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Abstract
Background: Type 2 diabetes mellitus (DM) is one of the cardiometabolic diseases with the highest prevalence worldwide, including Indonesia. The increasing number of type 2 DMs is known to have become an economic burden on Indonesia's health sector. There are several options for treating type 2 DM, either with monotherapy or in combination. At present, metformin, sulfonylurea, and acarbose have become common drugs in the treatment of type 2 DM. Variations in antidiabetic drugs will cause differences in therapy cost and effectiveness.
Objective: The purpose of this study is to analyze the cost-effectiveness of the combination therapy of metformin-glimepiride and acarbose-glimepiride antidiabetic drugs in patients with type 2 DM at RSUD Sumedang in 2021 based on the hospital's perspective.
Method: This study collected data by documenting medical records and patient costs from January to December 2021 using a cross-sectional design on 60 samples.
Results: Findings from the statistical analysis showed that the combination of metformin and glimepiride did not make a difference in GDS (mean difference 10.70 mg/dL-1; p-value = 0.457). The average total direct medical costs of the acarbose-glimepiride group were higher than that of the metformin-glimepiride group, and there was a significant difference between the average costs of the antidiabetic drugs (p-value = 0.000).
Conclusion: The combination of metformin-glimepiride therapy is more cost-effective than acarbose-glimepiride, with an ACER value of metformin-glimepiride Rp. 3,037.48.
Keywords: Acarbose, cost effectiveness analysis, glimepiride, metformin, type 2 DM
Intisari
Latar belakang: Diabetes Melitus (DM) tipe 2 merupakan salah satu penyakit kardiometabolik dengan prevalensi tertinggi di seluruh dunia termasuk Indonesia. Peningkatan jumlah DM tipe 2 diketahui telah menjadi beban ekonomi bagi sektor kesehatan di Indonesia. Terdapat beberapa pilihan terapi dalam pengobatan DM tipe 2 baik secara monoterapi maupun kombinasi beberapa obat. Saat ini obat metformin, sulfonilurea, dan acarbose telah menjadi obat umum dalam pengobatan DM tipe 2 di Indonesia. Variasi terapi obat antidiabetik akan menyebabkan adanya perbedaan biaya dan efektivitas terapi.
Tujuan: Tujuan penelitian ini untuk menentukan efektivitas biaya terapi kombinasi obat antidiabetik metformin-glimepirid dan acarbose-glimepirid pada pasien DM tipe 2 Instalasi Rawat Jalan di RSUD Sumedang Tahun 2021 berdasarkan perspektif rumah sakit.
Metode: Penelitian ini menggunakan desain studi potong-lintang pada 60 sampel dengan pengambilan data dilakukan secara dokumentasi terhadap data rekam medis dan biaya pasien periode Januari-Desember 2021.
Hasil: Hasil analisis statistik menunjukkan tidak terdapat perbedaan bermakna selisih GDS pada kombinasi metformin-glimepirid dan acarbose-glimepirid (rata-rata perbedaan 10,70 mg/dL-1; nilai-p=0.457). Rata-rata total biaya langsung medis kelompok acarbose-glimepirid lebih tinggi dibandingkan metformin-glimepirid serta terdapat perbedaan bermakna rata-rata biaya obat antidiabetik (nilai-p=0.000).
Kesimpulan: Kombinasi terapi metformin-glimepirid lebih cost-effective dibandingkan acarbose-glimepirid dengan nilai ACER metformin-glimepirid Rp. 3.037,48.
Kata Kunci: Acarbose, analisis efektivitas biaya, DM tipe 2, glimepirid, metfotmin
Keywords
Article Details
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References
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- Chia, C. W., Egan, J. M., & Ferrucci, L. (2018). Age-related Changes in Glucose Metabolism, Hyperglycemia, and Cardiovascular Risk. Circulation Research, 123(7), 886. https://doi.org/10.1161/CIRCRESAHA.118.312806
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- Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447–1463. https://doi.org/10.1016/J.JAND.2015.02.031
- Harreiter, J., & Kautzky-Willer, A. (2018). Sex and Gender Differences in Prevention of Type 2 Diabetes. Frontiers in Endocrinology, 9, 220. https://doi.org/10.3389/FENDO.2018.00220
- International Diabetes Federation - Home. (2019). Retrieved June 19, 2022, from https://www.idf.org/
- Isnani, N., Muliyani, M., Zaini, M., & Arif Riyadi, M. (2021). Analisis Efektivitas Biaya (Cost-Effectiveness) Penggunaan Antidiabetes Oral Kombinasi Pada Pasien Diabetes Melitus Tipe Ii Rawat Jalan Di Rsud Dr. H. Moch. Ansari Saleh Banjarmasin. Jurnal Insan Farmasi Indonesia, 4(1), 103–110. https://doi.org/10.36387/jifi.v4i1.683
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- Kementerian Kesehatan RI. (2013). Pedoman Penerapan Kajian Farmakoekonomi. Kementerian Kesehatan Republik Indonesia: Jakarta.
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- Lin, L. K., Sun, Y., Heng, B. H., Kwang Chew, D. E., & Chong, P. N. (2017). Medication adherence and glycemic control among newly diagnosed diabetes patients. BMJ Open Diabetes Research & Care, 5(1). https://doi.org/10.1136/BMJDRC-2017-000429
- Liu, X., Zeng, L., & Xu, W. (2018). Pharmacoeconomic evaluation of glimepirid combined with other drugs in the treatment of diabetes. Pakistan Journal of Pharmaceutical Sciences, 31(3), 1103–1107.
- Perkeni. (2021). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia. PB Perkeni: Jakarta.
- Pribadi, F. & Permana, I. (2018). Analysis of the Cost-Effectiveness of Antidiabetic Drugs among Self Paid Participant of the Indonesia National Security Service (NSS) with Type 2 Diabetes Mellitus. Int J Med. Public Health, 8(3), 108-111. https://doi.org/10.5530/ijmedph.2018.3.23.
- Putra, S., Udayani, NMW., Meriyani, H. (2021). Analisis Efektivitas Biaya Penggunaan Terapi Insulin Dan Insulin Kombinasi Pada Pasien Diabetes Mellitus Tipe Ii Analisis Efektivitas Biaya Penggunaan Terapi Insulin Dan Insulin Kombinasi Pada Pasien Diabetes Mellitus Tipe Ii Rawat Jalan Di Rsup Sanglah A. Jurnal Ilmiah Medicamento, 3(2), 97-103. https://doi.org/10.36733/medicamento.v3i2.907
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- Shaqquilla, RV. (2020). Asuhan Keperawatan Keluarga dengan Hipertensi di Wilayah Kerja Puskesmas Andalas Kota Padang. Karya Tulis Ilmiah. Politeknik Kesehatan Kemenkes Padang: Padang. 4
- Tramunt, B., Smati, S., Grandgeorge, N., Lenfant, F., Arnal, J. F., Montagner, A., & Gourdy, P. (2020). Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia, 63(3), 453–461. https://doi.org/10.1007/S00125-019-05040-3/FIGURES/2
- Wafa, W., Septini, R., & Sauriasari, R. (2021). Comparison of Metformin-sulfonylurea and Metformin-acarbose Combination Therapies on Glycemic Outcomes: A Retrospective Cohort Study. Current Diabetes Reviews, 18(7). https://doi.org/10.2174/1573399818666211103161917
- WHO Library. (2016). Global Report on Diabetes. Isbn, 978, 6–86. Available at http://www.who.int/about/licensing/
- Yang, H. K., Lee, S. H., Shin, J., Choi, Y. H., Ahn, Y. B., Lee, B. W., Rhee, E. J., Min, K. W., & Yoon, K. H. (2019). Acarbose Add-on Therapy in Patients with Type 2 Diabetes Mellitus with Metformin and Sitagliptin Failure: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Diabetes & Metabolism Journal, 43(3), 287. https://doi.org/10.4093/DMJ.2018.0054
- Yen, F. S., Wei, J. C. C., Lin, M. C., Hsu, C. C., & Hwu, C. M. (2021). Long-term outcomes of adding alpha-glucosidase inhibitors in insulin-treated patients with type 2 diabetes. BMC Endocrine Disorders, 21, 25. https://doi.org/10.1186/S12902-021-00690-0
- Yuswantina, R., & Dyahariesti, N. (2017). Analisis Efektivitas Biaya Penggunaan Antidiabetes Oral Tunggal Dan Kombinasi Pada Pasien Bpjs Penderita Diabetes Millitus Tipe 2 Di Rumah Sakit X. Media Farmasi Indonesia, 13(1).
References
ADA. (2020). Standards of Medical Care in Diabetes — 2020 Abridged for Primary Care Providers. 29.
Alzarea, A. I., Khan, Y. H., Alanazi, A. S., Butt, M. H., Almalki, Z. S., AlAhmari, A. K., Alsahali, S., & Mallhi, T. H. (2022). Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries. International Journal of Environmental Research and Public Health, 19(13), 7862. https://doi.org/10.3390/IJERPH19137862
Bahendeka, S., Wesonga, R., Mutungi, G., Muwonge, J., Neema, S., & Guwatudde, D. (2016). Prevalence and correlates of diabetes mellitus in Uganda: a population-based national survey. Tropical Medicine & International Health : TM & IH, 21(3), 405–416. https://doi.org/10.1111/TMI.12663
Chia, C. W., Egan, J. M., & Ferrucci, L. (2018). Age-related Changes in Glucose Metabolism, Hyperglycemia, and Cardiovascular Risk. Circulation Research, 123(7), 886. https://doi.org/10.1161/CIRCRESAHA.118.312806
Cho, N. H., Shaw, J. E., Karuranga, S., Huang, Y., da Rocha Fernandes, J. D., Ohlrogge, A. W., & Malanda, B. (2018). IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Research and Clinical Practice, 138, 271–281. https://doi.org/10.1016/J.DIABRES.2018.02.023
Fitriyani, F., Andrajati, R., & Trisna, Y. (2021). Analisis Efektivitas-Biaya Terapi Kombinasi Metformin-Insulin dan Metformin-Sulfonilurea pada Pasien Rawat Jalan dengan Diabetes Melitus Tipe 2 di RSUPN Dr. Cipto Mangunkusumo. Indonesian Journal of Clinical Pharmacy, 10(1), 10. https://doi.org/10.15416/ijcp.2021.10.1.10
Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447–1463. https://doi.org/10.1016/J.JAND.2015.02.031
Harreiter, J., & Kautzky-Willer, A. (2018). Sex and Gender Differences in Prevention of Type 2 Diabetes. Frontiers in Endocrinology, 9, 220. https://doi.org/10.3389/FENDO.2018.00220
International Diabetes Federation - Home. (2019). Retrieved June 19, 2022, from https://www.idf.org/
Isnani, N., Muliyani, M., Zaini, M., & Arif Riyadi, M. (2021). Analisis Efektivitas Biaya (Cost-Effectiveness) Penggunaan Antidiabetes Oral Kombinasi Pada Pasien Diabetes Melitus Tipe Ii Rawat Jalan Di Rsud Dr. H. Moch. Ansari Saleh Banjarmasin. Jurnal Insan Farmasi Indonesia, 4(1), 103–110. https://doi.org/10.36387/jifi.v4i1.683
Jia, W., Weng, J., Zhu, D., Ji, L., Lu, J., Zhou, Z., Zou, D., Guo, L., Ji, Q., Chen, L., Chen, L., Dou, J., Guo, X., Kuang, H., Li, L., Li, Q., Li, X., Liu, J., Ran, X., … Zhao, Z. (2019). Standards of medical care for type 2 diabetes in China 2019. Diabetes/Metabolism Research and Reviews, 35(6), e3158. https://doi.org/10.1002/DMRR.3158
Kalra, S., Bahendeka, S., Sahay, R., Ghosh, S., Md, F., Orabi, A., Ramaiya, K., Shammari, S. al, Shrestha, D., Shaikh, K., Abhayaratna, S., Shrestha, P. K., Mahalingam, A., Askheta, M., Rahim, A. A. A., Eliana, F., Shrestha, H. K., Chaudhary, S., Ngugi, N., … Das, A. K. (2018). Consensus recommendations on sulfonylurea and sulfonylurea combinations in the management of Type 2 diabetes mellitus - International Task Force. Indian Journal of Endocrinology and Metabolism, 22(1), 132–157. https://doi.org/10.4103/ijem.IJEM_556_17
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocrine Reviews, 37(3), 278–316. https://doi.org/10.1210/ER.2015-1137
Kementerian Kesehatan RI. (2013). Pedoman Penerapan Kajian Farmakoekonomi. Kementerian Kesehatan Republik Indonesia: Jakarta.
Kementerian Kesehatan RI. (2018). Riskesdas. In Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan. Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan (LPB). https://ejournal2.litbang.kemkes.go.id/index.php/lpb/article/view/3662
Lee, P. G., & Halter, J. B. (2017). The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations. Diabetes Care, 40(4), 444–452. https://doi.org/10.2337/DC16-1732
Lin, L. K., Sun, Y., Heng, B. H., Kwang Chew, D. E., & Chong, P. N. (2017). Medication adherence and glycemic control among newly diagnosed diabetes patients. BMJ Open Diabetes Research & Care, 5(1). https://doi.org/10.1136/BMJDRC-2017-000429
Liu, X., Zeng, L., & Xu, W. (2018). Pharmacoeconomic evaluation of glimepirid combined with other drugs in the treatment of diabetes. Pakistan Journal of Pharmaceutical Sciences, 31(3), 1103–1107.
Perkeni. (2021). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia. PB Perkeni: Jakarta.
Pribadi, F. & Permana, I. (2018). Analysis of the Cost-Effectiveness of Antidiabetic Drugs among Self Paid Participant of the Indonesia National Security Service (NSS) with Type 2 Diabetes Mellitus. Int J Med. Public Health, 8(3), 108-111. https://doi.org/10.5530/ijmedph.2018.3.23.
Putra, S., Udayani, NMW., Meriyani, H. (2021). Analisis Efektivitas Biaya Penggunaan Terapi Insulin Dan Insulin Kombinasi Pada Pasien Diabetes Mellitus Tipe Ii Analisis Efektivitas Biaya Penggunaan Terapi Insulin Dan Insulin Kombinasi Pada Pasien Diabetes Mellitus Tipe Ii Rawat Jalan Di Rsup Sanglah A. Jurnal Ilmiah Medicamento, 3(2), 97-103. https://doi.org/10.36733/medicamento.v3i2.907
RSUD Sumedang. (2022). https://rsud.sumedangkab.go.id/
Samsudin, Y. B., Mccarthy, J. F., Napitupulu, L., Dewi, R., Hadihardjono, D. N., Rouw, A., Melati, K., Bellotti, W., Tanoto, R., Campbell, S. J., Ariesta, D. L., Setiawan, M. H., Khomsan, A., & Ickowitz, A. (2021). Mulia Nurhasan Linking food, nutrition and the environment in Indonesia A perspective on sustainable food systems 2 Linking food, nutrition and the environment in Indonesia A perspective on sustainable food systems. https://doi.org/10.17528/cifor/008070
Shaqquilla, RV. (2020). Asuhan Keperawatan Keluarga dengan Hipertensi di Wilayah Kerja Puskesmas Andalas Kota Padang. Karya Tulis Ilmiah. Politeknik Kesehatan Kemenkes Padang: Padang. 4
Tramunt, B., Smati, S., Grandgeorge, N., Lenfant, F., Arnal, J. F., Montagner, A., & Gourdy, P. (2020). Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia, 63(3), 453–461. https://doi.org/10.1007/S00125-019-05040-3/FIGURES/2
Wafa, W., Septini, R., & Sauriasari, R. (2021). Comparison of Metformin-sulfonylurea and Metformin-acarbose Combination Therapies on Glycemic Outcomes: A Retrospective Cohort Study. Current Diabetes Reviews, 18(7). https://doi.org/10.2174/1573399818666211103161917
WHO Library. (2016). Global Report on Diabetes. Isbn, 978, 6–86. Available at http://www.who.int/about/licensing/
Yang, H. K., Lee, S. H., Shin, J., Choi, Y. H., Ahn, Y. B., Lee, B. W., Rhee, E. J., Min, K. W., & Yoon, K. H. (2019). Acarbose Add-on Therapy in Patients with Type 2 Diabetes Mellitus with Metformin and Sitagliptin Failure: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Diabetes & Metabolism Journal, 43(3), 287. https://doi.org/10.4093/DMJ.2018.0054
Yen, F. S., Wei, J. C. C., Lin, M. C., Hsu, C. C., & Hwu, C. M. (2021). Long-term outcomes of adding alpha-glucosidase inhibitors in insulin-treated patients with type 2 diabetes. BMC Endocrine Disorders, 21, 25. https://doi.org/10.1186/S12902-021-00690-0
Yuswantina, R., & Dyahariesti, N. (2017). Analisis Efektivitas Biaya Penggunaan Antidiabetes Oral Tunggal Dan Kombinasi Pada Pasien Bpjs Penderita Diabetes Millitus Tipe 2 Di Rumah Sakit X. Media Farmasi Indonesia, 13(1).