Cost-Effectiveness analisys on the implementation of clinical pathway of pediatric treatment for dengue hemorrhagic fever in PKU Muhammadiyah Hospital Yogyakarta

Riana Prastiwi Handayani, Dyah Ariyani Perwitasari, Didik Setiawan, Auliya Abdurrohim Suwantika

Abstract


Dengue Hemorrhagic Fever (DHF) remains a concerning world problem especially in Indonesia. This problem particularly deals with therapeutic management of hospitalized children requiring DHF treatment. The current practice of therapeutic management is not in accordance with the standard therapeutic management, which increases the treatment cost. On this account, the application of a clinical pathway is expected to minimize the treatment cost and reduce the length of stay (LoS). However, prior to its the application, it is necessary to analyze the cost effectiveness of the implementation of clinical pathway on pediatric DHF treatment in PKU Muhammadiyah Hospital, Yogyakarta. A retrospective cohort study and cost-effectiveness analysis were applied in this study by considering hospital’s (provider) perspective. Two groups (conform to clinical pathway and not conform to clinical pathway group) were involved in this study. Data of direct medical costs of pediatric DHF treatment, which were suitable with clinical pathways and LoS during 2016-2017 period, were collected in this study. The Incremental Cost Effectiveness Ratio (ICER) between both groups and the Risk Ratio (RR) were calculated as the outcome.  The result confirmed that from 200 patients involved, the treatments of 138 patients (69 %) and 62 patients (31%) were included in the conformed to clinical pathway and not conformed to clinical pathway groups, respectively, with p value of 0,000 and RR of 1,58. The average costs were calculated to be Rp 1.144.024 + Rp 556.372 and Rp 1.989.723 + Rp 1.296.899 for conformity to clinical pathway and non-conformity to clinical pathway groups, respectively. The ICER was calculated to be Rp 826.917. In conclusion, the implementation of clinical pathway on pediatric DHF treatment in PKU Muhammadiyah Hospital, Yogyakarta could reduce LoS and the possibility of having a shorter LoS of up to 1.58 times, it can save cost of Rp 919.238 per one-day reduction in LoS.


Keywords


clinical pathway; child DHF; cost-effectiveness

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References


Achmadi, Umar Fahmi, Prof. Dr. MPH, P. ., dr. Primal Sudjana, S., Prof. Supratman Sukowati, P., 2010. Buletin Jendela Epidemiologi. Pusat Data Dan Surveilans Epidemiologi Kementerian Kesehatan RI, 2, 1–27.

Bhatia, Vidyut., R. L. 2012., Gastrointestinal Bleeding Upper Gastrointestinal Bleeding. Indian J Pediatri, 78: 227–233.

Bryan, M. A., Desai, A. D., Wilson, L., Wright, D. R., Mangione-Smith, R., 2017. Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs. Pediatrics, 139 (3), e20163432.

Dinas Kesehatan DIY., 2015. Profil Kesehatan Tahun 2015 Kota Yogyakarta (Data Tahun 2014). Yogyakarta: Dinas Kesehatan Kota Yogyakarta.

Dinas Kesehatan DIY., 2016. PROFIL KESEHATAN DAERAH ISTIMEWA YOGYAKARTA TAHUN 2016 (Data Tahun 2015). Yogyakarta: Dinas Kesehatan Daerah Istimewa Yogyakarta.

Enarson, P., Gouin, S., Goldman, R. D., 2011. Dimenhydrinate use for children with vomiting. Canadian Family Physician, 57(4): 431–432.

HPRA., 2014. Domperidone-Containing Medicines : Reminder of The Risk of Cardiac Adverse Reactions-Restricted Indication , Contraindications and Reduced Dose, 2014.

Kassir, N., Mouksassi, S., Royal, M. A., 2011. Safety and Population Pharmacokinetic Analysis of Intravenous. J Pediatr Pharmacol Ther, 16(4): 246–261.

Kemenkes RI., 2013. Buletin BUK: INA CBGs Untuk Pelayanan Rumah Sakit Lebih Baik. Jakarta: Dirjen Bina Upaya Kesehatan Kementrian Kesehatan RI.

Kementrian Kesehatan RI., 2017. Kerugian Ekonomi Akibat Penyakit Tular Vektor. Retrieved from www.depkes.go.id/article/view/17082500003/kerugian-ekonomi-akibat-penyakit-tular-vektor-hampir-capai-rp-2-triliun.html

Kepmenkes RI., 2012. Keputusan Menteri Kesehatan No. 440 Tentang Tarif Rumah Sakit Berdasarkan Indonesia Case Based Group (INA-CBG). Jakarta.

Nagaram, P. P., Piduru, P., Munagala, V. K., Matli, V. V., 2017. Clinical and laboratory profile and outcome of dengue cases among children attending a tertiary care hospital of South India. International Journal of Contemporary Pediatrics, 4(3): 1074.

Olsson, L., Hansson, E., Ekman, I., 2009. A cost-effectiveness study of a patient-centred integrated care pathway, (Johnell 1997).

Rahman, A. A. A., 2017. Using Clinical Pathway to Manage Dengue Fever. International Journal for Quality in Health Care, 29(1): 56–57.

Rejeki, V. M. M., 2014. Cost of Treatment Demam Berdarah Dengue ( DBD ) di Rawat Inap Berdasarkan Clinical Pathway di RS X Jakarta. Jurnal Ekonomi Kesehatan Indonesia, 2: 66–74.

Rotter, T., Kinsman, L., James, E., Machotta, A., Willis, J., Snow, P., Kugler, J., 2012. The Effects of Clinical Pathways on Professional Practice , Patient Outcomes , Length of Stay , and Hospital Costs : Cochrane Systematic Review and Meta-Analysis.

Schmidt, H. M., El Lakis, M. A., Markar, S. R., Hubka, M., Low, D. E., 2016. Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs. Annals of Thoracic Surgery, 102(3): 931–939.

Soedarmo, S., Garna, H., Hadinegoro, S dan Satari, H., 2010. Buku Ajar Infeksi dan Pediatri Tropis (Kedua). Jakarta: Badan Penerbit IDAI.

Sumirah, Nika Enik., Arif Widodo., A. M., 2014. Hubungan Antara Tingkat Pengetahuan Keluarga dengan Tingkat Keparahan Awal Pasien Demam Berdarah Dengue (DBD) Di Wilayah Kerja Puskesmas Grogol, 4.

Sylvester, A. M., George, M., 2014. Effect of a Clinical Pathway on Length of Stay and Cost of Pediatric Inpatient Asthma Admissions : An Integrative Review.

Ward, R. M., Tammara, B., Sullivan, S. E., Stewart, D. L., Rath, N., Meng, X., Comer, G. M., 2010. Single-dose, multiple-dose, and population pharmacokinetics of pantoprazole in neonates and preterm infants with a clinical diagnosis of gastroesophageal reflux disease (GERD). European Journal of Clinical Pharmacology, 66(6), 555–561.

Wayan, N., Andriani, E., Tjitrosantoso, H., 2014. Kajian Penatalaksanaan Terapi Pengobatan Demam Berdarah Dengue (DBD) Pada Penderita Anak Yang Menjalani Perawatan Di RSUP Prof . DR . R . D Kandou. Pharmacon Jurnal Ilmiah Farmasi - UNSRAT, 3(2): 57–61.

WHO., 2012. Handbook for Clinical Management of Dengue. WHO Library Cataloguing in Publication Data.

Zheng, X., Zhong, F., Zhang, X., 2014. Doctors’ compliance with national guidelines and clinical pathway on the treatment of tuberculosis inpatients in Hubei, China. Journal of Evaluation in Clinical Practice, 20(3), 288–293.




DOI: http://dx.doi.org/10.12928/pharmaciana.v10i1.12332

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Pharmaciana
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