Cost-effectiveness analysis of COVID-19 treatment for hospitalized patients: a healthcare provider perspective in Batam, Indonesia 10.55131/jphd/2023/210223
Main Article Content
Abstract
The COVID-19 pandemic is a global crisis that has continued to impact health, population, and the economy. Therefore, this study aims to evaluate the cost-effectiveness of COVID-19 treatment for hospitalized patients from the perspective of healthcare providers. An observational study was conducted retrospectively by collecting data from medical records of hospitalized COVID-19 patients between April 1 and June 30, 2021. The effectiveness of the therapy was evaluated based on COVID-19 treatment guidelines in Indonesia, by calculating the number of recovered patients within 14 days. The study only considered the direct medical costs of treatment, while the cost-effectiveness was analyzed using Average Cost-Effectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER). The results showed that the average direct cost of COVID-19 treatment per patient was approximately IDR 28,114,775.52 ± IDR 16,352,597.11. The most effective treatment was Favipiravir + Levofloxacin + N-acetylcysteine, followed by Favipiravir + Levofloxacin + Azithromycin + N-acetylcysteine, with 97% and 91% effectiveness, respectively. The ACER of COVID-19 treatments ranged from Rp 15,596,973 to 58,140,864, while the ICER was mainly located in the South East Quadrant, with Favipiravir + Levofloxacin + N-acetylcysteine being dominant compared to other treatments, saving IDR 161,653.97 to 33,870,916.17 per recovered patient. Effective COVID-19 treatments for hospitalized patients provide good value for the health system. However, this study was limited by the unavailability of the most recent information on the rapidly evolving pandemic.
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References
Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, Farahmandian N, Miresmaeili SM, Bahreini E. A comprehensive review of COVID-19 characteristics. Biol Proced Online. 2020;22:19. doi: 10.1186/s12575-020-00128-2.
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60.
Perlman S. Another Decade, Another Coronavirus. N Engl J Med. 2020;382(8):760-2. doi: 10.1056/ NEJMe2001126.
Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192-206. doi: 10.1111/ joim.13091.
Infeksi-Emerging. Indonesia Ministry of Health: Infeksi-Emerging. 2023 [cited 2022 Nov 11]. Available from: https://covid19.kemkes.go.id/dashboard/covid-19.
Ministry of Health Indonesia. Regulation of the Minister of Health on Guidelines for the Implementation of the National Health Insurance Program. Jakarta; 2014.
Susanti G, Iva MIN, Yani AA, Hidayat AR. Assessing the National Health Insurance System: A Study of The Implementation of Health Insurance Policy in Indonesia. Public Policy Adm. 2022;21(4):511-25. doi: 10.13165/ VPA-22-21-4-13.
Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, Evaluation, and Treatment of Coronavirus (COVID-19). StatPearls. Treasure Island (FL): StatPearls Publishing Copyright 2023, StatPearls Publishing LLC.; 2023.
Mule S, Singh A, Greish K, Sahebkar A, Kesharwani P, Shukla R. Drug repurposing strategies and key challenges for COVID-19 management. J Drug Target. 2022; 30(4):413-29. doi: 10.1080/1061186X. 2021.2013852.
Adam AM. Sample Size Determination in Survey Research. J Sci Res Rep. 2020;26(5):90-7. doi: 10.9734/JSRR/ 2020/V26I530263.
Burhan E, Susanto AD, Isbaniah F, Nasution SA, Ginanjar E, Pitoyo CW, et al. Indonesia Protocol Guideline of COVID-19. 3rd ed. Indonesian Pulmonary Specialist Doctors Association (PDPI): Jakarta; 2020.
Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24): 759-65. doi: 10.15585/mmwr.mm 6924e2.
Setiadi W, Rozi IE, Safari D, Daningrat WOD, Johar E, Yohan B, et al. Prevalence and epidemiological characteristics of COVID-19 after one year of pandemic in Jakarta and neighbouring areas, Indonesia: A single center study. PLOS ONE. 2022;17(5):e0268241. doi: 10.1371/ journal.pone.0268241.
Abate BB, Kassie AM, Kassaw MW, Aragie TG, Masresha SA. Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis. BMJ Open. 2020; 10(10):e040129. doi: 10.1136/ bmjopen-2020-040129.
Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, Shahjouei S, et al. Racial, Economic, and Health Inequality and COVID-19 Infection in the United States. J Racial Ethn Health Disparities. 2021;8(3):732-42. doi: 10.1007/s40615-020-00833-4.
Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? Bmj. 2020;369:m1548. doi: 10.1136/ bmj.m1548.
Cleverley WO, Cleverley JO. Essentials of Health Care Finance. Jones and Bartlett Learning: Ohio; 2017.
Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. PLOS ONE. 2018;13(4): e0195901. doi: 10.1371/journal.pone. 0195901.
Clarias C, Sukoharsono EG, Mulawarman AD. The Implementation of INA-CBGs (Indonesia Case-Based Groups) System and Strategic Response in Institutional Theory Perspective (Case Research in RSUD Dr. Saiful Anwar Malang). JABE. 2018;2(2). doi: 10.26675/JABE.V2I2.11224.
Burhan E, Susanto AD, Isbaniah F, Nasution SA, Ginanjar E, Pitoyo CW, et al. Indonesia Protocol Guideline of COVID-19. 4th ed. Indonesian Pulmonary Specialist Doctors Association (PDPI): Jakarta; 2022.
Qomara WF, Primanissa DN, Amalia SH, Purwadi FV, Zakiyah N. Effectiveness of Remdesivir, Lopinavir/Ritonavir, and Favipiravir for COVID-19 Treatment: A Systematic Review. Int J Gen Med. 2021;14:8557-71.
Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci. 2017;93(7):449-63. doi: 10.2183/pjab. 93.027.
Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-71. doi: 10.1038/ s41422-020-0282-0.
Spinner CD, Gottlieb RL, Criner GJ, Arribas López JR, Cattelan AM, Soriano Viladomiu A, et al. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients with Moderate COVID-19: A Randomized Clinical Trial. Jama. 2020;324(11):1048-57. doi: 10.1001/ jama.2020.16349.
Eastman RT, Roth JS, Brimacombe KR, Simeonov A, Shen M, Patnaik S, et al. Remdesivir: A Review of Its Discovery and Development Leading to Emergency Use Authorization for Treatment of COVID-19. ACS Cent Sci. 2020;6(5):672-83. doi: 10.1021/ acscentsci.0c00489.
Coz Yataco AO, Simpson SQ. Coronavirus Disease 2019 Sepsis: A Nudge Toward Antibiotic Stewardship. Chest. 2020;158(5):1833-4. doi: 10.1016/j.chest.2020.07.023.
Wong KK, Lee SWH, Kua KP. N-Acetylcysteine as Adjuvant Therapy for COVID-19 - A Perspective on the Current State of the Evidence. J Inflamm Res. 2021;14:2993-3013. doi: 10.2147/JIR.S306849.
Zhou N, Yang X, Huang A, Chen Z. The Potential Mechanism of N-acetylcysteine in Treating COVID-19. Curr Pharm Biotechnol. 2021;22(12): 1584-90. doi: 10.2174/1389201021999 201228212043.
De Flora S, Balansky R, La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID-19. Faseb j. 2020;34(10):13185-93. doi: 10.1096/ FJ.202001807.
Robinson LA, Hammitt JK, Chang AY, Resch S. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds. Health Policy Plan. 2017;32(1):141-5. doi: 10.1093/heapol/czw096.
Priyadi A, Permana H, Muhtadi A, Sumiwi SA, Sinuraya RK, Suwantika AA. Cost-Effectiveness Analysis of Type 2 Diabetes Mellitus (T2DM) Treatment in Patients with Complications of Kidney and Peripheral Vascular Diseases in Indonesia. Healthcare (Basel). 2021;9(2). doi: 10.3390/healthcare 9020211.
Krylova O, Krasheninnikov A, Mamontova E, Tananakina G, Belyakova D. Pharmacoeconomic Analysis of Treatment Regimens for Coronavirus Infection Coronavirus Disease-19. OAMJMS. 2021;9(E): 1182-9. doi: 10.3889/OAMJMS. 2021.7015.
Alamer A, Almutairi AR, Halloush S, Al-Jedai A, Alrashed A, AlFaifi M, et al. Cost-effectiveness of Favipiravir in moderately to severely ill COVID-19 patients in the real-world setting of Saudi arabian pandemic referral hospitals. Saudi Pharm J. 2023; 31(4):510-6. doi: 10.1016/j.jsps. 2023.02.003.
Congly SE, Varughese RA, Brown CE, Clement FM, Saxinger L. Treatment of moderate to severe respiratory COVID-19: a cost-utility analysis. Sci Rep. 2021;11(1):17787. doi: 10.1038/ s41598-021-97259-7.
Jiang Y, Cai D, Chen D, Jiang S, Si L, Wu J. Economic evaluation of remdesivir for the treatment of severe COVID-19 patients in China under different scenarios. Br J Clin Pharmacol. 2021;87(11):4386-96. doi: 10.1111/bcp.14860.
Nguyen AA, Habiballah SB, Platt CD, Geha RS, Chou JS, McDonald DR. Immunoglobulins in the treatment of COVID-19 infection: Proceed with caution! Clin Immunol. 2020;216: 108459. doi: 10.1016/j.clim.2020. 108459.
Schwab I, Nimmerjahn F. Intravenous immunoglobulin therapy: how does IgG modulate the immune system? Nat Rev Immunol. 2013;13(3):176-89. doi: 10.1038/nri3401.
Indonesia Ministry of Health. Indonesia Ministry of Health Decree No HK.01.07/MENKES/5671/2021 about Clinical Management of COVID-19 in Health Care Facilities. Indonesia Ministry of Health: Jakarta; 2021.
Akinbolade S, Coughlan D, Fairbairn R, McConkey G, Powell H, Ogunbayo D, et al. Combination therapies for COVID-19: An overview of the clinical trials landscape. Br J Clin Pharmacol. 2022;88(4):1590-7. doi: 10.1111/ bcp.15089.