Evaluasi ekonomi jejaring Balai Pengobatan Penyakit Paru-paru (BP4) Yogyakarta dengan Puskesmas dalam pengobatan Tuberkulosis di Yogyakarta

SANTOSO, Joko, dr. Adi Utarini, M.Sc.,MPH.,Ph.D

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Manaj. Rumah Sakit)-

Latar Belakang. Sejak strategi pengobatan DOTS diperluas ke rumah sakit, BP4 dan praktisi swasta dengan membentuk jejaring kerjasama dengan Puskesmas se-DIY, yang dikenal dengan jejaring PPM-DOTS, secara bertahap mulai tahun 2002, angka penemuan dan kesembuhan TB BTA (+) semakin meningkat. Namun belum diketahui cost-effectiveness strategi tersebut. Tujuan Penelitian. Menetapkan model PPM-DOTS yang costeffectiveness bagi BP4 Yogyakarta. Metode Penelitian. Penelitian diskriptif, menggunakan rancangan cross sectional survey. Dua alternatif model penanganan pasien TB dibandingkan: 30 pasien didiagnosis dan diobati di BP4 dengan 30 pasien didiagnosis di BP4 kemudian dirujuk pengobatan ke Puskesmas. Biaya dianalisis dari persepsi pasien, dihitung biaya per-pasien, terdiri dari total biaya diagnosis dan pengobatan. Effectiveness hasil pengobatan diambil dari prosentase pasien TB BTA (+) yang sembuh dibagi jumlah kasus. Cost-effectiveness dihitung menggunakan medium biaya per-pasien dibanding angka kesembuhan. Hasil Penelitian. Biaya Diagnosis model 1 (Rp. 140.000,-) lebih rendah dari model 2 (Rp. 209.000,-), sedang biaya pengobatan model 1 (Rp.221.000,-) lebih tinggi dari model 2 (Rp.102.000,-), sehingga total biaya per-kasus model 1 dibanding model 2 hampir sama (Rp. 419.000,- dibanding Rp.431.000,-), tidak ada perbedaan bermakna. Angka kesembuhan model 1 dan model 2, sama sebesar 93,33%. Kesimpulan. Program jejaring PPM-DOTS di BP4 dengan Puskesmas, menggunakan model 1 (diagnosis dan pengobatan di BP4) dan model 2 (diagnosis di BP4 dan pengobatan di Puskesmas) sama-sama costeffective.

Backgrounds: Since DOTS strategy has been implemented in hospitals, lung clinic and private practitioner through creating a network with health centres in Yogyakarta (or PPM-DOTS network), the number of TB cases identified and treated has been gradually increasing from the year 2000. However, cost-effectiveness of different PPM-DOTS strategies have not yet been studied. Objectives: This study aimed to determine cost-effectiveness of the PPM-DOTS models for lung clinic in Yogyakarta. Methodology: A cross-sectional survey design was employed. Two alternative models for TB patien case management were compared: 30 patients diagnosed and treated in lung clinic (model 1) with 30 patients were diagnosed in lung clinic then referred for treatment to health centre (model 2). Expenditures were analysed from patient’s perspective, calculated expenditures per-patien, consist of total cost for diagnosis and treatment. Effectiveness was defined as percentage of smear positive TB patient cured: Cost-effectiveness was calculated by dividing the expenditure per-patient divided by the number cured. Results: The diagnostic cost for model 1 (Rp. 140.000,-) was lower than model 2 (Rp. 209.000,-), while the treatment cost of model 1 (Rp. 221.000,-) was higher than model 2 (Rp. 102.000,-). In total, the cost percase for model 1 was similar and not significantly different (Rp. 419.000,- vs to Rp. 431.000,-). The cure rate was similar (93,3%). Conclusion: the cost-effectiveness of model 1 and 2 in the PPM-DOTS applied by lung clinic was similar.

Kata Kunci : Tuberkulosis Paru,Ekonomi Kesehatan,Penghitungan Biaya, Cost-effectiveness, PPM-DOTS network, lung clinic