ABSTRAK

Nama : Rizky Wulandari

Program Studi : Farmasi
Judul : Analisis Efektivitas Biaya Penggunaan Kombinasi
Insulin, ADO dan Antihipertensi dengan Kombinasi
Insulin, Insulin dan Antihipertensi Pada Pasien DM Tipe 2
Disertai Hipertensi Rawat Inap di RSUP Fatmawati
Periode 2017

DM tipe 2 merupakan jenis diabetes yang paling banyak ditemukan dan lebih dari
50% disertai hipertensi. Bervariasinya penggunaan antidiabetes dan antihipertensi
menyebabkan adanya perbedaan efektivitas dan biaya. Analisis efektivitas biaya
dilakukan untuk mengetahui terapi manakah yang paling cost-effective. Penelitian
ini merupakan penelitian non eksperimental dengan desain observasi
menggunakan data sekunder pasien DM tipe 2 disertai hipertensi rawat inap di
RSUP Fatmawati periode 2017. Hasil penelitian menunjukkan pasien dengan
GDPP dan sistolik yang terkendali pada kelompok kombinasi insulin, ADO dan
antihipertensi sebesar 62,2% sedangkan pada kelompok kombinasi insulin, insulin
dan antihipertensi sebesar 37,8%. Terapi yang paling cost-effective adalah
kombinasi insulin, ADO dan antihipertensi dengan nilai ACER Rp 7.276.618 dan
ICER Rp 7.190.217.

Kata kunci :
DM tipe 2 disertai Hipertensi, Analisis Efektivitas Biaya, GDPP, Sistolik, ACER
dan ICER

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 ABSTRACT

Name : Rizky Wulandari

Study Program : Pharmacy
Type : Cost Effectiveness Analysis of Combination Use
Insulin, ADO and Antihypertension with Combination of
Insulin, Insulin and Antihypertension in Patient Type 2
DM with Hypertension at RSUP Fatmawati 2017 Period

Type 2 diabetes is the most common type of diabetes and more than 50% is
accompanied by hypertension. The varied use of antidiabetic and antihypertensive
causes different effectiveness and costs. Cost effectiveness analysis is done to find
out which therapy is the most cost-effective. This study is a non-experimental
study with observation design using secondary data of patients type 2 DM with
hypertension in RSUP Fatmawati 2017 period. The results showed patients with
GDPP and controlled systolic in the combination group insulin, ADO and
antihypertensive were 62.2% while in the combination group insulin, insulin and
antihypertensive were 37.8%. The most cost-effective therapy is a combination of
insulin, ADO and antihypertensive with an ACER value of IDR 7,276,618 and
ICER IDR 7,190,217.

Keywords :
Type 2 DM with Hypertension, Cost Effectiveness Analysis, GDPP, Systolic,
ACER and ICER

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 DAFTAR ISI

HALAMAN JUDUL........................................................................................ i
LEMBAR PERNYATAAN ORISINALITAS ................................................ ii
LEMBAR PERNYATAAN NON PLAGIAT ................................................. iii
LEMBAR PENGESAHAN ............................................................................. iv
KATA PENGANTAR ..................................................................................... v
LEMBAR PERSETUJUAN PUBLIKASI ILMIAH ....................................... vii
ABSTRAK ....................................................................................................... viii
DAFTAR ISI .................................................................................................... x
DAFTAR GAMBAR ....................................................................................... xii
DAFTAR TABEL ............................................................................................ xiii
DAFTAR LAMPIRAN .................................................................................... xiv
1. PENDAHULUAN ....................................................................................... 1
1.1 Latar Belakang ......................................................................................... 1
1.2 Rumusan Masalah .................................................................................... 3
1.3 Pertanyaan Penelitian............................................................................... 3
1.4 Tujuan Penelitian ..................................................................................... 4
1.5 Manfaat Penelitian ................................................................................... 4
1.6 Hipotesis .................................................................................................. 5
2. TINJAUAN PUSTAKA ............................................................................. 6
2.1 Diabetes Melitus ...................................................................................... 6
2.1.1 Definisi Diabetes Melitus ................................................................... 6
2.1.2 Klasifikasi Diabetes Melitus .............................................................. 6
2.2 Diabetes Melitus Tipe 2 ........................................................................... 7
2.2.1 Patogenesis Diabetes Melitus Tipe 2.................................................. 7
2.2.2 Faktor Risiko Diabetes Melitus Tipe 2............................................... 8
2.2.2.1 Faktor Risiko yang Tidak Bisa Dimodifikasi ............................... 8
2.2.2.2 Faktor Risiko yang Bisa Dimodifikasi .......................................... 9
2.2.3 Gejala Diabetes Melitus Tipe 2 .......................................................... 10
2.2.4 Diagnosis Diabetes Melitus Tipe 2 .................................................... 10
2.2.5 Penatalaksanaan.................................................................................. 10
2.2.5.1 Penatalaksanaan Non Farmakologi ............................................... 11
2.2.5.2 Penatalaksanaan Farmakologi ....................................................... 15
2.2.6 Kriteria Pengendalian DM.................................................................. 20
2.3 Hipertensi ................................................................................................. 21
2.3.1 Definisi Hipertensi ............................................................................. 21
2.3.2 Klasifikasi Hipertensi ......................................................................... 21
2.3.3 Faktor Risiko Hipertensi .................................................................... 22
2.3.3.1 Faktor Risiko yang Tidak Dapat Diubah ...................................... 22
2.3.3.2 Faktor Risiko yang Dapat Diubah ................................................. 23
2.3.4 Gejala Hipertensi ................................................................................ 26
2.3.5 Diagnosis Hipertensi .......................................................................... 26
2.3.6 Hipertensi pada Diabetes Melitus....................................................... 26
2.3.7 Penatalaksanaan Hipertensi pada Diabetes Melitus ........................... 27

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 2.3.7.1 Penatalaksanaan Non Farmakologi ............................................... 27
2.3.7.2 Penatalaksanaan Farmakologi ....................................................... 27
2.4 Farmakoekonomi ..................................................................................... 31
2.4.1 Kategori Biaya .................................................................................... 31
2.4.2 Tipe Studi Farmakoekonomi .............................................................. 33
2.4.3 Cost-Effectiveness Analysis (CEA) .................................................... 35
2.4.3.1 Definisi CEA ................................................................................. 35
2.4.3.2 Langkah-langkah Dalam Melakukan CEA ................................... 36
2.5 Kerangka Teori ........................................................................................ 41
3. METODE PENELITIAN .......................................................................... 42
3.1 Desain Penelitian ..................................................................................... 42
3.2 Tempat Penelitian .................................................................................... 42
3.3 Waktu Penelitian ...................................................................................... 42
3.4 Populasi dan Sampel Penelitian ............................................................... 42
3.4.1 Populasi Penelitian ............................................................................. 42
3.4.2 Sampel Penelitian ............................................................................... 42
3.5 Kriteria Inklusi dan Eksklusi ................................................................... 43
3.5.1 Kriteria Inklusi ................................................................................... 43
3.5.2 Kriteria Eksklusi ................................................................................. 44
3.6 Pengambilan Data .................................................................................... 44
3.7 Kerangka Konsep ..................................................................................... 44
3.8 Definisi Operasional ................................................................................ 45
3.9 Pengolahan dan Analisis Data ................................................................. 47
4. PEMBAHASAN ......................................................................................... 50
4.1 Keterbatasan Penelitian ........................................................................... 50
4.2 Karakteristik Pasien DM Tipe 2 Disertai Hipertensi yang
Menjalani Rawat Inap di RSUP Fatmawati Periode 2017...................... 50
4.3 Efektivitas ................................................................................................ 53
4.4 Biaya ........................................................................................................ 57
4.5 Analisis Efektivitas Biaya ........................................................................ 59
5. KESIMPULAN DAN SARAN .................................................................. 62
5.1 Kesimpulan .............................................................................................. 62
5.2 Saran ........................................................................................................ 62
DAFTAR REFERENSI ................................................................................. 63

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 DAFTAR GAMBAR

Gambar 2.1. Diagram Efektivitas Biaya .......................................................... 40

Gambar 2.2. Kerangka Teori ............................................................................ 41
Gambar 3.1. Kerangka Konsep Penelitian ....................................................... 45
Gambar 4.1. Simulasi Pohon Keputusan Terhadap Terkendalinya GDPP dan
Tekanan Darah Sistolik, serta Biaya Pada Kelompok
Kombinasi Insulin+ADO dan Antihipertensi dengan
Kombinasi Insulin+Insulin dan Antihipertensi Pada Pasien DM
Tipe 2 Disertai Hipertensi di RSUP Fatmawati Jakarta Periode
2017 ............................................................................................ 60

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 DAFTAR TABEL

Tabel 2.1. Klasifikasi DM Berdasarkan Etiologinya ....................................... 6

Tabel 2.2. Kriteria Diagnosis DM Menurut American Diabetes
Association (ADA) ......................................................................... 10
Tabel 2.3. Elemen Edukasi Perawatab Kaki .................................................... 12
Tabel 2.4. Golongan Sulfonilurea .................................................................... 15
Tabel 2.5. Golongan Biguanida ....................................................................... 16
Tabel 2.6. Golongan Tiazolidindion ................................................................ 17
Tabel 2.7. Golongan Penghambat α-glukosidase ............................................ 17
Tabel 2.8. Golongan Glinid.............................................................................. 18
Tabel 2.9. Farmakokinetik Insulin Eksogen Berdasarkan Waktu Kerja
(Time Course of Action) ................................................................. 19
Tabel 2.10. Sasaran Pengendalian DM ............................................................ 20
Tabel 2.11. Klasifikasi Tekanan Darah Pada Orang Dewasa .......................... 21
Tabel 2.12. Contoh Tipe Kategori Biaya ......................................................... 32
Tabel 3.1. Definisi Operasional Penelitian ...................................................... 45
Tabel 4.1. Distribusi Karakteristik Subjek Penelitian Berdasarkan Usia,
Jenis Kelamin dan Lama Rawat Inap ............................................. 51
Tabel 4.2. Pengukuran GDPP dan Tekanan Darah Sistolik Pasien DM
Tipe 2 Disertai Hipertensi Rawat Inap di RSUP Fatmawati
Periode 2017 ................................................................................... 53
Tabel 4.3 Distribusi Pasien DM Tipe 2 Disertai Hipertensi Rawat Inap
di RSUP Fatmawati Periode 2017 Berdasarkan Terkendalinya
GDPP dan Tekanan Darah Sistolik ................................................. 53
Tabel 4.4. Perbandingan Biaya Medik Langsung Pasein DM Tipe 2
Disertai Hipertensi Rawat Inap RSUP Fatmawati Jakarta
Periode 2017 .................................................................................... 58
Tabel 4.5. Perhitungan ACER, ICER Pada Pasien DM Tipe 2 Disertai
Hipertensi Antara Kelompok Kombinasi Insulin+
ADO dan Antihipertensi dengan Kombinasi Insulin+
Insulin dan Antihipertensi ............................................................... 61

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 DAFTAR LAMPIRAN

Lampiran 1 Surat Permohonan Penelitian........................................................ 66

Lampiran 2 Surat Balasan Ijin Penelitian......................................................... 67
Lampiran 3 Surat Kaji Etik .............................................................................. 69
Lampiran 4 Alur Penelitian .............................................................................. 70
Lampiran 5 Formulir Pengambilan Data.......................................................... 71
Lampiran 6 Hasil Analisis Data ....................................................................... 73

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