost-effectiveness of escitalopram and fluoxetine compared to sertraline, SSRI included in Fornas for treating major depressive disorder at a clinic in Bandung. Data collection was conducted retrospectively from patients’ medical records from a clinic in Bandung City, Indonesia, in the 2020–2021 period. The total medical cost was reviewed from a healthcare perspective (doctor fees, administration fees, and drug costs), while its effectiveness was calculated based on decreased of Hamilton Depression Rating Scale (HDRS). The value of the Incremental Cost-effectiveness Ratio (ICER) between sertraline and escitalopram and between sertraline and fluoxetine, respectively, Rp772,076.00 dan (Rp467,326.00) per 1 decrease in the HDRS score. The sensitivity analysis of the ICER value between sertraline and escitalopram showed a reduction in the HDRS score and the cost of antidepressants had the longest range. The decrease in HDRS scores and doctor’s fees had the longest range in ICER scores between sertraline and fluoxetine. In summary, escitalopram has higher effectiveness and cost than sertraline, while sertraline is more cost-saving than fluoxetine. The effectiveness of antidepressant therapy was the most influential factor in determining the ICER value.
Keywords: Antidepressants, cost-effective analysis, escitalopram, fluoxetine, major depressive disorder, sertraline
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DOI: https://doi.org/10.15416/ijcp.2022.11.3.256
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