Kasus pandemi COVID-19 adalah krisis yang berdampak pada aspek kesehatan, ekonomi, dan menjadi beban masyarakat global. Terapi antiviral yang efektif dan spesifik untuk COVID-19 masih kontroversi dan belum ditemukan, penggunaannya menjadi strategi mitigasi utama namun dapat bervariasi dalam efektivitas dan biaya tergantung pada berbagai faktor. Penelitian ini bertujuan untuk menganalisis perbandingan efektivitas, adverse drug events dan efektivitas biaya terapi antiviral dalam mengobati COVID-19.
Penelitian observasional analitik ini menggunakan rancangan kohort retrospektif. Analisis efektivitas biaya dilakukan berdasarkan perspektif rumah sakit dengan menghitung biaya medik langsung (biaya obat, alat kesehatan, jasa profesional, kamar, pemeriksaan laboratorium dan diagnosis, dan lain-lain). Penelitian dilakukan di RS Akademik UGM. Data diambil dari sistem informasi manajemen rumah sakit dan rekam medik elektronik periode Juli–Oktober 2021 dan Januari–Maret 2022. Subjek penelitian adalah pasien COVID-19 rawat inap derajat sedang. Efektivitas antiviral diukur dari penurunan Neutrophil-to-Lymphocyte Ratio (NLR) mencapai nilai normal dan status discharge, serta adverse drug events yang diamati. Efektivitas biaya dihitung berdasarkan nilai Average Cost-Effectiveness Ratio (ACER) dan Incremental Cost-Effectiveness Ratio (ICER).
Sebanyak 170 pasien terbagi menjadi dua kelompok, yaitu 94 pasien remdesivir dan 76 pasien favipiravir. Pada efektivitas diperoleh total 45 pasien dengan penurunan NLR (21 pasien mencapai target dan 24 pasien tidak mencapai target). Efektivitas favipiravir lebih tinggi dibanding remdesivir (70,6% vs 32,1%). Tidak terdapat perbedaan bermakna (p= 0,308) pada rata-rata penurunan nilai NLR. Remdesivir menunjukkan rata-rata penurunan (2,92) dan favipiravir (1,55). Lama rawat inap favipiravir lebih singkat dibandingkan remdesivir (8 vs 9 hari). Adverse drug events yang diamati pada remdesivir yaitu mual dan nyeri perut, sedangkan favipiravir teramati mual dan muntah. Rata-rata total biaya perawatan remdesivir (Rp 18.256.036) lebih tinggi dibandingkan favipiravir (Rp 12.103.765). Nilai ACER favipiravir (Rp 17.144.143) lebih rendah dari remdesivir (Rp 56.872.386). Favipiravir lebih cost-saving dibandingkan remdesivir dalam menurunkan NLR.
COVID-19 pandemic cases affect health, economic, and burdens the global community. Effective and specific antiviral therapy for COVID-19 is still controversial and has yet to be found. Antivirals use is the main mitigation strategy that tends to be more cost-effective but varies in effectiveness and cost depending on various factors. This study aims to analyse the comparative of effectiveness, adverse drug events, and cost-effectiveness of antiviral therapy in treating COVID-19.
This observational-analytic study used a retrospective cohort design. Cost-effectiveness analysis was conducted based on the hospital's perspective by calculating direct medical costs (cost of drugs, medical devices, professional service, rooms, laboratory and diagnosis, and others). Study was conducted at UGM Academic Hospital. Data were collected from hospital management information system and electronic medical records in July-October 2021 and January-March 2022. Subjects were hospitalized patients with moderate COVID-19. Effectiveness was measured by lowered NLR (Neutrophil-to-Lymphocyte Ratio) to normal value, discharge status and adverse drug events. Cost-effectiveness was calculated based on Average Cost-Effectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER).
A total of 170 patients were divided into two groups (94 remdesivir and 76 favipiravir). In this arm, there were 45 patients with lowered NLR (21 patients reached the target and 24 patients did not reach). Effectiveness of favipiravir is higher than remdesivir (70.6% vs 32.1%). No significant difference (p= 0.308) in the mean of lowering NLR value. Remdesivir showed a mean lowering NLR (2.92) and favipiravir (1.55). Favipiravir had a shorter length of stay than remdesivir (8 vs 9 days). Adverse drug events in remdesivir were nausea and abdominal pain, while in favipiravir nausea and vomiting. The average total cost of remdesivir (IDR 18,256,036) is higher than favipiravir (IDR 12,103,765). Favipiravir ACER value (IDR 17,144,143) is lower than remdesivir (IDR 56,872,386). Favipiravir was cost-saving than remdesivir in lowered NLR.
Kata Kunci : antiviral, biaya, cost-effectiveness, COVID-19, farmakoekonomi
