Tesis

Evaluasi Ekonomi Aplikasi HARKIT iCARE Pada Prevensi Sekunder Paska Sindrom Koroner Akut = Economic Evaluation of HARKIT iCARE Application in Secondary Prevention of Acute Coronary Syndrome.

Latar belakang: aplikasi mHealth memiliki potensi untuk menurunkan angka rekurensi sindrom koroner akut jika dibandingkan dengan layanan standar saja. Analisis efektivitas biaya diperlukan untuk menentukan efektivitas ekonomi dari mHealth. Tujuan: mengetahui efektivitas ekonomi layanan standar disertai monitoring menggunakan aplikasi HARKIT iCARE dibandingkan dengan layanan standar pada prevensi sekunder paska sindrom koroner akut. Metode: penelitian ini merupakan perintis analisis ekonomi mHealth di Indonesia dengan perspektif sosietal dalam uji klinis acak tersamar. Studi ini melibatkan 106 pasien paska sindrom koroner akut yang dirawat di Pusat Jantung Nasional Harapan Kita dari bulan Juni sampai bulan Desember 2022. Randomisasi menggunakan metode permutasi blok acak. Durasi tindak lanjut selama enam bulan. Nilai utilitas kesehatan dinilai menggunakan kuesioner EQ-5D-5L yang dikonversi menjadi quality adjusted life years. Luaran penelitian berupa analisis utilitas biaya dan analisis efektivitas biaya dalam bentuk incremental cost effectiveness ratio. Hasil: biaya lain-lain (Δ rerata Rp 3.319.179, SE Rp 3.342.412, p = 0,017) dan biaya non-kesehatan (Δ rerata Rp 922.612, SE Rp 1.031.003, p = 0,005) lebih besar pada kelompok HARKIT iCARE dibandingkan kelompok layanan standar. Permodelan Markov sederhana disusun dengan jangka waktu lima tahun dan siklus 30 hari. Total biaya dan nilai utilitas kesehatan memperhitungkan diskon sebesar 3%. Dilakukan analisis bootstrapping dengan 10.000 kali simulasi untuk menghitung rerata dan interval kepercayaan 95%. Quality adjusted life years lebih tinggi pada kelompok HARKIT iCARE (3,23 vs 3,06, Δ rerata 0,17) namun dengan total biaya keseluruhan yang lebih tinggi (Rp 5.495.920.454 vs Rp 5.041.510.027, Δ rerata Rp 454.410.427). Incremental cost effectiveness ratio per quality adjusted life years analisis utilitas biaya sebesar Rp 2.673.002.511 melebihi ambang batas kesediaan untuk membayar berdasarkan tiga kali lipat produk domestik bruto per kapita Indonesia pada tahun 2023 yaitu Rp 225.000.000. Tidak terdapat perbedaan yang bermakna pada kematian segala sebab (adjusted RR 0,62, IK 95% 0,12-3,29, p = 0,574) dan kejadian kardiovaskular mayor (adjusted RR 0,90, IK 95% 0,33-2,42, p = 0,833). Kesimpulan: layanan standar disertai monitoring menggunakan aplikasi HARKIT iCARE tidak bersifat efektif secara biaya atau hemat biaya jika dibandingkan dengan layanan standar pada prevensi sekunder paska SKA.
Kata kunci: HARKIT iCARE, mHealth, quality adjusted life years, incremental cost effectiveness ratio, sindrom koroner akut


Background: mHealth application has a potential to improve acute coronary syndrome recurrency compared with the conventional rehabilitation program. Cost effectivity analysis is required to determine the economic effectivity of mHealth. Objective: to determine the economic effectiveness of HARKIT iCARE compared to standard secondary prevention in acute coronary syndrome. Method: this study is a pioneer in economic evaluation of cardiovascular mHealth alongside randomized clinical trial in Indonesia with societal perspective approach. A total of 106 hospitalized acute coronary syndrome patients from June to December 2022 in National Cardiovascular Center Harapan Kita were randomized using permuted block method. Base case trial follow-up period was six months. Health utility values were assessed using EQ-5D-5L questionnaire and then converted into quality adjusted life years. Study outcomes were cost utility analysis and cost effectivity analysis in incremental cost effectiveness ratio. Results: other cost (Δ mean Rp 3.319.179, SE Rp 3.342.412, p = 0,017) and nonhealthcare cost (Δ mean Rp 922.612, SE Rp 1.031.003, p = 0,005) were higher in HARKIT iCARE group. A simple Markov model was constructed with time horizon of five years, 30 days cycle, and 3% discount rate. Bootstrapping analysis was performed 10,000 times to determine mean and 95% confidence interval. Quality adjusted life years was higher in HARKIT iCARE group (3,23 vs 3,06, Δ mean 0,17) with higher total cost (Rp 5.495.920.454 vs Rp 5.041.510.027, Δ mean Rp 454.410.427). Cost utility incremental cost effectiveness ratio per quality adjusted life years was Rp 2.673.002.511, exceeding the willingness to pay threshold based on three times of Indonesia gross domestic product per capita in 2023 Rp 225.000.000. There was no difference in all-cause mortality (adjusted RR 0,62, 95% CI 0,12-3,29, p = 0,574) and major adverse cardiovascular event (adjusted RR 0,90, 95% CI 0,33-2,42, p = 0,833). Conclusion: HARKIT iCARE as addition to standard secondary prevention was not cost effective or cost saving compared to standard care in post acute coronary syndrome patients.
Keywords: HARKIT iCARE, mHealth, quality adjusted life years, incremental cost effectiveness ratio, acute coronary syndrome