Analisis Efektivitas Biaya (Cost Effectiveness Analysis) Penggunaan Amitryptiline Dibandingkan Carbamazepine pada Pasien Nyeri Neuropatik (Studi Kasus Di Klinik Saraf Rumkital. Dr. Ramelan Surabaya)

Abstract

ABSTRAK

Nyeri neuropatik merupakan penyakit kronis yang memerlukan penanganan optimal, sehingga perlu memperhatikan aspek efektivitas dan biaya terapi. Efektivitas amitryptiline dan  carbamazepine untuk pengobatan nyeri neuropatik telah dibuktikan, tetapi belum  diketahui mana yang paling cost-effective. Penelitian ini dilakukan untuk menganalisis efektivitas biaya (cost-effectiveness) amitryptiline dan carbamazepine pada pasien nyeri neuropatik di klinik Saraf Rumkital dr. Ramelan Surabaya. Pengumpulan data dilakukan selama Februari-Mei 2014 didapatkan sebanyak 62 pasien. Metode penelitian Randomized Controlled Trial (RCT)  kemudian dilakukan analisis efektivitas biaya dengan menghitung nilai Average Cost-Effectiveness Ratio (ACER) masing-masing terapi. Pengukuran efektifitas terapi dilihat dari penurunan intensitas nyeri menggunakan Numerical Rating Scale (NRS) sebelum dan 4 minggu sesudah terapi. Berdasarkan hasil penelitian ini dapat disimpulkan bahwa terdapat perbedaan intensitas nyeri pre dan post pada terapi amitryptiline dan carbamazepine,akan tetapi tidak terdapat perbedaan efektifitas terapi dan nilai ACER antara amitryptiline dan carbamazepine. Biaya terapi amitryptilin (Rp.41.695) lebih murah dibandingkan carbamazepine (Rp.47.380) sehingga amitryptiline lebih menghemat biaya dari carbamazepine dengan efektivitas setara. Perbedaan biaya terapi hanya pada harga obat saja sehingga penelitian ini juga sesuai dengan metode Cost Minimation Analysis (CMA). Disarankan penelitian lebih lanjut cost-effectiveness menggunakan sampel yang lebih spesifik terkait penyebab nyeri neuropatik.

Kata kunci :   nyeri neuropatik, amitryptiline, carbamazepine, cost-  effectiveness

ABSTRACT

Neuropathic pain is a chronic disease that requires optimum handling, so it needs to consider the aspects of the effectiveness and cost of treatment. Carbamazepine’s and amitryptiline’s effectiveness for the treatment of neuropathic pain has been demonstrated, but there were no data available regarding the cost-effectiveness between those medications. This study was conducted to analyze the cost-effectiveness  of amitryptiline and carbamazepine in patients with neuropathic pain in the Neurology Clinic in dr.Ramelan Navy Hospital  Surabaya. Data collection was conducted during February until May 2014, it was found as many as 62 patients. Randomized Controlled Trial studies (RCT) then was conducted to make a cost effectiveness analysis by the calculation of the value of Average Cost-Effectiveness Ratio (ACER) for each therapy.  Measurement of the effectiveness of therapy was obtained from a decrease in pain intensity using a Numerical Rating Scale (NRS) before and 4 weeks after therapy. Based on these results, it can be concluded that there was a difference in decreasing rate of pain intensity between pre and post amitryptiline and carbamazepine therapy, but there were no difference in therapeutic effectiveness and value of ACER between amitryptiline and carbamazepine. Cost of Amitryptiline therapy (Rp.41.695) was cheaper than Carbamazepine (Rp.47.380), so amitryptiline more cost- saving  than  carbamazepine with equal effectiveness. The difference is on the cost of the drug therapy alone so this study was also in accordance with the Cost Minimation Analysis (CMA). Further research suggested cost-effectiveness using a sample that is more specifically related to the causes of neuropathic pain.

Keywords: neuropathic pain, amitryptiline, carbamazepine, cost-effectiveness