Efektivitas Biaya Strategi DOTS Program Tuberkulosis antara Puskesmas dan Rumah Sakit Swasta Kota Depok

Abstract

AbstrakAngka penemuan Tuberkulosis (TB) tahun 2016 adalah sebesar 77% di dunia, sebesar 46,5% di Asia Tenggara dan sekitar 32 - 33% di Indonesia. Di Kota Depok angka penemuan TB mencapai 58%. Sektor swasta menjangkau 18,7% kasus TB di Kota Depok meskipun baru 40% RS swasta yang terlibat. Penelitian ini bertujuan untuk mengetahui apakah penerapan strategi DOTS di Rumah Sakit swasta Kota Depok lebih menghemat biaya dibandingkan di Puskesmas. Penelitian dilakukan selama 6 bulan dengan kohort retrospektif di Puskesmas DOTS, RS DOTS dan RS Non DOTS menggunakan 36 sampel per kelompok. Penghitungan dari perspektif societal dengan microcosting berdasarkan tarif, harga pasar, serta nilai anggaran. Outputnya angka pengobatan lengkap (Success Rate). Hasil penelitian menunjukkan Success Rate di puskesmas paling tinggi yaitu 86,1%, RS DOTS sebesar 77.78 % dan Non DOTS 63.89 %. Penambahan biaya provider terutama tenaga pelaksana khusus di puskesmas dan RS DOTS meningkatkan success rate. Biaya societal di puskesmas 42% dari biaya di RS swasta. ACER (Average Cost Effectiveness Ratio) menunjukkan RS yang melaksanakan strategi DOTS lebih cost effective. Untuk menaikkan 1% angka kesuksesan pengobatan membutuhkan biaya Rp 10.084.572 dengan melakukan intervensi program DOTS ke RS Swasta. Uji t independen menyatakan bahwa terdapat perbedaan bermakna biaya societal pengobatan tuberkulosis antara puskesmas, RS DOTS, dan RS Non DOTS. AbstractGlobal TB notification rate at 2016 was 77% and 46.5% in Southeast Asia. Indonesia last 5 years still remain at 32-33% where Depok City reached 58%. In Depok City, private sector contributed 18.7% of the notified TB case in 2016 although only 40% of private hospitals were involved. The aims of this study is to determine cost-effectiveness of DOTS strategy implementation at private hospital and Public Health Centre (PHC). Comparative study carried out for six months with cohort retrospective between PHC, DOTS and non DOTS hospitals using 36 samples per group. The calculation of the societal perspective with micro costing based on tariffs, market prices and budget value. Output is Success Rate, where at PHC 86.1%, DOTS hospital 77.78% and Non DOTS hospital 63.89%. The addition cost providers especially person in charge at PHC and DOTS hospital increase success rate. The cost of TB treatment in PHC 42% of private hospital. ACER (Average Cost Effectiveness Ratio) is obtained that the hospital which carry out the DOTS strategy is cost effective. To increase 1% success rate of TB treatment costs Rp 10,084,572 with intervention DOTS programs into a private hospital. An Independent t test stated that cost-effectiveness societal perspectives on TB treatment has a significant difference between PHC, DOTS hospital and Non DOTS hospital.