Cost Effectiveness Analysis Glikuidon dibandingkan Insulin pada Pengobatan Pasien Diabetes Melitus dengan Penyakit Ginjal Kronik

AMANDA ANGGRAINI, Prof. Dr. apt. Tri Murti Andayani, Sp.FRS; Prof. Dr. apt. Zullies Ikawati

2022 | Tesis | MAGISTER FARMASI KLINIK

Di Indonesia, glikuidon merupakan pilihan terapi diabetes pasien PGK yang paling sering digunakan karena tidak diekskresikan melalui ginjal, namun melalui sistem bilier sehingga tidak memerlukan penyesuaian dosis. Disisi lain, insulin merupakan terapi utama diabetes pasien PGK karena aman dan dapat ditoleransi dengan baik. Penelitian ini bertujuan untuk menganalisis cost effectiveness terapi diabetes melitus pada PGK yaitu glikuidon dibanding insulin dalam mengontrol kadar glukosa darah dan insidensi efek samping hipoglikemik. Penelitian farmakoekonomi berbasi studi observasional dengan rancangan kohort retrospektif ini dilakukan di RSUD Depati Hamzah Pangkalpinang. Efektivitas terapi diukur dari penurunan kadar glukosa darah dan insidensi efek samping hipoglikemik, sedangkan biaya dihitung dari eprspektif rumah sakit berdasarkan nilai baiya medik langsung meliputi biaya administrasi, biaya konsultasi dokter, biaya pemeriksaan laboratorium, biaya terapi obat dan biaya lata kesehatan. selanjutnya efektivitas biaya dihitung berdasarkan nilai ACER dan ICER. Peneltian melibatkan 70 pasien dengan 34 pasien glikuidon dan 36 pasien insulin. Rata-rata GDS setelah penggunaan glikuidon 142,76+-21,79 dan kelompok insulin 143,92+-21,95 (p=0,826). Rata-rata GDP setelah penggunaan glikuidon 102,23+-13,70 dan kelompok insulin 101,00+5,68 (p=0,667) dan tidak ditemukan insidensi hipoglikemik selama penelitian. Biaya rata-rata terapi glikuidon Rp. 3.301.906,77 dan insulin Rp. 3.761.677,67. nilai ACER insulin sebesar RP. 108.499,50 dan ACER glikuidon sebesar 112.386,21. Nilai ICER insulin dibandingkan gikuidon dalam menurunkan kadar glukosa darah sebesar Rp. 89.913,21. Diperlukan besaran tambahan biaya Rp. 89.913,21 untuk setiap unit penurunan kadar glukosa. Hasil penelitian menunjukkan glikuidon dapat digunakan sebagai pilihan terapi yang lebih murah dan efektif pada DM tipe 2 pasien PGK.

In Indonesia, gliquidone is the most commonly used treatment option for diabetes in CKD patients because it is not excreted through the kidneys, but through the biliary system, so it does not require dose adjustment. Insulin is the main therapy for diabetic patients with CKD because is it safe and well tolerated. The aim of this study was to conduct a cost effectiveness analysis of gliquidone and insulin in patients with diabetic with chronic kidney disease (CKD). This pharmacoeconomic research based on an observational study with retrospective cohort design at RSUD Depati Hamzah Pangkalpinang. The effectiveness was measured based on blood glucose and incidence of hypoglycemia while using therapy and the calculated costs were direct medical costs including administrative costs, doctor consultation fees, laboratory examination fees, drug therapy costs and medical devise costs derived from patients financial recapitulation during treatment. The cost effectiveness is calculated based on ACER (average cost effectiveness ratio) and ICER (incremental cost effectiveness ratio). This study consist of 70 patients where 34 was received gliquidone and 36 was received insulin. The mean f random blood glucose after gliquidone therapy was 142,76+-21,79 and insulin group was 143,92+-21,95 (p=0,826). The mean of fasting blood glucose after gliquidone therapy was 102,23+-13,70 and insulin group was 101,00+-5,68 (p=0,667). The mean of costs after therapy gliquidone Rp. 3.301.906,77 and insulin Rp.3.761.677,67 with ACER insulin Rp. 108.499,50 and gliquidone Rp. 112.386,21. ICER of insulin compared gliquidone RP. 89.913,21. an additional fee for each unit of decrease in glucose levels was Rp. 89.913,21. The results showed that gliquidone could be used as a cheaper and effective treatment options in DM type 2 in CKD patients.

Kata Kunci : cost effectiveness, chronic kidney disease, diabetes, gliquidone, insulin