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Fulltext Cost effectiveness analysis between small incision cataract surgery and phacoemulsification

Wulandari, Anggun, Maznah Dahlui, Ernawaty, Wulandari, Ratna Dwi, Rochmah, Thinni Nurul

JUMMEC, 2020;23(101):231-237.
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Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision method (SICS) and Phacoemulsification method, and it is important to know the cost-effective comparison of those two methods.

Objective: This study aims to conduct Cost-Effectiveness Analysis (CEA) between cataract surgery; Small Incision Cataract Surgery (SICS) and Phacoemulsification, at Undaan Eye Hospital Surabaya.

Materials and Method: A prospective study following up patients from before surgery up to 21 days’ post surgery. A total of 155 cataract patients had undergone surgery; 25 patients and 130 patients had SICS and Phacoemulsification, respectively. Quality-Adjusted Life Years (QALYs) was used as the outcome measure. The assessment of utility using ‘Visual Function 25’ (VF-25) was the quality of life regarding visual function before surgery, 7 days, and 21 days post-surgery.

Result: The average cost of Phacoemulsification technique was Rp 10,821,038 and the average cost of SICS technique was Rp 10,443,544. QALYs at day7 post-surgery of Phacoemulsification and SICS was 9.49 and 8.95, respectively. While QALYs at day21 post- surgery of Phacoemulsification and SICS was 10.37 and 10.15, respectively. ICER values for Phacoemulsification versus SICS at day7 post-surgery was Rp 696,360 (USD 49,74) while at day 21 was Rp 1,723,559 (USD 123,11).

Conclusion: Phacoemulsification and SICS are effective ways to improve the quality of life related to visual function. The incremental cost per QALYs obtained via Phacoemulsification from SICS at D7 and day21 post- surgery were less than Indonesia’s GDP per capita income of USD 3,347, means that Phacoemulsification is more cost effective than SICS technique for cataract surgery.
Fulltext Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

Rochmah TN, Wulandari A, Dahlui M, Ernawaty, Wulandari RD

Int J Environ Res Public Health, 2020 08 18;17(16).
PMID: 32824872 DOI: 10.3390/ijerph17166010

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.
Achieving cost-efficient management of drug supply via economic order quantity and minimum-maximum stock level

Dewi EK, Dahlui M, Chalidyanto D, Rochmah TN

Expert Rev Pharmacoecon Outcomes Res, 2020 Jun;20(3):289-294.
PMID: 31203686 DOI: 10.1080/14737167.2019.1633308

BACKGROUND: A good drug inventory planning system is important for an efficient budgeting, procurement, and cost control of drugs. When stagnant drugs in the inventory are too much, wastage due to expired and spoiled drugs could occur. These will not only cause loss of income but could also jeopardize healthcare service delivery.
RESEARCH DESIGN AND METHODS: This study aimed to determine the most efficient and effective management of stagnant and shortage drugs by comparing three pharmacy logistic methods; the economic order quantity (EOQ), minimum-maximum stock level (MMSL), and the traditional consumption of drug inventory, at RA Basoeni Hospital, Mojokerto. Drug inventory was analyzed to calculate the opportunity loss, opportunity cost, and proportions of both stagnant and shortage drugs.
RESULTS: We found that EOQ and MMSL performed best for control of stagnant drugs and shortage drugs, respectively. Both methods had proved as effective pharmacy logistic planning. In addition, EOQ produced the lowest opportunity cost for stagnant drugs besides the lowest opportunity loss for shortage drugs.
CONCLUSION: The study concluded that EOQ is the most effective and efficient method to manage stagnant and shortage drugs at hospital pharmacy.
Fulltext Economic Burden of Stroke Disease: A Systematic Review

Rochmah TN, Rahmawati IT, Dahlui M, Budiarto W, Bilqis N

Int J Environ Res Public Health, 2021 07 15;18(14).
PMID: 34299999 DOI: 10.3390/ijerph18147552

Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June-July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method, which is approximately equal to USD 1809.51-325,108.84 (direct costs 86.2%, and indirect costs 13.8%). Those that used the health expenditure method did not present the total cost; instead, only either direct or indirect cost of health expenditure were reported. For most hospital admissions due to stroke, LOS (length of stay) was the dominant cost. The high economic burden to manage stroke justifies the promotion and preventive efforts by the policymakers and motivates the practice of healthy lifestyles by the people.
Fulltext Assessing the performance of non-specialised private hospitals in Malaysia - an upper-middle-income medical tourism destination country using the Pabón-Lasso model

Samsudin MF, Lim YC, Rochmah TN, Dahlui M

BMC Health Serv Res, 2024 Nov 16;24(1):1414.
PMID: 39548435 DOI: 10.1186/s12913-024-11768-5

BACKGROUND: The government has rapidly promoted the privatisation of healthcare to improve systemic performance, based on the theory that markets improve efficiency. This study aims to measure the efficiency of private hospitals following their expansion and venture into the medical tourism industry through extensive governmental support.
METHODS: Inpatient utilisation of 101 private, non-specialised hospitals in Malaysia in 2014 and 2018 from the Health Informatics Centre, Ministry of Health Malaysia database was studied using paired samples t-test, analysis of variance (ANOVA), and the Pabón-Lasso model.
RESULTS: Better quantitative performance was found among larger hospitals, those with hospital accreditation, and those participating in medical tourism activities. There is a scale effect of efficiency between smaller and larger hospitals. However, when compared within respective size categories, Category 1 (small hospitals with less than 100 beds) has the highest percentage of efficient hospitals (39.3 per cent in 2014 and 35.7 per cent in 2018 in Sector 3 of the Pabón Lasso graphs).
CONCLUSION: This study has found that a higher bed occupancy rate (BOR) and longer average length of stay (ALoS) are associated with larger private hospitals, hospital accreditation, and participation in medical tourism activities in Malaysia. There is a need to expedite strategic hospitals partnership for resource optimisation and capacity pooling towards producing better performance.