Cost of illness infertilitas di Indonesia

FITRI DAMAYANTI, Prof. dr. Mohammad Hakimi, Sp. O.G. (K.), Ph.D.; Prof.dr. Mochamad Anwar, Sp. O.G. (K.), M. Med. Sc.; Dr. Diah Ayu Puspandari, Apt., M. Kes.

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang: Infertilitas merupakan isu global dalam kesehatan reproduksi yang dialami oleh 22,3% pasangan dan merupakan suatu bagian yang harus menjadi perhatian. Kurangnya informasi mengenai akses pelayanan dan kesiapan finansial menjadi salah satu hambatan pasangan infertil, sehingga tidak mendapatkan penanganan sejak dini. Tujuan penelitan: Memberikan gambaran tentang alokasi anggaran atau biaya yang dibutuhkan untuk terhindar dari satu kasus infertilitas (avoidable cost) dari perspektif sosial dengan mengestimasi biaya langsung medis, biaya langsung non medis, biaya tidak langsung, dan biaya nirwujud. Metode: Jenis penelitian dengan desain mixed method eksplanatori. Data biaya langsung dan biaya tidak langsung diperoleh dari partisipan wanita yang sudah menjalani IVF di klinik infertilitas di Indonesia. Data diambil secara retrospektif dengan panduan wawancara mendalam dan cost diary. Biaya nirwujud (intangible cost) dengan kuesioner FertiQoL online dan survei kemauan untuk membayar (willingness to pay) pada wanita dari masyarakat umum terbagi dalam tiga kategori. Analisis univariat untuk distribusi frekuensi dan data numerik. Analisis bivariat untuk melihat perbandingan antar kelompok dan analisis multivariat untuk mengeksplorasi pengaruh variabel terhadap pertambahan/ pengurangan biaya satu siklus IVF/ICSI. Hasil: Sebanyak 17 wanita berpengalaman IVF dilakukan wawancara mendalam, 214 partisipan pengisian kuesioner FertiQoL online adalah orang dengan infertilitas yang berada di Indonesia. Sebanyak 131 wanita masyarakat umum mengikuti survei kemauan membayar program IVF/ICSI. Besaran biaya yang dikorbankan untuk satu siklus IVF berdasarkan kelompok umur kurang dari 35 tahun dengan rata-rata biaya total Rp99,139,468 dalam rentang IQR Q1-Q3 (Rp91,873,368 - Rp112,170,004), usia 35-39 tahun sebesar Rp112,547,433 (Rp69,365,432 - Rp141,977,841), usia 40 tahun atau lebih Rp109,943,598 (Rp96,136,722 - Rp 124,888,498). Berdasarkan faktor infertilitas kelompok gangguan kesuburan wanita sebesar Rp94,877,925 (Rp71,061,871 - Rp104,467,019) gangguan kesuburan pria sebesar Rp 110,292,261 (Rp101,013,180 - Rp119,571,341), gangguan kesuburan pria dan wanita mengeluarkan biaya sebesar Rp114,732,351 (Rp92,291,173 - Rp122,693,256). Berdasarkan jenis metode yang digunakan, ada dua yaitu siklus semi natural sebesar Rp53,673,111, injeksi hormon mengeluarkan biaya rata-rata lebih banyak, yaitu Rp110,548,132 (Rp88,433,833 - Rp122,911,906). Berdasarkan pemilihan fasilitas kesehatan terbagi menjadi negeri Rp102,319,691 (Rp80,292,952 - Rp116,434,102) dan swasta Rp143,823,928 (Rp133,695,893 -Rp153,951,964). Total cost of illness jika diestimasi berdasarkan hasil skor FertiQoL pada kelompok wanita IVF menggunakan regresi linier mengeluarkan biaya sebesar Rp123,610,690. Rata-rata skor FertiQoL adalah 64.14. Sebanyak 32.2% orang dengan infertilitas mengalami gangguan kejiwaan, yaitu depresi 16.36% dan ansietas 16.36%. Estimasi pengeluaran berdasarkan hasil kemauan membayar pada kelompok wanita IVF adalah Rp114,600.000. Kesimpulan: Infertilitas merupakan masalah kesehatan reproduksi yang membawa implikasi psikososial yang negatif, double burden of disease karena pembiayaan yang tinggi dan menyebabkan pengeluaran katastropik dan beban psikologis.

Background: Infertility constitutes a global issue in reproduction health suffered by 22.3% of couples and becomes a concern. Lack of information regarding service access and financial readiness becomes one of the problems dealt with by infertile couples; therefore, there is no early treatment. Research Objective: Providing a description of budget allocation or cost required to prevent infertility cases (avoidable cost) socially perceived by estimating the direct medical cost, direct non-medical cost, indirect cost, and intangible cost. Method: This study used a mixed-method explanatory design. Direct cost and indirect cost were collected from women participants already getting IVF treatment in infertility clinics in Indonesia. Data retrieval was in the retrospective manner with a guideline of in-depth interview and cost diary. Intangible cost with online FertiQol questionnaire and survey on willingness to pay for women from the public will classify into three categories. The univariate analysis for frequency distribution and numerical data. Bivariate analysis to compare groups and multivariate analysis to explore the variable effect on cost increase/decrease of one IVF/ICSI cycle. Results: 17 women having IVF treatment were in-depth interviewed, 214 participants of the online FertiQol questionnaire were infertile people residing in Indonesia. One hundred thirty-one women of public participated in a survey on willingness to pay IVF/ICSI program. Cost required for one IVF cycle in group under 35 years old was IDR99,139,468 in total average within range IQR Q1-Q3 (IDR91,873,368 - IDR112,170,004), IDR112,547,433 (IDR69,365,432 - IDR141,977,841) in 35-39 years old group, IDR109,943,598 (IDR96,136,722 - IDR124,888,498) in 40 years old or above. According to infertility factor of a group of women having fertility disorder in the amount of IDR94,877,925 (IDR71,061,871 - IDR104,467,019), a group of male having fertility problem in the amount of IDR110,292,261 (IDR101,013,180 - IDR119,571,341), men and women fertility problems shall incur IDR114,732,351 (IDR92,291,173 - IDR122,693,256). Based on the type of method used, there were two, including the semi-natural cycle of IDR53,673,111, hormone injection, which requires more average cost in IDR110,548,132 (IDR88,433,833 - IDR122,911,906). In accordance with the selection of medical facility, it was classified into public IDR102,319,691 (IDR80,292,952 - IDR116,434,102) and private IDR143,823,928 (IDR133,695,893 - IDR153,951,964). Total cost illness, as estimated based on FertiQol scores for IVF women groups using linear regression, required IDR123,610,690. The average of FertiQol score was 64.14. 32.2% of people with infertility came with mental disorders, namely depression of 16.36% and anxiety of 16.36%. Estimated expenditure following the willingness to pay for IVF women groups was in the amount of IDR114,600,000. Conclusion: Infertility is a reproduction health problem promoting a negative psychosocial implication, the double burden of disease resulting from prohibitive cost resulting in catastrophic expenditure and psychological burden.

Kata Kunci : cost of illness, infertility, mixed method, cost diary, FertiQoL online, WTP