Analisis Cost-Effectiveness Kombinasi Glimepiride-Metformin Dengan Glimepiride-Pioglitazone pada Pasien Diabetes Mellitus Tipe 2 Rawat Jalan

Abstract

Kombinasi glimepiride-metformin merupakan lini pertama pengobatan diabetes mellitus tipe 2 (DMT 2) dan kombinasi glimepiride-pioglitazon saat ini masuk dalam daftar pedoman pelayanan kefarmasian pada pasien diabetes mellitus. Penelitian ini bertujuan untuk mengetahui kombinasi terapi manakah yang paling cost-effective antara kombinasi glimepiride-pioglitazon dibandingkan kombinasi glimepiride-metformin dalam menurunkan gula darah puasa dan HbA1c. Pada penelitian ini didapatkan 60 sampel pada kelompok kombinasi obat glimepiride-pioglitazon dan 40 sampel pada kelompok kombinasi glimepiride-metformin. Desain penelitian yang dilakukan dengan metode observasional dan alur pengumpulan data secara retrospektif. Analisa data menggunakan perhitungan ACER (Average Cost-Effectiveness Ratio) dan ICER (Incremental Cost-Effectiveness Ratio) dan uji Mann Whitney. Hasil analisis pada kombinasi glimepiride-pioglitazon, yang memenuhi target GDP (gula darah puasa) sebanyak 21,67%, GDA sebanyak 45,00% dan HbA1c sebanyak 36,67% dengan rata-rata biaya pengobatan Rp 2.184.810,00. Sedangkan pada kelompok kombinasi glimepiride-metformin, GDP yang tercapai 2,50%, GDA yang tercapai 20,00% dan HbA1c yang tercapai sebanyak 20,00% dengan rata-rata biaya pengobatan Rp 2.198.060,00. Hasil analisis efektifitas biaya dalam menurunkan kadar GDP, GDA dan HbA1c menunjukan perbedaan efektifitas biaya untuk pengurangan per unit pada pencapaian glukosa darah dan HbA1c yang signifikan. Kombinasi glimepiride-pioglitazon merupakan terapi cost-effective yang signifikan sebagai terapi DMT2 dalam menurunkan GDP (ICER=Rp -387,767), GDA (ICER=Rp -935,074), dan HbA1c (ICER=Rp -794,841).   The glimepiride-metformin combination is the first line of treatment for T2DM and the glimepiride-pioglitazone combination is currently included in the list of pharmaceutical service guidelines for diabetes mellitus patients. This study aims to find out which combination of therapy is the most cost-effective, the glimepiride-pioglitazone combination compared to the glimepiride-metformin combination in reducing fasting blood sugar and HbA1c. In this study, 60 samples were obtained in the glimepiride-pioglitazone drug combination group and 40 samples in the glimepiride-metformin combination group. The research design was carried out using an observational method and a retrospective data collection flow. Data analysis used ACER (Average Cost-Effectiveness Ratio) and ICER (Incremental Cost-Effectiveness Ratio) calculations and the Mann Whitney test. The results of the analysis on the glimepiride-pioglitazone combination, which met the GDP target (fasting blood sugar) of 21.67%, GDA of 45.00% and HbA1c of 36.67% with an average treatment cost of IDR 2,184,810.00. Meanwhile, in the glimepiride-metformin combination group, GDP was achieved at 2.50%, GDA was achieved at 20.00% and HbA1c was achieved at 20.00% with an average treatment cost of IDR 2,198,060.00. The results of the cost-effectiveness analysis in reducing GDP, GDA and HbA1c levels show that the difference in cost-effectiveness for the reduction per unit in achieving blood glucose and HbA1c is significant and the combination of glimepiride-pioglitazone is a significant cost-effective therapy as DMT2 therapy in reducing GDP (ICER=IDR -387,767), GDA (ICER=IDR -935,074), and HbA1c (ICER=IDR -794,841).