Pengaruh Algoritma Indonesia Metastatic Bone Disease (INA-MBD) of unknown origin terhadap Time to diagnosis dan Cost to diagnosis

Yuni Artha Prabowo Putro, Prof. Dr. dr. Teguh Aryandono, Sp.B. Subsp. Onk(K).; Prof. Dr. dr. Irianiwati, Sp.PA(K).; Dr. dr. Rahadyan Magetsari, Sp.OT(K)

2025 | Disertasi | S3 Kedokteran Umum

Latar belakang. Pasien MBD of unknown origin membutuhkan waktu sekitar 4 bulan hingga diagnosis dapat ditegakkan. Hal tersebut dikarenakan belum adanya kesepakatan dalam diagnosis dan penanganan MBD of unknown origin. Untuk itu diperlukan algoritma tatalaksana MBD of unknown origin yang disusun secara sistematis dan berbasis bukti sehingga dapat mengatasi permasalahan tersebut.

Tujuan. Untuk meningkatkan diagnosis dan tatalaksana pasien MBD of unknown origin dengan penggunaan algoritma INA-MBD

Metode penelitian. Penelitian ini merupakan penelitian quasi experimental dengan rancangan pre-test post-test without control group design. Sebanyak 146 subjek penelitian yang memenuhi kriteria inklusi dikumpulkan secara konsekutif, terbagi menjadi kelompok intervensi (menggunakan algoritma INA-MBD) dan non-intervensi (tidak menggunakan algoritma). Analisis data untuk variable time to diagnosis dilakukan dengan uji Kaplan-Meier dan uji Cox-regresion untuk analisis bivariat dan Cox-regression untuk analisis multivariat terhadap faktor luar. Analisis cost to diagnosis dengan analisis covariance.

Hasil. Analisis hasil time to diagnosis median 29 hari (p=0.000), HR 2,52 (p=0.000) dan cost to diagnosis rerata Rp. 23.878.055( p=0.000) pada kelompok algoritma INA-MDB dan tanpa algoritma menunjukan perbedaan yang signifikan.

Kesimpulan. Implementasi algoritma INA-MBD dalam penanganan kasus metastatic bone disease of unknown origin dapat mempersingkat time to diagnosis dan mengurangi cost to diagnosis.

Background. Patients with metastatic bone disease (MBD) of unknown origin require approximately four months for a definitive diagnosis. This delay is due to the lack of consensus on the diagnosis and management of MBD of unknown origin. Therefore, a systematically structured and evidence-based treatment algorithm is needed to address this issue effectively.

Purpose. To improve dignosis and management of MBD patients of unknown origin by using the INA-MBD algorithm.

Research method. This study employs a quasi-experimental with pre-test post-test design. A total of 146 subject fulfill the inclusion criteria were collected consecutively and divided into an intervention group (using the INA-MBD algorithm) and a non-intervention group (not using the algorithm). Data analysis for the time to diagnosis variable was conducted using Kaplan-Meier and Cox- regression for bivariate analysis, while Cox-regression was also used for multivariate analysis to account for external factors. Cost to diagnosis was analyzed using analysis of covariance.

Result. Analysis of time to diagnosis with median 29 days (p=0.000), HR 2,52 (p=0.000) and cost to diagnosis mean Rp. 23.878.055 (p=0.000) in the INA-MDB algorithm group and without the algorithm showed significant differences.

Conclusion. The implementation of the INA-MBD algorithm in managing metastatic bone disease cases able to shorten the time to diagnosis and reduce the cost of diagnosis.

Kata Kunci : metastatic bone disease, neoplasm metastasis, unknown primary, algoritma, tatalaksana.