Hypertension medication is taken for a long period and thus requires considerable costs. As antihypertensives vary in efficacy, research is needed to assess the cost effectiveness of medication, particularly between candesartan-amlodipine and candesartan-diltiazem combinations on hypertensive outpatients. This study applied a prospective cohort design with outcome observations for three months at a private hospital in Yogyakarta. The outcome used to gauge the cost effectiveness of medication was the achievement of the targeted blood pressure reduction after treatment. The cost effectiveness analysis was conducted through payer’s perspective, namely that of the social security agency (BPJS), with direct medical cost as the cost component measured. Cost effectiveness was analyzed using an average cost effectiveness ratio (ACER), calculated according to the ratio of cost to the outcome percentage of the blood pressure reduction target attainment, and an incremental cost effectiveness ratio (ICER) based on the ratio between differences in cost and outcome in both medication groups. The research subjects consisted of 33 patients, 24 of whom underwent medication with candesartan-amlodipine combination and 9 with candesartan-diltiazem. As many as 81.82% were female and 72.73% were within the age range of 51-70, while their most frequent complication was diabetes mellitus (48.48%). Results revealed the effectiveness of candesartan-amlodipine medication to be 58.33% with an ACER value of IDR 6,617, whereas that of candesartan-diltiazem was 22.22% with an ACER of IDR 29,733. The ICER value was IDR -7607, indicating that candesartan-amlodipine was categorically more cost-effective than candesartan-diltiazem.
ABSTRAKKepuasan konsumen terhadap pelayanan kefarmasian di apotek dapat diukur dengan membandingkan antara harapan konsumen terhadap kualitas pelayanan kefarmasian yang diinginkan dengan kenyataan yang diterimanya. Tujuan penelitian adalah untuk mengetahui gambaran dimensi-dimensi kualitas pelayanan kefarmasian yang diharapkan, dianggap penting, dan yang memiliki kinerja yang baik dengan model kualitas pelayanan kefarmasian terhadap konsumen apotek di Kota Yogyakarta. Penelitian ini dilakukan dengan metode observasional deskriptif dan hasil penelitian disajikan dengan diagram kuadran. Hasil penelitian menunjukkan bahwa konsumen apotek di Kota Yogyakarta puas terhadap pelayanan kefarmasian dalam dimensi Tangible dan Empathy. Hal ini ditunjukkan dengan dimensi Tangible dan Empathy berada di kuadran II pada diagram. Sedangkan pada dimensi Assurance, Responsiveness dan Reliability konsumen kurang puas karena konsumen beranggapan kinerja apotek masih rendah dibandingkan harapan konsumen. Hal ini ditunjukkan dengan dimensi Assurance, Responsiveness dan Reliability berada di kuadran III pada diagram. Kata kunci : kepuasan konsumen, pelayanan kefarmasian, apotek ABSTRACTCustomer satisfaction with pharmaceutical care in pharmacy can be measured by comparing the expectations of consumers on the quality of pharmacy services desired by the fact that it received. This study was aimed to identify the dimensions of the expected quality of pharmaceutical care, is considered important, and which has a good performance with a model of quality pharmaceutical care to costumer at pharmacy in Yogyakarta. This study was observational descriptive method and the results are presented with quadrant diagram. The results showed that the costumer at pharmacy in Yogyakarta satisfied with pharmaceutical care in Tangible and Empathy dimension. The Tangible and Empathy dimensions are in quadrant II of the diagram. Howefer, the Assurance, Responsiveness and Reliability dimension, costumers less satisfied because the assume of patients if the pharmacy performance is still lower than the expectations of consumers. That showed the Assurance, Responsiveness and Reliability dimensions are in quadrant III of the diagram.
Many factors can affect a person's quality of life, including therapy with antihypertensive drugs that often have uncomfortable side effects and lead to decreased quality of life. This study aimed to determine the statistical relationship between the characteristics and quality of life of hypertensive outpatients at a private hospital in Yogyakarta, Indonesia. This cross-sectional study used the EQ5D questionnaire to measure the quality of life of 56 respondents, who had met the inclusion criteria, after three months of antihypertensive therapy. The data were processed by scoring the questionnaire items and then converting the EQ5D dimensions to EQ5D Index based on the Malaysian value set. The data analysis also included descriptive statistics andchi-square test. The results showed that the quality of life, as represented by the EQ-5D index, ranged from 0.375 (lowest) to 0.933 (highest). The severe problems in the quality of life were identified in three dimensions, namely anxiety/ depression (7.14%), pain/discomfort (5.36%), and usual activities (3.57%). Meanwhile, difficulties were not found in the other two dimensions, namely self-care (89.29%) and mobility (55.36%). The results showed that the patients' characteristics, namely sex, age, employment, education, and complication, correlated with quality of life at different levels (p-values), i.e., 0.350, 0.418, 0.992, 0.726, and 0.099, respectively. As a conclusion, there is no significant relationship between patients' characteristics and quality of life (p-values> 0.05).
Hypertension and diabetes mellitus are the leading risk factors for cardiovascular diseases, which are increasing rapidly throughout the world. Hypertension is a non-communicable disease that remains a health problem in Indonesia, with a prevalence of up to 34.11% in 2018. This research was intended to identify cost-effective antihypertensive medication for inpatients with hypertension-diabetes mellitus and hypertensionheart failure. The research method used a retrospective cohort design and measured blood pressure (BP) 72 hours after treatment as the outcome of the observation. Based on a payer perspective, the medical expense was calculated from direct medical costs written in billing invoices. The research subjects were inpatients with hypertension-diabetes mellitus and hypertension-heart failure at a government hospital in Yogyakarta, Indonesia. In the cost-effectiveness analysis, Incremental Cost-Effectiveness Ratio (ICER) was calculated by dividing the difference in cost by the difference in the outcome of hypertension treatment.In the antihypertensive medication of hypertension-diabetes mellitus inpatients, angiotensin-receptor blockers/ calciumchannel blockers (ACB-CCB) were found to be more cost-effective than CCB with incremental costs of IDR 191,405/488,864 for every mmHg decrease of systolic/diastolic BP. Meanwhile, in the antihypertensive treatment of hypertension-heart failure inpatients, the combination of angiotensin-converting-enzyme inhibitors (ACEI) and diuretics was more cost-effective than ACEI-CCB (ICERs= IDR 8,303,483/-39,856,718 per mmHg) and ARB (ICERs= IDR 3,627,694/-2,380,075 per mmHg).In conclusion, ARB-CCB is a cost-effective medication for hypertension-diabetes mellitus inpatients, while ACEI-Diuretics offers a cost-effective hypertensive treatment for hypertension-heart failure inpatients.
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