Tesis

Perbandingan Efektivitas-Biaya Tatalaksana Imunoglobulin Intravena dan Plasmaferesis pada Pasien Sindrom Guillain-Barré = Cost-Effectiveness Analysis of Intravenous Immunoglobulin and Plasmapheresis in the Treatment ofGuillain-Barré Syndrome in Resource-limited Tertiary Hospital.

Latar Belakang: Sindrom Guillain-Barré (SGB) memiliki manifestasi dan luaran klinis yang beragam, dengan pilihan tatalaksananya yang mahal. Imunoglobulin intravena (IVIg) dan plasmaferesis merupakan imunoterapi yang terbukti sama efektif pada SGB, namun berbeda-beda laporan terkait perbandingan biayanya. Penelitian ini bertujuan membandingkan efektivitas-biaya tatalaksana IVIg dan plasmaferesis berdasarkan luaran klinis, lama perawatan, dan komplikasi. Metode: Penelitian ini menggunakan desain kohort retrospektif melibatkan 48 pasien SGB yang memperoleh IVIg atau plasmaferesis di RSUP Nasional Dr. Cipto Mangunkusumo Jakarta dalam periode Juli 2021 hingga Juni 2024. Karakteristik klinis, luaran, dan total biaya perawatan dikumpulkan berdasarkan data rekam medis dan sistem pembiayaan rumah sakit. Dilakukan statistik deskriptif, serta analisis efektivitas-biaya menggunakan perhitungan rasio penambahan efektivitas biaya (ICER). Hasil: Empat puluh delapan subjek penelitian yang diikutkan memiliki rerata usia 43,3±12,9 tahun serta perbandingan laki-laki dan perempuan 0,7:1. Lama awitan gejala hingga subjek memperoleh imunoterapi memiliki median 17 (6 - 54) hari. Temuan defisit kranial pada separuh pasien. Varian degenerasi aksonal adalah subtipe SGB yang paling sering ditemukan (50%). Kebutuhan ventilasi mekanik pada 18,8% subjek. IVIg diberikan pada sepertiga subjek. Kelompok IVIg memiliki lama perawatan yang lebih lama dibandingkan plasmaferesis (median 13 (8 - 118) vs 19 (6 - 77) hari, p = 0,015) dan total biaya perawatan yang lebih besar (median Rp 136.750.016 vs Rp 79.587.646, p = 0,008). Pada perhitungan ICER plasmaferesis lebih efektif-biaya dibandingkan IVIg dengan penambahan efektivitas-biaya Rp 41.124.007 per nilai skor total MRC dibandingkan IVIg. Walau tidak signifikan secara statistik, kelompok IVIg memiliki rasio subjek yang mengalami perbaikan berdasarkan GBS disability scale saat discharge lebih besar dibandingkan plasmaferesis. Kesimpulan: Pada penelitian ini plasmaferesis dinilai lebih efektif-biaya dibandingkan IVIg dalam tatalaksana SGB. IVIg menunjukkan keunggulan dalam membantu perbaikan fungsional dalam luaran jangka pendek. Lama perawatan subjek dengan IVIg secara signifikan lebih singkat dibandingkan plasmaferesis. Biaya perawatan pada penggunaan IVIg secara signifikan lebih besar dibandingkan plasmaferesis.
Kata Kunci: Efektivitas-biaya, ICER, IVIg, Plasmaferesis, Sindrom Guillain-Barré


Background: Guillain-Barré syndrome (GBS) has diverse clinical manifestations and outcomes, with expensive treatment options. Intravenous immunoglobulin (IVIg) and plasmapheresis are immunotherapies of choice in GBS. Both have been shown to be equally effective, albeit different reports regarding the cost comparison. This study aims to compare the cost-effectiveness of IVIg and plasmapheresis based on clinical outcomes, length of treatment, and complications. Methods: This retrospective cohort study involved 48 GBS patients who received IVIg or plasmapheresis at Dr. Cipto Mangunkusumo National Hospital in Jakarta during the period July 2021 to June 2024. Clinical characteristics, outcomes, and total cost of care were collected based on medical record data and hospital financing system. Descriptive statistics were carried out, as well as cost-effectiveness analysis using the calculation of the incremental cost-effectiveness ratio (ICER). Results: Forty-eight study subjects had a mean age of 43.3±12.9 years and a male to female ratio of 0.7:1. The duration of symptom onset until the subject received immunotherapy had a median of 17 (6 - 54) days. Cranial deficits were found in half of the patients. Axonal degeneration variant was the most common subtype of SGB (50%). Need for mechanical ventilation in 18.8% of subjects. IVIg was administered in one third of the subjects. The IVIg group had a longer length of stay than plasmapheresis (median 13 (8 - 118) vs 19 (6 - 77) days, p = 0.015) and greater total cost of care (median Rp 136,750,016 vs Rp 79,587,646, p = 0.008). In the ICER calculation, plasmapheresis was more cost-effective than IVIg with an additional cost-effectiveness of Rp 41,124,007 per MRC total score value compared to IVIg. Although not statistically significant, the IVIg group had a greater ratio of subjects with improvement based on the GBS disability scale at discharge than plasmapheresis. Conclusion: In this study, plasmapheresis was considered more cost-effective than IVIg in the management of SGB. IVIg showed superiority in aiding functional improvement in short-term outcomes. The length of stay of subjects with IVIg was significantly shorter than plasmapheresis. The cost of treatment in the use of IVIg was significantly greater than plasmapheresis.
Keywords: Cost-effectiveness, Guillain-Barré syndrome, ICER, IVIg, Plasmapheresis