Analisis Efektivitas-Biaya Terapi Kombinasi Metformin-Insulin dan Metformin-Sulfonilurea pada Pasien Rawat Jalan dengan Diabetes Melitus Tipe 2 di RSUPN Dr. Cipto Mangunkusumo

Fitriyani Fitriyani; Retnosari Andrajati; Yulia Trisna

doi:10.15416/ijcp.2021.10.1.10

Analisis Efektivitas-Biaya Terapi Kombinasi Metformin-Insulin dan Metformin-Sulfonilurea pada Pasien Rawat Jalan dengan Diabetes Melitus Tipe 2 di RSUPN Dr. Cipto Mangunkusumo

Fitriyani Fitriyani, Retnosari Andrajati, Yulia Trisna

Abstract

Diabetes melitus tipe 2 (DMT2) diketahui sebagai salah satu masalah kesehatan yang memberikan beban ekonomi yang cukup besar pada sistem pelayanan kesehatan di seluruh dunia. Bervariasinya penggunaan terapi obat akan mengakibatkan adanya perbedaan dalam efektivitas dan biaya terapi, sehingga perlu dilakukan analisis efektivitas-biaya. Tujuan dari penelitian ini adalah menganalisis efektivitas-biaya terapi kombinasi metformin-insulin (Met-Ins) dan metformin-sulfonilurea (Met-SU) pada pasien rawat jalan dengan DMT2 berdasarkan perspektif rumah sakit. Penelitian ini menggunakan desain studi kohort, pengambilan data dilakukan secara retrospektif di RSUPN Dr. Cipto Mangunkusumo menggunakan rekam medik pasien rawat jalan dengan DMT2 dan data billing rumah sakit pada periode Januari 2016–Juni 2019. Dilakukan perbandingan efektivitas terapi (∆HbA1c) dan biaya medis langsung antara kedua kelompok. Hasil analisis menunjukkan ∆HbA1c antara kelompok Met-Ins dan kelompok Met-SU tidak memiliki perbedaan yang bermakna secara statistik (rata-rata perbedaan 0,123%; p=0,608). Median biaya medis langsung kelompok Met-Ins lebih tinggi dibandingkan kelompok Met-SU (p<0,001). Hasil analisis efektivitas-biaya menunjukkan bahwa terapi kombinasi Met-SU lebih cost-effective dibandingkan kombinasi Met-Ins.

Kata kunci: Analisis efektivitas-biaya, diabetes melitus tipe 2, insulin, metformin, sulfonilurea

Cost-Effectiveness Analysis of Metformin-Insulin and Metformin-Sulfonylurea Combination Therapy in Outpatients with Type 2 Diabetes Mellitus at Dr. Cipto Mangunkusumo Hospital

Abstract

Type 2 diabetes mellitus (T2DM) is a health problem that impose economic costs on the health care systems globally. Consequently, variation of drug therapy leads to differences in the effectiveness and cost of therapy, therefore cost-effectiveness analysis is of importance. The purpose of this study was to analyze the cost-effectiveness of metformin-insulin (Met-Ins) and metformin-sulfonylurea (Met-SU) combination therapy in outpatients with T2DM based on the hospital perspective. A retrospective cohort study was conducted at Dr. Cipto Mangunkusumo Hospital using medical records of outpatients with T2DM and hospital billing between January 2016–June 2019. The effectiveness of the therapy (∆HbA1c) and direct medical costs between the two groups was compared. The analysis showed that ∆HbA1c between the Met-Ins group and the Met-SU group had no statistically significant differences (mean difference 0,123%; p=0.608). Meanwhile, the median of direct medical costs of the Met-Ins group was higher than the Met-SU group (p<0.001). The results of the analysis showed that the combination therapy of Met-SU was more cost-effective compared to that of Met-Ins.

Keywords: Cost-effectiveness analysis, insulin, metformin, sulfonylurea, type 2 diabetes mellitus

Keywords

Analisis efektivitas-biaya, diabetes melitus tipe 2, insulin, metformin, sulfonilurea

Full Text:

PDF (Bahasa Indonesia)

References

de León-Castañeda CD, Altagracia-Martínez M, Kravzov-Jinich J, Cárdenas-Elizalde M del R, Moreno-Bonett C, Martínez-Núñez JM. Cost-effectiveness study of oral hypoglycemic agents in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City. Clinicoecon Outcomes Res. 2012;4(1):57–65. doi: 10.2147/CEOR.S27826

Yang W, Dall TM, Beronjia K, Lin J, Semilla AP, Chakrabarti R, et al. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917–28. doi: 10.2337/dci18-0007

International Diabetes Federation. IDF diabetes atlas, 8th edition. Brussels, Belgium: International Diabetes Federation; 2017.

Bullard KM, Cowie CC, Lessem SE, Saydah SH, Menke A, Geiss LS, et al. Prevalence of diagnosed diabetes in adults by diabetes type-United States, 2016. Morb Mortal Wkly Rep 2018;67(12):359–61. doi: 10.15585/mmwr.mm6712a2

Agus IM, Putra S, Nyoman NI, Udayani W, Meriyani H. Analisis efektivitas biaya penggunaan terapi insulin dan insulin kombinasi pada pasien diabetes mellitus Type II rawat jalan di RSUP Sanglah. Medicamento. 2017;3(2):103–9.

American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(1):S1–2. doi: 10.2337/dc18-Sint01

Perkumpulan Endokrinologi Indonesia. Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2015. Jakarta: Pengurus Besar Perkumpulan Endokrinologi Indonesia; 2015.

Kwon CS, Seoane-Vazquez E, Rodriguez-Monguio R. Cost-effectiveness analysis of metformin+dipeptidyl peptidase-4 inhibitors compared to metformin+sulfonylureas for treatment of type 2 diabetes. BMC Health Serv Res. 2018;18(1):1–12. doi: 10.1186/s12913-018-2860-0

Tamiselvan T, Kumutha T, Amrita L V, James AC, Reji JS, Cheriyan N. Pharmacoeconomical evaluation of oral hypoglycemic agents for type-2 diabetes mellitus in a multispeciality hospital. Int J Pharm Sci Res. 2017;8(5):2243–8. doi: 10.13040/IJPSR.0975-8232.8(5).2243-48

Kupsal K, Mudigonda S, Sai NVBK, Neelala K, Hanumanth SR. Metformin combinatorial therapy for type 2 diabetes mellitus. J Metab Syndr. 2016;5(3):1000210. doi: : 10.4172/ 2167-0943.1000210

Home P, Baik SH, Gálvez GG, Malek R, Nikolajsen A. An analysis of the cost-effectiveness of starting insulin detemir in insulin-naïve people with type 2 diabetes. J Med Econ. 2015;18(3):230–40. doi: 10.3111/13696998.2014.985788

DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A pathophisiology approach, 10th edition. Amerika Serikat: McGraw-Hill Education; 2017.

Mu P-W, Chen Y-M, Lu H, Wen X, Xie R, Shu J, et al. Effects of a combination of oral anti-diabetes drugs with basal insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes. Diabetes Metab Res Rev. 2012;28(3):236–40. doi: 10.1002/dmrr.1292

Kvapil M, Swatko A, Hilberg C, Shestakova M. Biphasic insulin aspart 30 plus metformin: an effective combination in type 2 diabetes. Diabetes Obes Metab. 2006;8(1):39–48. doi: 10.1111/j.1463-1326.2005.00492.x

Sakpal TV. Sample size estimation in clinical trial. Perspect Clin Res. 2010;1(2):67–9.

Dahlan MS. Besar sampel dan cara pengambilan sampel dalam penelitian kedokteran dan kesehatan. Jakarta: Salemba Medika; 2009.

Poolsup N, Suksomboon N, Setwiwattanakul W. Efficacy of various antidiabetic agents as add-on treatments to metformin in type 2 diabetes mellitus: Systematic review and meta-analysis. 2012;2012:798146. doi: 10.5402/2012/798146

Galani V, Patel HM. Comparison of metformin and insulin monotherapy with combined metformin and insulin therapy in patients of type 2 diabetes with HbA1c > 7%. Int J Pharm Biol Arch. 2011;2(1):563–8.

Klarenbach S, Cameron C, Singh S, Ur E.Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin. CMAJ. 2011;183(16):E1213–20. doi: 10.1503/cmaj.110178

Nishanth T, Maheswari CU, Lakshmi RS, Sri D, Goud P, Tabassum K, et al. A study to compare efficacy of metformin-glimepiride versus metformin-teneligliptin in type II diabetic patients. Int J Pharm Sci Res. 2018;9(12):5258–64. doi: 10.13040/ IJPSR.0975-8232.9(12).5258-64

Lee YK, Song SO, Kim KJ, Cho Y, Choi Y, Yun Y, et al. Glycemic effectiveness of metformin-based dual-combination therapies with sulphonylurea, pioglitazone, or DPP4-inhibitor in drug-naïve korean type 2 diabetic patients. 2013;37(6)465–74. doi: 10.4093/dmj.2013.37.6.465

Lee PG, Halter JB. The pathophysiology of hyperglycemia in older adults: Clinical considerations. Diabetes Care. 2017;40(4):444–52. doi: 10.2337/dc16-1732

Kautzky-Willer A, Kosi L, Lin J, Mihaljevic R. Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: Results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab. 2015;17(6):533–40. doi: 10.1111/dom.12449

Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev. 2016;37(3):278–316. doi: 10.1210/er.2015-1137

Bays HE, Chapman RH, Grandy S, SHIELD Investigators’ Group. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: Comparison of data from two national surveys. Int J Clin Pract. 2007;61(5):737–47. doi: 10.1111/j.1742-1241.2007.01336.x

Scott RA, Langenberg C, Sharp SJ, Franks PW, Rolandsson O, Drogan D, et al. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study. Diabetologia. 2013;56(1):60–9. doi: 10.1007/s00125-012-2715-x

Sari MI, Sari N, Darlan DM, Prasetya RJ. Cigarette smoking and hyperglycaemia in diabetic patients. Maced J Med Sci. 2018;6(4):634–7. doi: 10.3889/oamjms.2018.140

Vlassopoulos A, Lean MEJ, Combet E. Influence of smoking and diet on glycated haemoglobin and ‘pre-diabetes’ categorisation: a cross-sectional analysis. BMC Public Health. 2013;13(1):1013. doi: 10.1186/1471-2458-13-1013

Hayashino Y, Izumi K, Okamura S, Nishimura R, Origasa H, Tajima N, et al. Duration of diabetes and types of diabetes therapy in Japanese patients with type 2 diabetes: The Japan Diabetes Complication and its Prevention prospective study 3 (JDCP study 3). J Diabetes Investig. 2017;8(2):243–9. doi: 10.1111/jdi.12550

Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes Diabetologia. 2014;57(12):2465–74. doi: 10.1007/s00125-014-3369-7

Haghighatpanah M, Mallayasamy S, Thunga G, Nejad ASM, Haghighatpanah M. Factors that correlate with poor glycemic control in type 2 diabetes mellitus patients with complications. Osong Public Heal Res Perspect. 2018;9(4):167–74. doi: 10.24171/j.phrp.2018.9.4.05

Kassahun T, Eshetie T, Gesesew H. Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia. BMC Res Notes. 2016;9(1):78.doi: 10.1186/s13104-016-1896-7

Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications. 2010;24(2):84–9. doi: 10.1016/j.jdiacomp.2008.12.008

Nathan DM, Buse JB, Kahn SE, Krause-Steinrauf H, Larkin ME, Staten M, et al. Rationale and design of the glycemia reduction approaches in diabetes: A comparative effectiveness study (GRADE). Diabetes Care. 2013;36(8):2254–61. doi: 10.2337/dc13-0356

Franz MJ, MacLeod J, Evert A, Brown C, Gradwell E, Handu D, et al. Academy of nutrition and dietetics nutrition practice guideline for type 1 and type 2 diabetes in adults: Systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process. J Acad Nutr Diet. 2017;117(10):1659–79. doi: 10.1016/j.jand.2017.03.022

Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115(9):1447–63. doi: 10.1016/j.jand.2015.02.031

Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials. J Am Med Assoc. 2001;286(10):1218–27. doi: 10.1001/jama.286.10.1218

Pribadi F, Permana I. 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. 2018;8(3):108–11. doi: 10.5530/ijmedph.2018.3.23

Khoiriyah SD, Zakiyah N, Suwantika AA. Analisis efektivitas biaya penggunaan kontrasepsi di Indonesia tahun 2014–2017. Indones J Clin Pharm. 2019;8(3):188–95. doi: 10.15416/ijcp.2019.8.3.188