Gambaran Terapi dan Biaya Medis Langsung pada Pasien Tuberkulosis Resistan Obat di RSUP Dr. Sardjito dan RS Paru Respira

Kayla Dahayu Citta Nararya, Prof. Dr. apt. Tri Murti Andayani, Sp.FRS

2025 | Skripsi | FARMASI

Tuberkulosis (TB) masih menjadi masalah kesehatan global dengan angka kematian yang tinggi. Salah satu tantangan dalam pengendaliannya adalah tuberkulosis resistan obat (TB-RO), yang memerlukan pengobatan lebih kompleks dan biaya lebih tinggi dibandingkan TB sensitif obat. Penelitian ini bertujuan untuk memberikan gambaran terapi dan biaya medis langsung pada pasien TB-RO di RSUP Dr. Sardjito dan RS Paru Respira Yogyakarta.

Penelitian ini merupakan studi observasional dengan rancangan cross-sectional. Data diperoleh secara retrospektif dari rekam medis dan bagian keuangan. Subjek penelitian adalah pasien TB-RO pada periode 2021–2024 di RSUP Dr. Sardjito dan RS Paru Respira, dengan mengambil seluruh pasien yang memenuhi kriteria yang ditetapkan. Data dianalisis secara deskriptif dengan aspek yang dikaji meliputi regimen terapi, durasi, status pengobatan, efek samping obat, obat lain, biaya medis langsung layanan rawat inap dan rawat jalan, serta biaya medis langsung pada pasien dengan pengobatan lengkap.

Hasil penelitian menunjukkan terdapat 56 pasien TB-RO dengan 94 episode rawat inap dan 818 episode rawat jalan. Regimen terbanyak adalah kombinasi bedaquiline-levofloxacin-linezolid-cycloserine-clofazimine pada fase intensif (35,71%) dan levofloxacin-linezolid-cycloserine-clofazimine pada fase lanjutan (35,71%), yang termasuk pada paduan jangka panjang. Durasi pengobatan terbanyak adalah 18 bulan (19,64%). Sebagian besar pasien mencapai status pengobatan sembuh (80,36%). Efek samping terbanyak adalah mual (83,93%), dengan obat tambahan terbanyak adalah vitamin B6 (100%). Rata-rata total biaya medis langsung per episode rawat inap sebesar Rp10.071.661 ± 7.284.165, dengan komponen biaya terbesar berasal dari pelayanan dan tindakan. Biaya rata-rata per episode fase intensif rawat jalan adalah Rp3.085.404 ± 1.556.609 dan fase lanjutan sebesar Rp1.797.220 ± 534.100, dengan komponen biaya terbesar berasal dari obat anti tuberkulosis.

Tuberculosis (TB) remains a global health problem with a high mortality rate. One of the challenges in its control is drug-resistant tuberculosis (DR-TB), which requires more complex treatment and incurs higher costs compared to drug-sensitive TB. This study aims to provide an overview of treatment and direct medical costs among DR-TB patients at RSUP Dr. Sardjito and RS Paru Respira Yogyakarta.

This research is an observational study with a cross-sectional design. Data were collected retrospectively from medical records and financial departments. The study subjects were DR-TB patients from the 2021–2024 period at RSUP Dr. Sardjito and RS Paru Respira, including all patients who fulfilled the criteria. The data were analyzed descriptively, covering aspects of treatment regimens, duration, treatment outcomes, adverse drug reactions, additional medications, direct medical costs for inpatient and outpatient services, and direct medical costs among patients who completed treatment.

The results showed 56 DR-TB patients with 94 inpatient episodes and 818 outpatient episodes. The most frequently used regimen was bedaquiline–levofloxacin–linezolid–cycloserine–clofazimine during the intensive phase (35.71%) and levofloxacin–linezolid–cycloserine–clofazimine during the continuation phase (35.71%), both classified as long-term regimens. The most common treatment duration was 18 months (19.64%). Most patients (80.36%) achieved a cured treatment outcome. The most frequently reported adverse effect was nausea (83.93%), and the most commonly prescribed additional medication was vitamin B6 (100%). The average direct medical cost per inpatient episode was IDR 10,071,661 ± 7,284,165, with the largest cost component from medical services and procedures. The average cost per outpatient episode was IDR 3,085,404 ± 1,556,609 during the intensive phase and IDR 1,797,220 ± 534,100 during the continuation phase, with the largest cost coming from anti tuberculosis drugs. 

Kata Kunci : tuberkulosis resistan obat, terapi, biaya medis langsung