Cost Effectiveness Analysis Analgesia Epidural Dibandingkan Opioid Intravena sebagai Analgetik Pasca Operasi Abdominal Mayor di RSUP Dr. Sardjito

Krisna Hario Adiyatma, dr. Mahmud, M.Sc, SpAn-TI, Subsps. M.N.(K) .; Dr. dr. Sudadi, SpAn-TI, Subsps. NA (K), Subsp. AR (K).; Dr. Dyah Ayu Puspandari Apt, M.Kes, MBA

2023 | Tesis-Spesialis | S2 Anestesiologi

Latar Belakang : Salah satu komplikasi paska operasi yang sering terjadi yaitu nyeri, yang dialami oleh lebih dari 80% pasien dan 75% diantaranya mengalami nyeri paska operasi dengan intensitas moderat hingga berat. Operasi abdominal mayor merupakan salah satu prosedur operasi dengan intensitas nyeri paska operasi moderat hingga berat. Strategi pendekatan analgetik yang sering digunakan adalah opioid intravena dan epidural analgesia. Epidural analgesia dianggap sebagai terapi analgetik pilihan untuk paska operasi abdominal mayor, namun dengan biaya yang lebih tinggi bila dibandingkan dengan opioid intravena. Adanya perbedaan rute pemberian, efikasi dan profil efek samping menjadikan penilaian efektivitas biaya antara kedua pendekatan penting untuk dilakukan sebagai bagian manajemen kendali mutu dan biaya Rumah Sakit. Tujuan : Mengetahui cost effectiveness analgesia epidural dibandingkan dengan opioid intravena sebagai anti nyeri paska operasi abdominal mayor. Metode : Penelitian ini menggunakan desain deskriptif analitik dengan decision tree analysis untuk menilai outcome klinis dan estimasi biaya pada dua alternatif terapi. Sampel penelitian diambil secara retrospektif dari bulan September – Desember 2022 di RSUP Dr. Sardjito Yogyakarta, secara simple random sampling. Nilai Incremental Cost Effectiveness Ratio (ICER) dinilai dan Probabilistic Sensitivity Analysis (PSA) dilakukan dengan simulasi Monte Carlo menggunakan Microsoft Excel®. Hasil : Analgesia epidural sebagai anti nyeri paska operasi abdominal mayor memiliki nilai Incremental Cost Effectiveness Ratio (ICER) sebesar Rp 20.857.416/pain free days. Probabilistic Sensitivity Analysis (PSA) menghasilkan sebaran data dengan dominasi di kuadran 3 CEA Plane. Kesimpulan : Strategi epidural analgesia sebagai antinyeri paska operasi abdominal mayor merupakan strategi yang lebih murah namun dengan efektivitas yang sedikit lebih rendah dibandingkan opioid intravena di RSUP Dr. Sardjito. Epidural analgesia memiliki nilai ICER sebesar Rp 20.857.416/pain free days, berpeluang menjadi alternatif pilihan antinyeri paska operasi abdominal mayor yang bersifat cost effective.

Background : One of the most common postoperative complications is pain, which is experienced by more than 80% of patients and 75% of them experience postoperative pain with moderate to severe intensity. Major abdominal surgery is a surgical procedure with moderate to severe postoperative pain intensity. The most frequently used analgetic approaches are intravenous opioids and epidural analgesia. Epidural analgesia is considered the analgesic therapy of choice after major abdominal surgery, but at a higher cost than intravenous opioids. The existence of differences in the route of administration, efficacy and side effect profile makes it important to evaluate the cost-effectiveness of the two approaches as part of quality and cost control of the Hospital. Objectives : To Study the cost effectiveness of epidural analgesia compared to intravenous opioids as an anti-pain after major abdominal surgery. Methods : This study used a descriptive analytical design with decision tree analysis to assess clinical outcomes and estimated costs for two alternative therapies. Research samples were taken retrospectively from September – December 2022 at RSUP Dr. Sardjito Yogyakarta, using simple random sampling. The Incremental Cost Effectiveness Ratio (ICER) value was assessed and Probabilistic Sensitivity Analysis (PSA) was carried out using Monte Carlo simulation using Microsoft Excel®. Results : Epidural analgesia as analgetic after major abdominal surgery has an Incremental Cost Effectiveness Ratio (ICER) value of IDR 20,857,416/pain free days. Probabilistic Sensitivity Analysis (PSA) produces data distribution with dominance in quadrant 3 of the CEA Plane. Conclusion : The epidural analgesia strategy for pain relief after major abdominal surgery is a cheaper strategy but with slightly lower effectiveness than intravenous opioids at RSUP Dr. Sardjito. Epidural analgesia has an ICER value of IDR 20,857,416/pain free days, has the opportunity to be an alternative choice for post-major abdominal pain that is cost effective.

Kata Kunci : nyeri, paska operasi, cost effectiveness, pain, post operative, cost effectiveness