STUDI COST-EFFECTIVENESS ANALYSIS (CEA) TERHADAP TERAPI SIROSIS HEPATIK DI RUMAH SAKIT ADI HUSADA UNDAAN WETAN SURABAYA

Sirosis merupakan suatu proses difusi yang dikarakteristikkan dengan fibrosis dan perubahan dari struktur hepatik normal menjadi nodul abnormal secara struktural. Oleh karena besarnya biaya pengobatan jangka panjang sirosis hepatik yang harus ditanggung, maka diperlukan suatu penelitian untuk menganalisa terapi sirosis hepatik yang tidak hanya efektif tapi juga efisien dari segi biaya. Tujuan: Menganalisis perbandingan efektifitas biaya (cost-effectiveness) dari terapi komplikasi pasien sirosis hepatik (ascites, hematemesis/melena, dan hepatic encepalopathy) di rumah sakit. Metode: Metode penelitian yang digunakan ialah Cost-Effectiveness Analysis (CEA). Pada CEA, dilakukan pengukuran dan pembandingan biaya terapi dan konsekuensi dari suatu intervensi. Hasil penelitian: Pengobatan paling cost-effective pada ascites adalah terapi diuretik furosemid iv bolus dibandingkan dengan spironolakton oral-furosemid iv bolus dan spironolakton oral-furosemid iv bolus-furosemid oral. Penggunaan terapi vitamin K lebih cost-effective dibandingkan terapi kombinasi vitamin K-transamin. Sedangkan CEA pada pasien hepatic encephalopathy menyebutkan bahwa laktulosa 2x1C mempunyai nilai yang lebih kecil daripada laktulosa 3x1C. Kesimpulan: Perlunya peningkatan peran farmasis dalam pemilihan terapi yang paling efentif dan efisien bagi pasien dengan komplikasi sirosis

CYP2C19*17 Polymorphisms And Platelet Aggregation In Coronary Artery Disease Patients With Clopidgrel

Background: Clopidogrel is the alternative therapy for patients with Coronary Artery Disease (CAD) that couldn’t use Aspirin as antiplatelet. There’s some factors that contribute to clopidogrel effectiveness, such as obesity, Diabetes Mellitus, Smoking, and genetic polymorphisms. Objective: The aim of this study is to analyze the CYP2C19*17 polymorphism related with platelet aggregation as marker of Clopidogrel effectiveness. Methods: Cross sectional study was used. Some criteria were used for patient recruitment such as: compliance with drug therapy (measured by Morisky Medication Adherence Scale), without diabetes mellitus, no obese and no smoking. Patients used clopidogrel for 3 months. Blood sample was collected for genetic polymorphism analysis and platelet aggregation. Genetic polymorphisms would analyze by Polymerase Chain Reaction and Platelet Aggregation with Light Transmission Aggregometry. Result 20 CAD patients used for this study. 30% patients have polymorphisms in CYP2C19*17. 80% patients have hipoaggregation and 20% have normoaggregation. In this study, 30% patients that have CYP2C19*17 polymorphisms still have a normal platelet aggregation. None of them have a high level of platelet aggregation. Conclusion: Patients with CYP2C19*17 polymorphisms have a normal and low level of platelet aggregation

COST-EFFECTIVENESS ANALYSIS OF PHARMACOTHERAPY FOR HEMATEMESIS-MELENA TREATMENT IN HOSPITALIZED PATIENT WITH HEPATIC CIRRHOSIS

BACKGROUND: Acute variceal haemorrhage is a complication of cirrhosis, which could have life threatening impact. It is a pharmacist duty to ensure therapeutic and pharmaceutical care which is not only safe and effective for patients but has also a cost-effective property which purpose is the improvement of patient’s quality of life. Therefore, pharmacoeconomic evaluation specifically CEA (cost-effectiveness analysis) which compare cost and consequences of therapy is needed. This study was aimed to evaluate therapeutic cost-effectiveness of hematemesis-melena treatment in hepatic cirrhosis patients. METHODS: A total of 42 patients receiving vitamin K-only parenterally and combination of vitamin K+transamin parenterally were studied retrospectively from patient’s medical record in 2 years, and analyzed with cost-effectiveness grid and ACER (average cost-effectiveness ratio) based on Child-Turcotte-Pugh Score. RESULTS: Cost-effectiveness grid showed dominant for vitamin K-only in patient with Child-Turcotte-Pugh Score A. ACER analysis showed lower score for vitamin K-only in all patient included Child-Turcotte Pugh Score classification. There were no significant difference for duration of cessation of bleeding treatment in patients with vitamin K-only compare to vitamin K+transamin in patients with Child-Turcotte Pugh Score A and B, while there was significant difference in patients with Child-Turcotte Pugh Score C. CONCLUSION: Vitamin K-only appear to be more cost-effective compare to vitamin K+transamin in all patients. The use of vitamin K-only has greater benefit than the combination of vitamin K with transamin in all patient and Child-Turcotte-Pugh score classification, and should be considered as a primary therapy. Thus, transamin addition as an alternative therapy for hepatic cirrhosis patient with hematemesis-melena should be reconsidered

STUDI KELENGKAPAN PENJELASAN CARA PENGGUNAAN SEDIAAN CONTROLLER INHALER (KOMBINASI KORTIKOSTEROID DENGAN BETA-2 AGONIS) JENIS DISKUS® DAN TURBUHALER® OLEH APOTEKER DI APOTEK

Asthma is a chronic disease that can be controlled by treatment with a controller containing a corticosteroid combination with beta-2 agonists, which are available in the form Diskus® and Turbuhaler® which is DPI (dry powder inhaler) in Indonesia. Techniques improper use can give less than optimal results, therefore, the role of pharmacists to provide education in the form of how to explain the inhaler. This study aims to find out information on how to use Diskus® and Turbuhaler® by pharmacists to patients with asthma in the pharmacy area of ​​the city of Surabaya. This research is non-experimental research with cross sectional method, and using observation techniques in the form of a checklist. Sampling by non-random sampling method by using purposive. The data will be processed with descriptive statistical analysis. Based on the results of research on the use of information studies preparation Diskus® explanation is given, it can be concluded there is no pharmacist in the category optimal technique that is able to mention all the steps properly. Most pharmacists categorized adequate technique for the pharmacist is able to name all of the critical step. While on how to use Turbuhaler® information provided by pharmacists in explaining Turbuhaler to patients in pharmacies is still lacking for by an explanation of each step are not all pharmacists can explain all the steps correctly and based on the critical step yet pharmacists who achieve adequate and optimal techniques

Cost-Effectiveness Analysis Kloramfenikol Dan Seftriakson Untuk Pengobatan Demam Tifoid Pada Pasien Dewasa Di Rumah Sakit Sanglah Denpasar

Jumlah pasien demam tifoid di Indonesia masih tinggi. Demam tifoid dapat diobati dengan terapi antibiotik seperti kloramfenikol dan seftriakson. Tujuan dari penelitian ini adalah untuk membandingkan efektivitas biaya kloramfenikol dan seftriakson yang diberikan kepada pasien dewasa yang didiagnosis demam tifoid di Rumah Sakit Sanglah Denpasar. Pada penelitian ini dilakukan perbandingan antara dua alternatif yang ada dengan menggunakan perspektif rumah sakit. Metode retrospektif digunakan untuk mengumpulkan data dari rekam medis pasien, yang didiagnosis dan dirawat inap di Rumah Sakit Sanglah Denpasar selama Januari 2017 hingga Juli 2018. Analisis biaya dilakukan dengan menggunakan metode cost-effectiveness grid dan costeffectiveness ratio (ACER). Cost-effectiveness grid menunjukkan bahwa dominan seftriakson untuk pasien dengan demam tifoid. Analisis ACER untuk seftriakson adalah Rp. 2.097.170,88 dengan efektifitas (lama tinggal) 4,27 hari, dan Rp. 2.097.170,88 dengan efektivitas (waktu mencapai suhu normal) 2,42 hari. Analisis ACER untuk kloramfenikol adalah Rp. 2.555.464,22 dengan efektifitas (lama tinggal) 10,22 hari, dan Rp. 2.555.464,22 dengan efektivitas (waktu mencapai suhu normal) 3,44 hari. Analisis ACER menunjukkan tingkat seftriakson yang lebih rendah dan efektivitas yang lebih tinggi berdasarkan lama tinggal dan waktu mencapai suhu normal. Kesimpulan dari penelitian ini adalah bahwa seftriakson lebih cost-effective daripada kloramfenikol

KARAKTERISTIK INFORMASI TERKAIT CARA PENGGUNAAN METERED-DOSE INHALER DENGAN SPACER YANG MENGANDUNG KOMBINASI BETA-2 AGONIS DAN KORTIKOSTEROID OLEH APOTEKER DI APOTEK WILAYAH SURABAYA TIMUR

Treatment of respiratory disorders using a metered-dose inhaler (MDI) with spacer becomes one of the important points. Pharmacists at pharmacies are the final key in therapy to ascertain how the use of inhalation tools is correct. This study aims to determine the completeness of each step of information on how to use MDI with spacer given by pharmacists at pharmacies in East Surabaya. The research design used is cross-sectional study with the subject of research is pharmacist in pharmacy. The research variable is the explanation of how to use MDI inhaler with spacer. An assessment method of 8 steps on how to use MDI with spacer and each number gets a value. Research subjects were 22 pharmacists. Most pharmacists describe each step orally by using the tool directly, ie at step: 1a (77.27%), 1b (77.27%), 2 (81.81%), 3 (31.81%) , 4a (59.09%), 4b (13.63%), 5a (100%), 5b (63.63%), 6a (90.90%), 6b (40.90%), 8a (9 , 09%), and 8b (9.09%). Most of the pharmacists explain verbally with a demonstration tool but only one pharmacist can explain all the steps completely. Therefore, pharmacists need to improve IEC services related to the use of MDI with a spacer for respiratory treatment

KELENGKAPAN INFORMASI MENGENAI CARA PENGGUNAAN PEAK FLOW METER YANG DIBERIKAN KEPADA PASIEN ASMA DI APOTEK

Measurement of lung fungction  is a way to determine the effectiveness of a given therapy. A monitoring asthma symptoms is to see the value of peak expiratory flow (PEF) with a peak flow meter. The measurement is objective and can be used to predict the prognosis of asthma through the monitoring of conditions of the lung. This study aims to find out information on the use of a peak flow meter explanations given to the patient’s pharmacist in a pharmacy in a town in East Java. This research method is a non-experimental with cross sectional study. This study uses observation techniques in the form of a checklist, using the concept of a mysterious patient. Sampling by the proportional method, and then the data will be processed descriptively. The research sample of 80 pharmaceutical personnel consisting of 33 pharmacists and 47 non-pharmacists. In the group of non-pharmacists and pharmacists, the points most overlooked is the explanation of the recording of the results (number 6) and compared with the best value (number 8). Pharmacists still need to improve in understanding the basics and techniques in order to use a peak flow meter can help asthma patients to monitor their asthma medicatio

Cost Effectiveness Analysis of Diuretics Therapy for Ascites in Hepatic Cirrhosis at Adi Husada Undaan Wetan Hospital in Surabaya

Background: Hepatic cirrhosis is a seriously chronic degenerative disease in which normal liver cells are damaged and are replaced by scar tissue. Ascites is the most frequent complication that happened in hepatic cirrhosis and need to be managed properly, especially in the cost effectiveness analysis. Cost Effectiveness Analysis is a form of Pharmacoeconomic study that evaluates and compares the cost and the clinical outcome of two or more treatments. Objective: The purpose of this research is to compare the cost-effectiveness of 3 kinds of Ascites treatments: bolus intravenous Furosemid versus combination of oral Spironolakton and bolus intravenous Furosemid versus combination of oral Spironolakton, oral Furosemid and bolus intravenous Furosemid. Method: Subjects (N = 29) were hepatic cirrhosis patients with ascites, and their age ranging from 34 to 85 years old. Data were collected from Adi Husada Undaan Wetan Hospital, Surabaya, from January 2010 to December 2011, using the retrospective approach. The sampling method used is purposive sampling. The measurement of cost was based on the cost of the drug used for the treatment and the effectiveness of the treatment is calculated based on the measurement of the increase of urine collection and the length of therapy. Data were analysed with Kruskal Wallis method and by calculating the value of Average Cost Effectiveness Ratio (ACER). Result: The value of ACER for Furosemid bolus intravenous was IDR 139,800, for oral Spironolakton and Furosemid bolus intravenous was IDR 158,763 and for Spironolakton oral and Furosemid oral and Furosemid bolus intravenous was IDR 332,337. Conclusion: This study showed that Ascites treatment with Furosemid bolus intravenous is most cost-effective. This result supports the preparation of the formulary with an alternative therapy which is more cost-effective. Keywords : cost-effectiveness analysis, diuretic, cirrhosis hepatic, ascites

KELENGKAPAN INFORMASI MENGENAI CARA PENGGUNAAN PEAK FLOW METER YANG DIBERIKAN KEPADA PASIEN ASMA DI APOTEK

Measurement of lung fungction is a way to determine the effectiveness of a given therapy. A monitoring asthma symptoms is to see the value of peak expiratory flow (PEF) with a peak flow meter. The measurement is objective and can be used to predict the prognosis of asthma through the monitoring of conditions of the lung. This study aims to find out information on the use of a peak flow meter explanations given to the patient's pharmacist in a pharmacy in a town in East Java. This research method is a nonexperimental with cross sectional study. This study uses observation techniques in the form of a checklist, using the concept of a mysterious patient. Sampling by the proportional method, and then the data will be processed descriptively. The research sample of 80 pharmaceutical personnel consisting of 33 pharmacists and 47 non-pharmacists. In the group of non-pharmacists and pharmacists, the points most overlooked is the explanation of the recording of the results (number 6) and compared with the best value (number 8). Pharmacists still need to improve in understanding the basics and techniques in order to use a peak flow meter can help asthma patients to monitor their asthma medication

Studi Farmakokinetika Teofilina Setelah Pemberian Oral Dosis Tunggal Tablet Teofilina dan Aminofilina Lepas Kendali pada Subyek Normal

Telah dilakukan penelitian untuk mempelajari farmakokinetika dari teofilina setelahpemberian oral dosis tunggal tablet teofilina dan aminofilina lepas kendali pada subyek normal. Ta–blet teofilina (dosis 300 mg) dan aminofilina (dosis 350 mg) lepas kendali diberikan dalam bentukoral dosis tunggal, pada pria normal (20-30 tahun, 50-75 kg), tidak merokok, dengan fungsi paruparu,hati, ginjal dan jantung normal. Kadar teofilina serum ditentukan dengan metode FlourescencePolarization Immunoassay (FPIA). Parameter farmakokinetika yang diamati meliputi: t maks, Cpmaks, AUC, tetapan laju absorpsi (Ka) dan eliminasi (K) serta t ½ eliminasi. Hasil penelitian menunjukkanbahwa profil kurva kadar teofilina serum terhadap waktu untuk tablet teofilina (AUC=97,56μg/ml jam, Cp maks=5,83 μg/ml, Ka=0,209 jam-1, t maks=4 jam, K=0,080 jam-1, dan t½=8,87 jam)dan aminofilina (AUC=121,93 μg/ml jam, Cp maks=6,70 μg/ml, Ka=0,239 jam-1, t maks=6,8 jam,K=0,061 jam-1, dan t½=11,51 jam) lepas kendali sesuai dengan profil farmakokinetika sediaan lepaskendali pada umumnya