Cost Utility Analysis Fentanyl Transdermal Versus Morfin Oral pada Pasien Kanker Payudara Rawat Jalan di RSUP Dr Sardjito
Anggita Fatwa, Dr. dr. Mahmud, Sp.An-TI, Subsp. M.N (K), FIPM, M.Sc.; dr. Calcarina Fitriani Retno Wisudarti, Sp.An-TI, Subsp. T.I (K).; Dr. Diah Ayu Puspandari, Apt., MBA, M.Kes
2025 | Tesis-Spesialis | S2 Anestesiologi
Latar belakang: Kanker payudara
menduduki peringkat pertama
jenis kanker
terbanyak di Asia Tenggara dengan persentase sebesar 13,2% dan juga di Indonesia
sebesar 16,2%. Pasien kanker payudara sebagian besar terdiagnosis pada usia produktif sehingga dapat menimbulkan gangguan pada kualitas hidup pasien. Tatalaksana nyeri pada pasien kanker
payudara di RSUP Dr. Sardjito saat ini
menggunakan terapi morfin dan fentanyl transdermal. Tatalaksana nyeri di
era Jaminan Kesehatan Nasional memerlukan evaluasi dan analisis
ekonomi untuk menghasilkan pilihan terapi yang lebih
efisien dari segi biaya dengan efek
terapeutik dan
kualitas hidup
yang
maksimal.
Tujuan: untuk menilai perbandingan
analisis tingkat utilitas biaya antara terapi
fentanyl transdermal dan morfin oral pada pasien kanker payudara rawat jalan
di RSUP Dr Sardjito.
Metode: Penelitian
ini
menggunakan desain penelitian potong
lintang observasional prospektif dengan
masa observasi 1
bulan dan periode pengambilan
data
dari bulan Januari – Juni 2025. Total pasien adalah 105 pasien
dengan
pasien
pada
kelompok terapi fentanyl transdermal dan morfin oral adalah 48 dan 57 pasien.
Peneliti meminta pasien
mencatat pengeluaran
selama 1 bulan
dan mengisi
kuesioner kualitas
hidup serta meminta data pembiayaan dari Bagian Tarif RSUP
Dr. Sardjito. Penghitungan
pembiayaan dilakukan
dengan alat bantu Time-Driven
Activity Based
Cost (TDABC) Kemenkes kemudian dilakukan analisa statistik.
Analisis
utilitas biaya menggunakan formulasi Incremental Cost-Utility Ratio
(ICUR) dengan nilai negatif menandakan terapi pembanding lebih
unggul.
Hasil: Nilai utilitas kelompok fentanyl transdermal dan morfin
oral didapatkan 0,5
dan 0,48. QALY kelompok
fentanyl transdermal dan
morfin oral didapatkan 38,70 dan 37,15. Rerata total cost kelompok
fentanyl transdermal dan morfin oral
didapatkan Rp 3.146.740 dan Rp 1.717.299.
Kesimpulan: Cost utility analysis fentanyl transdermal
tidak lebih unggul bila
dibandingkan dengan morfin oral pada pasien kanker payudara rawat jalan di RSUP
Dr.
Sardjito. Hal ini ditunjukkan dengan
nilai ICUR yang bernilai positif sebesar Rp 922.220/1 QALY.
Background: Breast cancer ranks first as the most common type of cancer in Southeast Asia with a percentage of 13.2% and in Indonesia at 16.2%. Breast cancer patients are mostly diagnosed during their productive age, which can cause disruption to the patient's quality of life. Pain management in breast cancer patients at RSUP Dr. Sardjito currently uses oral morphine and transdermal fentanyl therapy. Pain management in the era of National Health Insurance (JKN) requires evaluation and economic analysis to produce more cost-efficient therapy options with maximum therapeutic effects and quality of life improvement.
Objective: To assess the cost-utility analysis between oral morphine and transdermal fentanyl therapy in outpatients breast cancer patients at RSUP Dr. Sardjito.
Methods: This study used a prospective observational cross-sectional study design with an observation period of 1 month and data collection period from January to June 2025. A total of 105 patients were enrolled, with 57 patients in the oral morphine therapy group and 48 patients in the transdermal fentanyl therapy group. The researchers asked patients to record their expenses for 1 month and complete a quality-of-life questionnaire and request financing data from the Tariff Section of RSUP Dr. Sardjito. Cost calculations were carried out using the Ministry of Health's Time-Driven Activity Based Cost (TDABC) tool, then statistical analysis was performed to compare the significance of all questionnaire components and the costs. Cost utility analysis used the Incremental Cost-Utility Ratio (ICUR) formulation with a negative value indicating that the comparison therapy was superior.
Results: Utility value of transdermal fentanyl and oral morphine was 0.5 and 0.48. QALY of transdermal fentanyl and oral morphine measured was 38.70 and 37.15. The total cost average of transdermal fentanyl and oral morfin was Rp 3.146.740 and Rp 1.717.299.
Conclusion: The cost-utility analysis of transdermal fentanyl was not superior to oral morphine in outpatients with breast cancer at RSUP Dr. Sardjito. This was demonstrated by the positive ICUR value of Rp 922,220/1 QALY.
Kata Kunci : analisis utilitas biaya, ICUR, kanker payudara, fentanyl transdermal, morfin oral, QALY, RSUP Dr. Sardjito
