Skripsi

Analisis Biaya Antara Open Surgical Repair (OSR) dan Endovascular Aneurysm Repair (EVAR) Berdasarkan Cakupan Jaminan Kesehatan Nasional di RSCM 2018—2024 = Cost Analysis between Open Surgical Repair and Endovascular Aneurysm Repair (EVAR) according to National Health Insurance in RSCM 2018—2024.

Latar Belakang Aneurisma aorta abdominalis (AAA) adalah kondisi patologis dengan dilatasi aorta abdominal ≥3.0 cm. Tantangan penanganan AAA terletak pada pemilihan metode perbaikan, yaitu Open Surgical Repair (OSR) dan Endovascular Aneurysm Repair (EVAR). Penelitian ini bertujuan membandingkan biaya antara kedua metode dalam konteks cakupan Jaminan Kesehatan Nasional di Indonesia. Metode Penelitian ini adalah analitik komparatif dengan desain potong lintang, dilaksanakan di RSUPN Dr. Cipto Mangunkusumo (RSCM) dari Januari hingga Oktober 2024, menggunakan data sekunder rekam medis pasien AAA. Didapatkan 31 subjek penelitian yang terpilih dengan teknik purposive consecutive sampling, serta memenuhi kriteria inklusi dan eksklusi dari populasi terjangkau, yaitu pasien yang menjalani OSR dan EVAR di RSCM tahun 2018—2024. Hasil Hasil klinis menunjukkan mortalitas dalam 30 hari OSR yang lebih tinggi (P < 0,001), durasi operasi EVAR lebih singkat (P < 0,001), perdarahan intraoperasi EVAR lebih sedikit (P < 0,001), dan lama rawat inap ICU EVAR lebih singkat (P = 0,016). Total tarif rumah sakit untuk prosedur EVAR per pasien lebih tinggi (median Rp257.863.450; minmaks Rp190.303.604—Rp516.732.830) dibandingkan OSR (median Rp147.126.896,50; min-maks Rp104.283.881—Rp209.428.374) (P < 0,001). Namun, cakupan JKN untuk EVAR juga lebih tinggi (P = 0,017) sehingga biaya yang ditanggung rumah sakit per pasien pada EVAR (median, Rp90.558.357; min-maks, Rp41.829.504—Rp456.526.930) tidak berbeda signifikan (P = 0,092) dengan OSR (median, Rp73.438.468,50; min-maks, -Rp58.552.619—Rp160.465.384). Kesimpulan EVAR menunjukkan biaya yang sebanding berdasarkan cakupan JKN dengan hasil klinis yang lebih baik dibandingkan OSR. Namun, diperlukan studi lebih lanjut dengan populasi lebih besar dan multisenter.
Kata Kunci: Aneurisma aorta abdominalis, Bedah endovaskular, BPJS Kesehatan, Perbandingan biaya


Introduction Abdominal Aortic Aneurysm (AAA) is a pathological condition characterized by abdominal aorta dilation of ≥3.0 cm. The challenge in managing AAA lies in selecting the appropriate repair method, namely Open Surgical Repair (OSR) and Endovascular Aneurysm Repair (EVAR). This study aims to compare the costs between these two methods in the context of the National Health Insurance coverage in Indonesia. Method This is a comparative analytical study with a cross-sectional design, conducted at Dr. Cipto Mangunkusumo National General Hospital (RSCM) from January to October 2024, using secondary data from the medical records of AAA patients. A total of 31 subjects were selected using purposive consecutive sampling, meeting the inclusion and exclusion criteria from the accessible population, which consists of patients undergoing OSR and EVAR at RSCM from 2018 to 2024. Results Clinical outcomes showed that the 30-day mortality for OSR was higher (P < 0.001), the duration of EVAR surgery was shorter (P < 0.001), intraoperative bleeding during EVAR was less (P < 0.001), and ICU stay for EVAR was shorter (P = 0.016). The total hospital cost for the EVAR procedure per patient was higher (median Rp257,863,450; min-max Rp190,303,604—Rp516,732,830) compared to OSR (median Rp147,126,896.50; minmax Rp104,283,881—Rp209,428,374) (P < 0.001). However, the JKN coverage for EVAR was also higher (P = 0.017), making the hospital costs per patient for EVAR (median Rp90,558,357; min-max Rp41,829,504—Rp456,526,930) not significantly different (P = 0.092) from OSR (median Rp73,438,468.50; min-max -Rp58,552,619— Rp160,465,384). Conclusion EVAR demonstrates comparable costs based on JKN coverage with better clinical outcomes compared to OSR. However, further studies with a larger and multi-center population are needed.
Keywords: Abdominal aortic aneurysm, Cost comparison, Endovascular surgery, Mortality