Cost Analysis Monotherapy of Type 2 Diabetes Mellitus Patients in

RSUD. Prof. Dr. Margono Soekarjo

Fajar Wahyu Pribadi

, Afifah

, and Catharina Widiartini

Department of Pharmacology, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia

Department of Anatomy, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia

Keywords: cost analysis, type 2 diabetes mellitus, INA-CBG's rates, monotherapy, effectiveness.

Abstract: Type 2 Diabetes Mellitus (D.M.) is a metabolic syndrome characterized by hyperglycemia due to decreased

insulin sensitivity. High prevalence and long-term treatment to be burdened on the health economy indicate

that D.M. therapy must be cost-effective. The study aimed to know the cost analysis monotherapy of type 2

Diabetes Mellitus patients. Twenty-three patients without complications were given monotherapy and

followed six months from D.M.'s initial diagnostic in a descriptive study. Data was taken from medical

records, clinical pathology laboratory and finansial data between January 1, 2016, and June 30, 2018. The

cost analysis therapy was compared between monotherapy Insulin, Metformin, Glimepiride and Pioglitazone.

Of the 23 patients monotherapy of the study population, nine patients received Insuline; 8 patients received

Metformin; 3 patients received Glimepirid, and three patients received Pioglitazone. The analysis showed that

the total cost INA-CBG's rates Rp9.0189 million; Rp7.9648 million; Rp2.9609 million and Rp2.9633 million.

Effectiveness therapy rates 44.44%; 70.83%; 50% and 66.67%. CER Rp202925; Rp112444; Rp59218 and

Rp44449. As a conclusion, Pioglitazone is more cost-effective when compared to Insulin, Metformin and

Glimepiride. Our findings suggest it needed to assess the total costs effectiveness of therapy with more and

longer periods.

1 INTRODUCTION

Type 2 Diabetes Mellitus is caused by insulin

insensitivity to the cells. It requires long-term therapy

to reduce the risk of complications (ADA, 2015). The

prevalence of D.M. in Indonesia is 6.2% or 10.7

million sufferers, and it is estimated that in 2035 it

will increase to 14.1 million sufferers (IDF, 2020).

Data from the 2015 World Economic Forum,

Indonesia has the potential to experience losses due

to non-communicable diseases such as diabetes

mellitus for the 2012-2030 period of 34.47 trillion

dollars, and specifically, in 2015, 33% of JKN

expenditure was used to finance health care for

diabetes mellitus and its complications (Kemenkes,

2016). In research conducted at UPT. Puskesmas

Dawan II in Klungkung Regency in 2015-2016,

apparently there is no significant difference in the

effectiveness of the drugs given (Udayani dan

https://orcid.org/0000-0002-9706-8110

https://orcid.org/0000-0002-5703-7061

https://orcid.org/0000-0002-2789-5292

Herleeya, 2016). The high incidence of D.M. cases,

high D.M. health care costs and no significant

difference in the effectiveness of the drug will affect

the analysis of the cost of two-drug combination

therapy in type 2 Diabetes Mellitus patients. By

knowing this analysis, it can provide input in

selecting the most cost-effective drug in the therapy.

2 MATERIALS AND METHODS

This descriptive study used a total sampling method

from all the secondary data archives of medical

records, financial records (INA-CBGs) and clinical

pathology laboratory of Prof. Dr Margono Soekarjo

Purwokerto. Patient of Type 2 Diabetes Mellitus

without complications from a BPJS (national health

insurance) participant followed for the next six

months. The variables used were the type of drug

Pribadi, F., Aﬁfah, . and Widiartini, C.

Cost Analysis Monotherapy of Type 2 Diabetes Mellitus Patients in RSUD. Prof. Dr. Margono Soekarjo.

DOI: 10.5220/0010488100810083

In Proceedings of the 1st Jenderal Soedirman International Medical Conference in conjunction with the 5th Annual Scientiﬁc Meeting (Temilnas) Consortium of Biomedical Science Indonesia

(JIMC 2020), pages 81-83

ISBN: 978-989-758-499-2

given, the Cost of therapy, and the Effectiveness of

blood sugar levels.

3 RESULTS

From January 1, 2016, to December 31, 2017, twenty-

three new patients were on combination therapy with

two drugs. These diabetes mellitus patients were then

followed for the next six months.

Characteristics of type 2 Diabetes Mellitus

patients, including gender, age, Body Mass Index

(BMI), and type of drugs were presented in Table 1.

Table 1. Characteristics

Gende

Man 10 43,5

Woman 13 56,5

<50 5 21,74

50-59 9 39,13

≥60 9 39,13

IMT

Underwei

3 13,04

ormal 4 17,39

Overwei

7 30,44

Obesitas 9 39,13

Monotherap

Insulin 9 39

Metformin 8 35

Glimepiride 3 13

Pio

litazone 3 13

Total Cost Based On INA-CBGs of type 2 Diabetes

Mellitus patients were presented in Table 2.

Table 2. Total cost (in thousands of rupiah)

Drugs n Total Mean Med Min Max

Insuli

9 9.018,9 143,16±12,

142,

135,9 198,

Metfor

min

8 7.964,8 142,23±10,

142,

135,9 183,

Glimep

iride

3 2.960,9 140,99±14,

142,

135,9 202,

Piogli

tazon

3 2.963,3 141,11±8,6

142,

135,9 165,

Effectiveness Therapy Rates of type 2 Diabetes

Mellitus patients were presented in Table 3.

Table 3. Effectiveness therapy rates

Drugs n Reach

the

tar

Total

examination

Insuline 9 24 54 44,4

Metformin 8 34 48 70,83

Glimepiri

39 18 50

Pio

litazon 3 12 18 66,67

Cost-Effectiveness Ratio of type 2 Diabetes Mellitus

patients, as presented in Table 4.

Table 4. Cost-Effectiveness Ratio (in thousands of rupiah)

Dru

sCER

Insuline 202,925

Metformin 112,444

Glimepiride 59,218

Pio

litazone 44,449

4 DISCUSSIONS

This characteristic is under research from Lestari

(2013) in a study conducted at Fatmawati General

Hospital in 2012 which shows that the distribution of

Type 2 Diabetes Mellitus sufferers is more dominated

by women and research from Gautam (2009)

regarding the quality of life of type 2 D.M. patients in

India also has results. Most of the sufferers are

female. According to the American Diabetes

Association (ADA), gender may be an indirect risk

factor for D.M. since their personalities like lack of

physical activity, obesity, and a history of diabetes

during pregnancy (PERKENI, 2015; Smeltzer et al.,

2008).

This age characteristic is slightly different from

Lestari's research (2013) conducted at Fatmawati

General Hospital in 2012, which shows that at the age

of 50-59 years, the most Type 2 Diabetes Mellitus

sufferers are 35%. However, according to Smeltzer et

al. (2008), insulin resistance in type 2 diabetes

mellitus tends to increase in the elderly or aged 40-65

years.

This BMI characteristic follows Lestari's (2013)

research, which shows that the distribution of Type 2

Diabetes Mellitus sufferers is more dominated by

obesity by 38%. Obesity is one of the risk factors for

type 2 Diabetes Mellitus. Due to overweight or

obesity, fat cells are also fat, and cells like this will

produce several substances classified as

adipocytokines which are more in number. These

JIMC 2020 - 1’s t Jenderal Soedirman International Medical Conference (JIMC) in conjunction with the Annual Scientiﬁc Meeting

(Temilnas) Consortium of Biomedical Science Indonesia (KIBI )

substances cause resistance to insulin (Smeltzer et al.,

2008; Hartini, 2009).

In this study, the effectiveness of therapy was

similar according to Priharsi (2015) research at Dr

Moewardi Surakarta in 2014, which stated that

Metformin had the highest effectiveness (58.33%) to

other drugs. And according to the American Diabetes

Association (2015), Metformin is safe for the elderly,

accompanied by decreased physiological function.

For CER data, when compared with each therapy,

the most cost-effective is Pioglitazone therapy

because the cost of this therapy is cheaper than other

therapies. And according to Jameson (2012) and

Nathan, et al. (2008) Pioglitazone can reduce insulin

resistance by binding to the gamma Peroxisome

Proliferator Activator receptor (PPAR-gamma) found

in muscles, fat tissue, liver, and vascular.

5 CONCLUSIONS

Pioglitazone is more cost-effective when compared to

Insulin, Metformin, and Glimepiride. However,

further research is needed with a larger sample, over

a more extended period and using GD2PP and

HbA1C

ACKNOWLEDGMENTS

I am grateful to Lantip Rujito for writing this article,

Director of RSUD Prof. Dr Margono Soekarjo, Dean

and Head of the Pharmacology Section of the Faculty

of Medicine and Head of LPPM, Jenderal Soedirman

University, for allowing this research to be carried

out.

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American Diabetes Association (ADA), 2015. Standards of

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Cost Analysis Monotherapy of Type 2 Diabetes Mellitus Patients in RSUD. Prof. Dr. Margono Soekarjo