e-ISSN 2598-3849       print ISSN 2527-8878

Vol 5, No 1 (2020)

Evaluasi Ekonomi Parsial antara Pemberian Terapi Rivaroxaban dan Terapi Kombinasi (Unfractionated Heparin + Warfarin) untuk Pengobatan Trombosis Vena Dalam pada Pasien Kanker di Rumah Sakit Kanker Dharmais

Wirda Syari, Mardiati Nadjib, Dody Ranuhardy

Abstract


Abstrak

Berdasarkan penelitian sebelumnya, diketahui bahwa terapi rivaroxaban memiliki beberapa kelebihan dibandingkan dengan terapi kombinasi (UFH+warfarin) untuk pengobatan trombosis vena dalam (deep vein thrombosis/DVT). Akan tetapi, masih sedikit dokter di RS Kanker Dharmais yang memberikan terapi rivaroxaban untuk pengobatan DVT. Penelitian evaluasi ekonomi parsial ini bertujuan untuk menganalisis outcome dan besarnya biaya yang dibutuhkan dari perspektif rumah sakit antara pemberian terapi rivaroxaban dan terapi kombinasi (UFH+warfarin) untuk pengobatan DVT pada pasien kanker di Rumah Sakit Kanker Dharmais tahun 2016 – 2018. Desain penelitian ini adalah kohort retrospektif dengan unit analisis individu. Karena keterbatasan jumlah pasien yang mendapatkan terapi rivaroxaban selama 3 – 6 bulan, studi ini menganalisis biaya dan outcome dari pasien yang mendapatkan terapi selama 1 bulan. Outcome yang diukur adalah intermediate outcome, yang meliputi lama hari rawat, kesembuhan, dan kejadian perdarahan. Biaya dihitung berdasarkan biaya yang dibebankan kepada pasien (charge), yang meliputi biaya obat, pemeriksaan penunjang, tindakan, serta administrasi dan akomodasi. Hasil penelitian menunjukkan bahwa untuk outcome terapi rivaroxaban, sebagian besar pasien tidak mendapatkan perawatan rawat inap, 40% pasien dinyatakan sembuh dari DVT, dan tidak ada pasien yang mengalami kejadian perdarahan. Rata-rata biaya terapi rivaroxaban adalah Rp 7.169.383,00 per pasien. Untuk outcome terapi kombinasi (UFH+warfarin), sebagian besar pasien memiliki lama hari rawat antara 8 – 14 hari, 46% pasien dinyatakan sembuh dari DVT, dan tidak ada pasien yang mengalami kejadian perdarahan. Rata-rata biaya terapi kombinasi (UFH+warfarin) adalah Rp 11.878.813,00 per pasien.


Abstract

Based on previous studies, rivaroxaban therapy has several advantages compared to combination therapy (UFH+warfarin) for the treatment of deep vein thrombosis (DVT). However, the use of rivaroxaban in Dharmais Cancer Hospital is still low. This partial economic evaluation study aims to analyze cost and outcome of rivaroxaban therapy and combination therapy (UFH+warfarin) for DVT treatment in cancer patients at the Dharmais Cancer Hospital during 2016 – 2018. Data collection was done using cohort-retrospective and individual unit of analysis. Due to limited number of patient treated with rivaroxaban therapy within 3-6 months, we estimated the cost and outcome related to patients who were successfully treated in one month. The outcome was the intermediate outcome, i.e length of stay, recovery, and the occurrence of bleeding. The cost was calculated based on hospital perspective including drugs, laboratory tests, procedures, as well as the administrative and accommodation costs. The results showed that patients with rivaroxaban therapy were not admitted to inpatient care, 40% of patients were recovered from DVT, and none of the patients experienced bleeding. The average cost of rivaroxaban therapy to reach the expected outcome was Rp 8,824,791.00. The study also showed that patients with combination therapy (UFH+warfarin) had a hospital length of stay between 8 to 14 days, 46% of patients were recovered from DVT, and none of the patients experienced bleeding. The average cost of combination therapy (UFH+warfarin) to reach the expected outcome was Rp 13,201,698.00.


Keywords


evaluasi ekonomi; kanker; rivaroxaban; trombosis vena dalam; warfarin

References


Adnyana IWL, Suega K, dan Bakta IM. 2013. Trombosis Vena Dalam. Pendidikan Kedokteran Berkelanjutan (PKB) XXI. Fakultas Kedokteran Universitas Udayana.

Bamber, L., et al. 2015. Cost-effectiveness analysis of treatment of venous thromboembolism with rivaroxaban compared with combined low molecular weight heparin/vitamin K antagonist. Thrombosis Journal, 13, 20. http://doi.org/10.1186/s12959-015-0051-3

Coleman, C. I., et al. 2016. Healthcare costs associated with rivaroxaban or warfarin use for the treatment of venous thromboembolism, Journal of Medical Economics, DOI: 10.1080/13696998.2016.1243544

Coleman, C. I., Bunz, T. J., & Turpie, A. G. G. 2017. Effectiveness and safety of rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism. Thromb Haemost 2017; 117: 1841–1847. https://doi.org/10.1160/TH17-03-0210

Drummond, M. F., et al. 2015. Methods for the Economic Evaluation of Health Care Programmes. Fourth Edition. New York: Oxford University Press.

Info BPJS Kesehatan. 2014. Perubahan Tarif INA-CBGs Membuat Biaya Kesehatan Lebih Efektif. Edisi VIII. Jakarta: BPJS Kesehatan. Available from: https://bpjs-kesehatan.go.id/bpjs/dmdocuments/2b67b6556b028d910d2ee8df4245e886.pdf

Larsen, Torben B, et al. 2017. Effectiveness and safety of rivaroxaban and warfarin in patients with unprovoked venous thromboembolism: a propensity-matched nationwide cohort study. The Lancet Haematology, Volume 4, Issue 5, e237-e244. DOI: 10.1016/S2352-3026(17)30054-6

Mantha, Simon, et al. 2017. Safe and effective use of rivaroxaban for treatment of cancer-associated venous thromboembolic disease: a prospective cohort study. J Thromb Thrombolysis 43: 166-171. DOI 10.1007/s11239-016-1429-1.

Margolis, J. M., et al. 2016. Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions. Journal of the American Heart Association, 5(10). Available from: http://jaha.ahajournals.org/content/5/10/e003788

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI). 2016. Panduan Praktik Klinis dan Clinical Pathway Penyakit Jantung dan Pembuluh Darah (Edisi Pertama). Jakarta: PERKI.

Scott, D., et al. 2010. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. New England Journal of Medicine, 363(26), 2499–2510. https://doi.org/10.1056/NEJMoa1007903

Seaman, C.D., Smith K.J., dan Ragni M.V. 2013. Cost-effectiveness of rivaroxaban versus warfarin anticoagulation for the prevention of recurrent venous thromboembolism: A U.S. perspective. Thrombosis Research Volume 132, Issue 6, pp. 647-651. DOI: 10.1016/j.thromres.2013.09.015

Sinombor, Sonya Hellen. 2010. Pengobatan Sederhana untuk Pasien DVT. http://nasional.kompas.com/read/2010/10/28/02432339/about.html

Yaznil MR, Sahil MF, dan Lubis ND. 2010. Prevalensi Trombosis Vena Dalam (Deep Vein Thrombosis) dengan Compression Ultrasound B-Mode Image pada Pasien Tumor Ginekologi Resiko Tinggi dan Resiko Rendah di RS H. Adam Malik Medan. Medan: Fakultas Kedokteran Universitas Sumatera Utara.


Full Text: PDF

DOI: 10.7454/eki.v5i1.3773

Refbacks

  • There are currently no refbacks.