Background: Evaluation of health-related quality of life (HRQOL) in cervical cancer patients is important in order to design the interventions for improving patient outcomes. Reports of HRQOL among cervical cancer patients in Indonesia are limited. Moreover, measurement using EQ-5D-3L is to our best knowledge has hitherto not been performed. This study aimed to examine the HRQOL of cervical cancer patients in Indonesia using EQ-5D-3L. Materials and Methods: A cross-sectional study was conducted by interviewing cervical cancer patients using the EQ-5D-3L questionnaire. Percentages of patients who reported having problems in each dimension of EQ-5D as well as EQ-5D index score (utility) were calculated. Results: Our findings indicated that the most frequent reported problems were pain/discomfort (67.8%) followed by anxiety/depression (57.5%). The mean of EQ-5D VAS was 75.8 (SD=17.0). The mean (SD) utility scores were 0.85 (0.19), 0.76 (0.20), 0.71 (0.21), and 0.77 (0.13) for cervical cancer patients in stage I, II, III, and IV, respectively. Conclusions: Cervical cancer significantly affects patient HRQOL. Efforts should be made to improve the quality of life of cervical cancer patients especially in terms of pain /discomfort and anxiety/depression reduction.

Background: As smoking is the leading preventable cause of multiple diseases and premature cancer deaths, estimating the burden of cancer attributable to smoking has become the standard in documenting the adverse impact of smoking. In Indonesia, there is a dearth of studies assessing the economic costs of cancers related to smoking. This study aimed to estimate indirect mortality costs of premature cancer deaths and years of potential life lost (YPLL) attributable to smoking among the Indonesian population. Materials and Methods: A prevalence based method was employed. Using national data, we estimated smoking-attributable cancer mortality in 2013. Premature mortality costs and YPLL were estimated by calculating number of cancer deaths, life expectancy, annual income, and workforce participation rate. A human capital approach was used to calculate the present value of lifetime earnings (PVLE). A discount rate of 3% was applied. Results: The study estimated that smoking attributable cancer mortality was 74,440 (30.6% of total cancer deaths), comprised of 95% deaths in men and 5% in women. Cancers attributed to smoking wereresponsible for 1,207,845 YPLL. Cancer mortality costs caused by smoking accounted for USD 1,309 million in 2013. Among all cancers, lung cancer is the leading cause of death and economic burden. Conclusions: Cancers related to smoking pose an enormous economic burden in Indonesia. Therefore, tobacco control efforts need to be prioritized in order to prevent more losses to the nation. The data of this study are important for advocating national tobacco control policy.

This study aimed to estimate the current prevalence and treatment cost of noncommunicable diseases attributed to tobacco in the Indonesian population in 2015. An epidemiological study was performed. Using the national universal coverage database, we calculated the morbidity and treatment cost of 19 diseases. Proportion of smoking-attributed diseases and treatment costs because of smoking were calculated using smoking-attributable fraction. The study revealed that the morbidity of smoking-related diseases accounted for 991 331 cases, about 21.6% of total cases of chronic diseases in Indonesia. The highest incidences of disease were hypertension, chronic obstructive pulmonary diseases, and ischemic heart disease. The treatment cost of smoking in Indonesia was conservatively estimated to be at least US$2177 million, approximately 2.5% of the 2015 gross domestic product. A majority of the cost was largely concentrated in the male population (US$2164 million). Treatment costs of hypertension, chronic obstructive pulmonary diseases, and ischemic heart disease had the highest cost burden. This study's findings provide scientific evidence about the economic burden of smoking, particularly the health care expenditure covered by the government. This study's evidence is important for informing national public health policy to advocate the health promotion and prevention program.

No abstract

ABSTRAKPrevalensi penyakit diabetes melitus (DM) dan hipertensi di Indonesia semakin tahun semakin meningkat. Pemerintah melalui Badan Penyelenggara Jaminan Sosial (BPJS) mencanangkan Program Pengelolaan Penyakit Kronis (Prolanis) untuk mencapai kesehatan yang optimal dan kualitas hidup yang baik pada penyakit DM dan hipertensi. Studi ini bertujuan untuk mengukur kualitas hidup pasien prolanis di puskesmas menggunakan instrumen EQ-5D-5L. Studi dilakukan pada 200 pasien prolanis yang terdiri dari 100 pasien diabetes melitus dan 100 pasien hipertensi. Lokasi pengambilan sampel berada di puskesmas Kota Palu Provinsi Sulawesi Tengah untuk pasien DM dan Kabupaten Aceh Barat Provinsi Nangroe Aceh Darussalam untuk pasien hipertensi yang dilakukan dalam kurun waktu 3 bulan (September-November 2018). Penelitian menggunakan rancangan cross-sectional study dengan metode convenience/accidental sampling. Kualitas hidup diukur menggunakan instrumen European Quality of Life-5 Dimension-5 Level (EQ-5D-5L) dan konversi health utility (utility) dengan value set Indonesia. Analisis data menggunakan uji independent t-test untuk melihat perbedaan kualitas hidup pada tiap kelompok karakteristik pasien DM dan hipertensi. Hasil penelitian menunjukkan domain rasa sakit/tidak nyaman merupakan domain yang paling banyak dilaporkan terjadi masalah pada pasien DM maupun Hipertensi. Nilai utility pasien DM sebesar 0,843±0,081, sedangkan hipertensi sebesar 0,767±0,154. Terdapat perbedaan signifikan nilai utility berdasarkan karakteristik umur (p=0,001), riwayat penyakit keluarga (p=0,006), lama menderita penyakit (p=0,000) dan frekuensi kontrol (p=0,000) pada pasien hipertensi, sedangkan pada pasien DM hanya pada karakteristik memiliki penyakit lain (p=0,026). ABSTRACTThe prevalence of diabetes mellitus (DM) and hypertension in Indonesia is increasing every year. The government through the BPJS has launched a prolanis program to achieve optimal health and good quality of life in DM and hypertension patients. This study aimed to measure the quality of life of prolanis patients in primary healthcare centers using the EQ-5D-5L instrument. The study was conducted on 200 prolanis patients consisting of 100 diabetes mellitus patients and 100 hypertensive patients. Data were collected from patients in the primary healthcare centers of Palu Municipality Central Sulawesi Province for DM and from patients in the primary healthcare centers West Aceh District Nangroe Aceh Darussalam Province which were carried out within 3 months (September-November 2018). The study was a cross-sectional study design using convenience/accidental sampling method. Health related quality of life was measured using the European Quality of Life-5 Dimension-5 Level (EQ-5D-5L) and conversion to health utility (utility) used the Indonesian value set. Data analysis used the independent t-test to show the difference in quality live in each group of patients characteristics. The results showed that pain/discomfort was the domain most reported to have problems in DM and hypertension p...

Background: The national health insurance of Indonesia has implemented the Indonesian Case Base Groups (INA-CBGs) tariff rates for healthcare payment. However, there is still problem of difference between the real cost of healthcare and the INA-CBGs tariff rates. This study aimed to evaluate the real cost of healthcare in comparison with the INA-CBG’s tariff rates and to analyze factors associating with the real cost. The study focus on healthcare cost of non-chemotherapy expenditure among patients of high-incidence cancers having chemotherapy covered by the national health insurance. Methods: The study was conducted from the perspective of healthcare provider. Costs data was obtained from hospital billing of Sanglah hospital, a referral hospital in Bali Provincein the period of January – July 2014. The data involved 383, 161, and 152 of in-patient breast cancer cases, cervical cancer cases, and nasopharyngeal cancer cases, respectively. Descriptive statistic was used to analyze patients characteristics, one sample t-test was used to analyze the mean difference of healthcare cost based on real cost and INA-CBG’s tariff rates, and finally, bivariate analysis was used to examine relationship between patients’ characteristics and the real cost. Results: The study shows there were significant differences of non-chemotherapy expenditures based on the real cost and INA-CBG’s tariff rates, in which the costs were lower for the real cost. Factors which significantly associated with the real cost were number of procedure, type of hospitalized room, and length of stay. Conclusions: The study supports the necessary of evaluation of the INA-CBG’s tariff rates to adjust to the real healthcare expenditure. On the other hand, the hospital needs to evaluate the service quality of patient treatment by optimizing budget allocated by the health insurance.

No abstract

Background: Cervical cancer is the second leading cause of death in Indonesia, causing a significant societal burden. This study aims to quantify the burden of cervical cancer in terms of years of life lost (YLL) and productivity cost to support the idea that cervical cancer has substantial economic implications. Methods: Using an epidemiological approach on the prevalence data of 2018, the productivity cost and YLL were estimated by calculating the number of cervical cancer deaths, life expectancy, annual earnings and employment participation rate. Cervical cancer mortality data were obtained from the Global Cancer Observatory (GLOBOCAN) 2018, life expectancy for Indonesia from the WHO Life Tables (2019), and the annual earnings and participation rate of Indonesia were retrieved from the National Statistics Bureau (2018). Results: In 2018, there were 17,253 deaths due to cervical cancer in Indonesia, resulting in 246,350 YLL with a total productivity cost of Indonesian Rupiah (IDR)23,174 trillion. The age group of 50 years old–64 years old experienced the greatest loss of earnings (IDR12,149 trillion), followed by the 35 years old–49 years old (IDR8,944 trillion) and 20 years old–34 years old (IDR8,944 trillion) age groups. Conclusion: The productivity impact of loss of earning due to cervical cancer mortality is significant. This information may assist decision makers in allocating scarce resources among competing priorities.