Latar Belakang: TB tercatat sebagai salah satu penyakit yang mematikan. Angka kejadian multidrug-resistant Tuberculosis (MDR-TB) di dunia juga masih cukup tinggi. Kejadian putus obat pada MDR-TB lebih tinggi dibandingkan dengan kejadian putus obat pada TB sensitif obat. Psikopatologi dan perilaku merupakan salah satu penghalang utama kepatuhan terhadap pengobatan. Mindfullness therapy merupakan bagian dari cognitive – behavioural therapy yang menggunakan pendekatan pencegahan psikologis. Mindfullness therapy diharapkan dapat menurunkan angka putus obat pada pasien yang mendapat regimen terapi MDR - TB. Penelitian ini bertujuan untuk mengetahui efikasi klinis metode mindfulness therapy dalam menurunkan kejadian putus obat pada pasien- pasien yang mendapat regimen terapi MDR TB disertai analisis terhadap biaya yang diperlukan. Metode: Penelitian ini merupakan penelitian eksperimental dengan desain penelitian single blind randomized controlled trial. Subyek penelitian adalah pasien – pasien penderita TB paru yang mendapat regimen terapi MDR-TB bulan pertama dan berobat ke poliklinik MDR di Rumah Sakit Umum Drajat Prawiranegara Serang dan Rumah Sakit Umum Tangerang Selatan, Banten. Pasien – pasien yang memenuhi kriteria inklusi dan eksklusi dikelompokkan ke dalam dua kelompok yaitu kelompok A(kelompok metode mindfulness therapy) dan kelompok B (kelompok konsultasi biasa sebagai kontrol) secara random permuted blocks random allocation. Karakteristik dasar subyek penelitian, tingkat gejala depresi, tingkat gejala kecemasan, dan kualitas hidup pada tiap pasien diukur pada awal pelaksanaan penelitian. Tingkat depresi, tingkat kecemasan, dan kualitas hidup pada tiap pasien diukur ulang setiap bulan hingga total setiap pasien didapatkan data 5 kali pengukuran. Intervensi berupa metode mindfulness therapy dan konsultasi biasa akan diberikan satu bulan sekali secara berkelompok hingga setiap pasien akan mendapat intervensi sebanyak 4 kali. Data yang diperoleh dianalisis dengan analisis bivariat t test ¬ dan chi square kemudian akan dilanjutkan dengan analisis multivariat logistic regression multivariate. Number needed to treat (NNT) dihitung, dan analisis ekonomi akan dilakukan dengan menghitung incremental cost effectiveness ratio (ICER). Hasil: Subyek penelitian pada penelitian ini berjumlah 106 pasien penderita TB paru yang mendapat regimen terapi MDR – TB yang terdiri atas 65 pasien pria dan 41 pasien wanita. Pada analisis bivariat ditemukan bahwa variabel yang ix memiliki hubungan dengan kejadian putus obat adalah usia (p = 0,034), status terapi (p = 0,001) dan kehadiran pertemuan (p = 0,001). Metode metode mindfulness therapy tidak mempengaruhi kejadian putus obat secara statistik (p = 0,440), namun berpengaruh secara klinis. Pada analisis multivariat ditemukan bahwa hanya variabel jumlah pertemuan yang dihadiri yang memiliki hubungan dengan kejadian putus obat dengan p = 0,016 dan relative risk (RR) sebesar 0,1. Selain itu, didapatkan pula bahwa tingkat gejala depresi dan skor indeks depresi antara kelompok A dan kelompok B setelah selesai terapi fase intensif berbeda bermakna dengan nilai p = 0,012 dan p = 0,015. Skor indeks kecemasan antara kelompok A dan kelompok B setelah selesai terapi fase intensif juga menunjukkan berbeda bermakna dengan nilai p = 0,040. Perhitungan Number Needed to Treat (NNT) menunjukkan bahwa perlu dilakukan metode metode mindfulness therapy terhadap 20 pasien penderita TB paru yang mendapat regimen terapi MDR TB fase intensif untuk dapat mencegah putus obat pada 1 orang pasien. Total biaya ideal yang diperlukan untuk melaksanakan 4 kali metode metode mindfulness therapy terhadap 50 pasien adalah sebesar Rp 72.421.667,- dan biaya satuan ideal per kasus tidak putus obat pada metode mindfulness therapy adalah sebesar Rp 1.508.785,- per kasus tidak putus obat. ICER untuk penurunan angka gejala depresi berat dengan dilakukannya mindfullness therapy bila dibandingkan dengan konsultasi biasa adalah sebesar Rp 299.625,- Kesimpulan: Metode mindfulness therapy belum dapat menurunkan angka putus obat yang bermakna secara statistik namun, bermakna secara klinis pada penderita TB paru yang mendapat regimen terapi Multi Drug Resisten Tuberculosis (MDR TB) fase intensif. Akan tetapi metode mindfulness therapy pada penelitian ini dapat menurunkan gejala depresi dan skor kecemasan secara bermakna dan biaya satuan ideal per kasus tidak putus obat pada metode mindfulness therapy adalah sebesar Rp 1.508.785,- per kasus tidak putus obat Kata Kunci Metode mindfulness therapy , putus obat, Multi Drug Resisten Tuberculosis, depresi, kecemasan, analisis ekonomi.

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Background: TB is listed as one of the deadliest diseases. The number of multidrug-resistant tuberculosis (MDR-TB) in the world is also still quite high. The incidence of drug withdrawal in MDR-TB is higher than the incidence of drug withdrawal in drug sensitive TB. Psychopathology and behavior is one of the main barriers to adherence to treatment. Mindfulness therapy method is part of cognitive - behavioral therapy that uses a psychological prevention approach. Mindfulness therapy method is expected to reduce the rate of drug withdrawal in patients receiving MDR-TB treatment regimens. This study aims to determine the clinical efficacy of mindfulness therapy method in reducing the incidence of drug withdrawal in patients receiving TB MDR therapy regimens along with an analysis of the costs involved. Method: This study is an experimental study with a single blind randomized controlled trial research design. The subjects of the study were patients with pulmonary TB who received the first month MDR-TB therapy regimen and went to the MDR polyclinic at Drajat Prawiranegara Serang General Hospital and South Tangerang General Hospital, Banten. Patients who met the inclusion and exclusion criteria were grouped into two groups namely group A (the mindfulness therapy group) and group B (the usual consultation group as a control) by random permuted blocks random allocation. The basic characteristics of the study subjects, the level of depression, anxiety level, and quality of life in each patient were measured at the beginning of the study. Depression level, anxiety level, and quality of life in each patient were remeasured every month until the total of each patient was obtained 5 times the measurement data. Interventions in the form of mindfulness therapy method and regular consultation will be given once a month in groups so that each patient will get intervention 4 times. The data obtained were analyzed by bivariate t-test analysis and chi square will then proceed with multivariate analysis of multivariate logistic regression. Number needed to treat (NNT) is calculated, and economic analysis will be performed by calculating the incremental cost effectiveness ratio (ICER). xi Universitas Indonesia Results: The study subjects in this study were 106 patients with pulmonary TB who received MDR-TB therapy regimen consisting of 65 male patients and 41 female patients. In the bivariate analysis it was found that the variables that had a relationship with the incidence of drug withdrawal were age (p = 0.034), therapeutic status (p = 0.001) and attendance in the sessions (p = 0.001). Mindfulness therapy method did not affect the incidence of drug withdrawal statistically(p = 0.440) but affected clinically. In multivariate analysis, it was found that only meeting attendance variables were associated with drug withdrawal events with p = 0.016 and relative risk (RR) 0.1. In addition, it was also found that the level of depression symptoms and depression index scores between groups A and group B after the completion of the intensive phase of therapy were significantly different with p = 0.012 and p = 0.015. Anxiety index score between group A and group B after the completion of intensive phase therapy also showed a significantly different value of p = 0.040. Calculation of Number Needed to Treat (NNT) shows that it is necessary to do mindfulness therapy method to 20 patients with pulmonary TB who receive intensive phase MDR TB therapy regimen in order to be able to prevent drug withdrawal in 1 patient. Total ideal cost needed for implementing 4 times mindfullness therapy to 50 patients is Rp 72.421.667,- and ideal unit cost per not withdrawal case in mindfulness therapy method group is Rp 1.508.785. ICER for decreasing number of patients with severe depression symptoms by doing mindfulness therapy method when compared to usual consultation is Rp. 299,625, Conclusion: Mindfulness therapy method has not been able to significantly reduce the rate of drug withdrawal statistically but able to reduce clinically in patients with pulmonary TB who are on the intensive phase of Multi Drug Resistant Tuberculosis (MDR TB) regimen. However, mindfulness therapy method in this study can significantly reduce depression symptoms and anxiety scores. Ideal unit cost per not withdrawal case in mindfulness therapy method group is Rp 1.508.785. Keywords Mindfulness therapy method, drug withdrawal, Multi Drug Resistant Tuberculosis, depression, anxiety, economic analysis.