Pekerja Perempuan dalam Sektor Informal di Daerah Istimewa YOGYAKARTA Analisis Faktor Pengaruh Berdasarkan Susenas Kor 2014

Kegiatan ekonomi yang dilakukan perempuan tidak terlepas dari faktor yang mempengaruhinya seperti kurangnya pendapatan suami, banyaknya tanggungan keluarga yang menjadikan perempuan ikut serta dalam kegiatan perekonomian demi mencukupi kebutuhan keluarga. Sektor informal menjadi salah satu pilihan yang digunakan perempuan dalam memperoleh pendapatan. Selain tidak membutuhkan modal yang besar, sektor informal juga tidak mengharuskan pelakunya untuk berpendidikan tinggi. Penelitian ini bertujuan untuk mengetahui pengaruh umur, tingkat pendidikan, status perkawinan, dan jumlah anak serta kaitan pengeluaran rumah tangga dengan masuknya perempuan ke sektor informal. Data yang digunakan dalam penelitian ini adalah data Susenas Kor di Daerah Istimewa Yogyakarta tahun 2014 dan dianalisis menggunakan analiasis regresi logistik serta uji t-test untuk mengkaitkan pengeluaran dengan sektor informal. Hasil penelitian menunjukkan bahwa umur, tingkat pendidikan, status perkawinan, dan jumlah anak adalah variabel yang dapat menjelaskan terhadap partisipasi perempuan pada sektor informal. Pendidikan menjadi variabel yang paling dominan dengan nilai exp (B) sebesar 3,534 yang mempengaruhi partisipasi perempuan dalam sektor informal di Daerah Istimewa Yogyakart

Pekerja Perempuan dalam Sektor Informal di Daerah Istimewa YOGYAKARTA Analisis Faktor Pengaruh Berdasarkan Susenas Kor 2014

Kegiatan ekonomi yang dilakukan perempuan tidak terlepas dari faktor yang mempengaruhinya seperti kurangnya pendapatan suami, banyaknya tanggungan keluarga yang menjadikan perempuan ikut serta dalam kegiatan perekonomian demi mencukupi kebutuhan keluarga. Sektor informal menjadi salah satu pilihan yang digunakan perempuan dalam memperoleh pendapatan. Selain tidak membutuhkan modal yang besar, sektor informal juga tidak mengharuskan pelakunya untuk berpendidikan tinggi. Penelitian ini bertujuan untuk mengetahui pengaruh umur, tingkat pendidikan, status perkawinan, dan jumlah anak serta kaitan pengeluaran rumah tangga dengan masuknya perempuan ke sektor informal. Data yang digunakan dalam penelitian ini adalah data Susenas Kor di Daerah Istimewa Yogyakarta tahun 2014 dan dianalisis menggunakan analiasis regresi logistik serta uji t-test untuk mengkaitkan pengeluaran dengan sektor informal. Hasil penelitian menunjukkan bahwa umur, tingkat pendidikan, status perkawinan, dan jumlah anak adalah variabel yang dapat menjelaskan terhadap partisipasi perempuan pada sektor informal. Pendidikan menjadi variabel yang paling dominan dengan nilai exp (B) sebesar 3,534 yang mempengaruhi partisipasi perempuan dalam sektor informal di Daerah Istimewa Yogyakart

The Role of Administrative and Secondary Data in Estimating the Costs and Effects of School and Workplace Closures due to the COVID-19 Pandemic

As a part of mitigation strategies during a COVID-19 pandemic, the WHO currently recommends social distancing measures through school closures (SC) and work closures (WC) to control the infection spread and reduce the illness attack rate. Focusing on the use of administrative and secondary data, this study aimed to estimate the costs and effects of alternative strategies for mitigating the COVID-19 pandemic in Jakarta, Indonesia, by comparing the baseline (no intervention) with SC + WC for 2, 4, and 8 weeks as respective scenarios. A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for the spread of infection during the latent period was applied by taking into account a 1-year time horizon. To estimate the total pandemic cost of all scenarios, we took into account the cost of healthcare, SC, and productivity loss due to WC and illness. Next to costs, averted deaths were considered as the effect measure. In comparison with the baseline, the result showed that total savings in scenarios of SC + WC for 2, 4, and 8 weeks would be approximately $24 billion,$25 billion, and $34 billion, respectively. In addition, increasing the duration of SC and WC would increase the number of averted deaths. Scenarios of SC + WC for 2, 4, and 8 weeks would result in approximately 159,075, 173,963, and 250,842 averted deaths, respectively. A sensitivity analysis showed that the wage per day, infectious period, basic reproduction number, incubation period, and case fatality rate were found to be the most influential parameters affecting the savings and number of averted deaths. It can be concluded that all the mitigation scenarios were considered to be cost-saving, and increasing the duration of SC and WC would increase both the savings and the number of averted deaths

Impact of Switch Options on the Economics of Pneumococcal Conjugate Vaccine (PCV) Introduction in Indonesia

As one of Gavi, the Vaccine Alliance (previously the Global Alliance for Vaccines and Immunization), graduating countries, Indonesia is still eligible to access Gavi price for PCV13, PCV10 A and B. This study aims to estimate the economic impact of switch from the existing product/presentation of PCV (single-dose of PCV13) to the new product/presentation of PCV (multi-dose of PCV13, PCV10 A and B) since PCV is one of the most expensive vaccines in the Expanded Program on Immunization (EPI) schedule. Assuming that Gavi-Advance Market Commitment (AMC) price for all PCVs can be accessed in 2021, the use of multi-dose PCV13, PCV10 A and PCV10 B with Gavi-AMC price in 2021-2024 were considered as respective scenarios. The result showed that the scenario assuming the use of single-dose of PCV13 with contract price in 2019-2020 that would be switched into multi-dose of PCV10 B with Gavi-AMC price in 2021-2024 resulted in the highest potential saving, compared with other scenarios. Our analysis suggests an economic advantage to switch from single-dose into a multi-dose presentation. Vaccination coverage, vaccine price, vaccine wastage and additional Gavi-AMC vaccine costs were considered to be the most influential parameter affecting the savings in all scenarios. Applying the effectiveness of PCV13 and PCV10 A on reducing the risk for invasive pneumococcal disease (IPD), potential averted incidence of IPD in children under one year of age during 2019-2024 would be 246,164 and 105,587 in both scenarios. Despite the result confirmed that PCV13 may provide an additional benefit, a more comprehensive economic evaluation study is required to investigate further the comparison of cost-effectiveness values among all PCVs in Indonesia

Cost-Effectiveness Analysis of Spending on Research and Development to Address the Needs for Innovative Therapeutic Products in Indonesia

Background: The annual gross domestic expenditure on research and development (GERD) per capita of Indonesia ($24) remains relatively lower than the annual GERD per capita of neighboring countries, such as Vietnam ($36), Singapore ($1804), Malaysia ($361), and Thailand (111). Objective: The aim of this study was to conduct a cost-effectiveness analysis of spending on healthcare R&D to address the needs of developing innovative therapeutic products in Indonesia. Methods: A decision tree model was developed by taking into account four stages of R&D: stage 1 from raw concept to feasibility, stage 2 from feasibility to development, stage 3 from development to early commercialization, and stage 4 from early to full commercialization. Considering a 3-year time horizon, a stage-dependent success rate was applied and analyses were conducted from a business perspective. Two scenarios were compared by assuming the government of Indonesia would increase GERD in health and medical sciences up to 2- and 3-times higher than the baseline (current situation) for the first and second scenario, respectively. Cost per number of innovative products in health and medical sciences was considered as the incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was conducted to investigate the effects of different input parameters on the ICER. Results: There was a statistically significant association (P-value<0.05) between countries' GERD in medical and health sciences with the number of innovative products. We estimated the ICER would be 8.50 million and $2.04 million per innovative product for the first and second scenario, respectively. The sensitivity analysis showed that the success rates in all stages and total GERD were the most influential parameters impacting the ICER. Conclusion: The result showed that there was an association between GERD in medical and health sciences with the number of innovative products. In addition, the second scenario would be more cost-effective than the first scenario

Pneumococcal Vaccination for Children in Asian Countries:A Systematic Review of Economic Evaluation Studies

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable

Pre-eclampsia Diagnosis and Treatment Options:A Review of Published Economic Assessments

Pre-eclampsia is a pregnancy complication affecting both mother and fetus. Although there is no proven effective method to prevent pre-eclampsia, early identification of women at risk of pre-eclampsia could enhance appropriate application of antenatal care, management and treatment. Very little is known about the cost effectiveness of these and other tests for pre-eclampsia, mainly because there is no clear treatment path. The aim of this study was to provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis and treatment options in pre-eclampsia.We searched three electronic databases (PubMed, EMBASE and the Cochrane Library) for studies on screening, diagnosis, treatment or prevention of pre-eclampsia, published between 1994 and 2014. Only full papers written in English containing complete economic assessments in pre-eclampsia were included.From an initial total of 138 references, six papers fulfilled the inclusion criteria. Three studies were on the cost effectiveness of treatment of pre-eclampsia, two of which evaluated magnesium sulphate for prevention of seizures and the third evaluated the cost effectiveness of induction of labour versus expectant monitoring. The other three studies were aimed at screening and diagnosis, in combination with subsequent preventive measures. The two studies on magnesium sulphate were equivocal on the cost effectiveness in non-severe cases, and the other study suggested that induction of labour in term pre-eclampsia was more cost effective than expectant monitoring. The screening studies were quite diverse in their objectives as well as in their conclusions. One study concluded that screening is probably not worthwhile, while two other studies stated that in certain scenarios it may be cost effective to screen all pregnant women and prophylactically treat those who are found to be at high risk of developing pre-eclampsia.This study is the first to provide a comprehensive overview on the economic aspects of pre-eclampsia in its broadest sense, ranging from screening to treatment options. The main limitation of the present study lies in the variety of topics in combination with the limited number of papers that could be included; this restricted the comparisons that could be made. In conclusion, novel biomarkers in screening for and diagnosing pre-eclampsia show promise, but their accuracy is a major driver of cost effectiveness, as is prevalence. Universal screening for pre-eclampsia, using a biomarker, will be feasible only when accuracy is significantly increased.</p

Early cost-effectiveness analysis of screening for preeclampsia in nulliparous women:A modelling approach in European high-income settings

BACKGROUND: Preeclampsia causes substantial maternal and perinatal morbidity and mortality and significant societal economic impact. Effective screening would facilitate timely and appropriate prevention and management of preeclampsia. OBJECTIVES: To develop an early cost-effectiveness analysis to assess both costs and health outcomes of a new screening test for preeclampsia from a healthcare payer perspective, in the United Kingdom (UK), Ireland, the Netherlands and Sweden. METHODS: A decision tree over a 9-month time horizon was developed to explore the cost-effectiveness of the new screening test for preeclampsia compared to the current screening strategy. The new test strategy is being developed so that it can stratify healthy low risk nulliparous women early in pregnancy to either a high-risk group with a risk of 1 in 6 or more of developing preeclampsia, or a low-risk group with a risk of 1 in 100 or less. The model simulated 25 plausible scenarios in a hypothetical cohort of 100,000 pregnant women, in which the sensitivity and specificity of the new test were varied to set a benchmark for the minimum test performance that is needed for the test to become cost-effective. The input parameters and costs were mainly derived from published literature. The main outcome was incremental costs per preeclampsia case averted, expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty. RESULTS: Base case results showed that the new test strategy would be more effective and less costly compared to the current situation in the UK. In the Netherlands, the majority of scenarios would be cost-effective from a threshold of €50,000 per preeclampsia case averted, while in Ireland and Sweden, the vast majority of scenarios would be considered cost-effective only when a threshold of €100,000 was used. In the best case analyses, ICERs were more favourable in all four participating countries. Aspirin effectiveness, prevalence of preeclampsia, accuracy of the new screening test and cost of regular antenatal care were identified as driving factors for the cost-effectiveness of screening for preeclampsia. CONCLUSION: The results indicate that the new screening test for preeclampsia has potential to be cost-effective. Further studies based on proven accuracy of the test will confirm whether the new screening test is a cost-effective additional option to the current situation

Cost-Effectiveness of Dengue Vaccination in Indonesia:Considering Integrated Programs withWolbachia-Infected Mosquitos and Health Education

Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination,Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst takingWolbachiaand health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and aWolbachiaprogram, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and$6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and aWolbachiaprogram would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and$14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and$9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9995,$4460, and $6399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with aWolbachiaprogram was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost ofWolbachiaprogram, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs

Antidepressant use during pregnancy and the risk of developing gestational hypertension:A retrospective cohort study

Background: Prior studies reported that exposure to antidepressants during pregnancy may be associated with gestational hypertension. The aim of this study is to assess the association between the use of antidepressants during pregnancy and the risk of developing gestational hypertension. Methods: A retrospective cohort study using the prescription database IADB.nl was conducted among nulliparous women with singleton pregnancies between 1994 and 2015 in the Netherlands. Logistic regression analysis was used to estimate odds ratios (OR), adjusted OR (aOR) and their corresponding 95% confidence intervals (95% CI). Gestational hypertension as main outcome measure was defined as at least one dispensed record of an antihypertensive drug (methyldopa, nifedipine, labetalol, ketanserin, nicardipine) after 20 weeks of gestation until 14 days after delivery. Sub- analyses were conducted for class of antidepressant, duration and amount of use of antidepressant (= 30 Defined Daily Doses or DDDs), and maternal age. Sensitivity analyses to assess uncertainties were conducted. Results: Twenty-eight thousand twenty women were included, of which 539 (1.92%) used antidepressants. The risk of gestational hypertension was doubled for women using antidepressant (aOR 2.00 95% CI 1.28-3.13). Significant associations were also found for the subgroup selective serotonin reuptake inhibitors (SSRIs) (aOR 2.07 95% CI 1.25-3.44), >= 30 DDDs (aOR 2.50 95% CI 1.55-3.99) and maternal age of 30-34 years (aOR 2.59 95% CI 1.35-4.98). Varying the theoretical gestational age showed comparable results. Conclusion: Prolonged use of antidepressants during the first 20 weeks of gestation appeared to be associated with an increased risk of developing gestational hypertension. When balancing the benefits and risks of using these drugs during pregnancy, this should be taken into account