Di Indonesia kanker payudara merupakan kanker tertinggi yang banyak datang pada stadium lanjut sehingga berdampak terhadap mortalitas dan tingginya pembiayaan. Mammografi merupakan alat skrining dan diagnosis yang sudah terbukti efektifitasnya menghasilkan “down staging” pada negara maju, Indonesia sebagai negara berkembang belum menjadikan skrining mammografi sebagai program nasional. Dilakukan studi parsial evaluasi ekonomi biaya dan luaran dengan membandingkan mammografi untuk skrining berbasis populasi terhadap oportunistik skrining di RS. Dilakukan uji coba skrining berbasis populasi terhadap 683 wanita dengan menggunakan mobil mammografi hingga didapatkan case detected serta diambil data retrospektif pasien deteksi dini dengan mammografi hingga penegakan diagnosis di RS dalam periode satu tahun. Dilakukan analisis biaya berdasarkan perspektif program dengan analisis luaran case detected. Didapatkan unit cost pemeriksaan skrining adalah Rp871,045. dengan case detected 0,4% dan cost per case detected Rp Rp290,348,509. Pada deteksi dini di RS didapakan unit cost Rp1,137,881 dan 3% kasus positif kanker. Terhadap skrining berbasis populasi, untuk mendapatkan satu kasus positif kanker diperlukan biaya sebesar Rp 262.342.333. Dengan sumber daya yang dimiliki perlu dilakukan inovasi dalam deteksi dini mammografi melalui penguatan pelaksanaan skrining CBE sebagai program nasional didukung pendekatan akses melalui diagnosis dini dengan mobil mammografi terutama di daerah rentan sehingga dihasilkan diagnosis secara cepat dan tepat dan biaya yang murah. Diperlukan peran pemerintah melalui pembiayaan yang berkelanjutan terhadap deteksi dini mammografi untuk dapat menurunkan angka mortalitas dan pembiyaan dalam pengobatan kanker. Kata kunci: Kanker payudara, mammografi, cost and outcome.

Breast cancer is the highest cancer in Indonesia that come at late stage so have impact on mortality and high funding. Mammography is a screening and diagnosis that has proven its effectiveness in producing "down staging" in developed countries, Indonesia as a developing country has not made mammography screening a national program. A partial study of economic evaluation of costs and outcomes was conducted by comparing mammography for population-based screening to opportunistic screening in hospitals. A population-based screening was conducted on 683 women using a mobile mammography until a case was detected and retrospective data taken from early detection patients with mammography to diagnose the hospital in a period of one year. A cost analysis is carried out based on the program perspective with a case detected output analysis. The unit cost of screening is Rp.871,045. with case detected 0.4% and cost per case detected Rp.290,348,509. At early detection in the hospital unit unit costs are obtained Rp1,137,881 and 3% of positive cases of cancer. For population-based screening, to get one positive case of cancer costs Rp 262,342,333. With the available resources, innovation in the early detection of mammography needs to be done through strengthening the implementation of CBE screening as a national program supported by an access approach through early diagnosis by mammography cars, especially in vulnerable areas so that diagnosis is produced quickly and accurately and at a low cost. The role of government is needed through ongoing financing of early detection of mammography to be able to reduce mortality and financing in the treatment of cancer. Keywords: Breast cancer, mammography, cost and outcome

ABSTRAK Nama : Firda Tania Program Studi: Kajian Administrasi Rumah Sakit Judul : Cost and Outcome Analysis Tindakan Hemodialisis Pada Pasien Gagal Ginjal Kronik (GGK) di Rumah Sakit Kelas B dan C Tahun 2016 Latar belakang: GGK merupakan kondisi yang semakin meningkat kejadiannya, menghabiskan banyak biaya dan mengakibatkan hilangnya produktivitas. Sejak 2014, BPJS menanggung sebagian besar biaya hemodialisis (HD) di Indonesia dengan besaran tarif yang berbeda sesuai kelas Rumah Sakit (RS). Pertanyaan penelitian ini ialah apakah tarif BPJS yang dibayarkan lebih tinggi pada kelas RS lebih tinggi menghasilkan hasil yang lebih baik atau malah mencerminkan inefisiensi. Selain itu, perlu diketahui pula apakah terdapat perbedaan biaya yang sebenarnya dikeluarkan RS dengan kelas berbeda untuk menyelenggarakan HD. Metode: Studi evaluasi ekonomi ini dilakukan di dua RS dengan kelas berbeda: kelas B (RS B) dan kelas C (RS C). Responden dipilih dari pasien GGK yang menjalani HD di kedua RS selama Februari-April 2016. Analisis biaya menurut perspektif pasien dengan metode kuantitatif, sedangkan perspektif RS dengan metode kualitatif. Analisis hasil dilakukan penilaian kualitas hidup (instrumen EQ-5D), IDWL dan Hb. Perbedaan rerata nilai hasil diuji dengan Student’s t-test. Hasil: Pada penelitian, total responden sebanyak 100 orang (RS B 76 orang & RS C 24 orang). Menurut perspektif pasien, biaya langsung medis HD selama sebulan di RS B Rp5.215.331 dan di RS C Rp7.781.744. Biaya langsung non medis HD selama sebulan di RS B Rp566.260 dan di RS C Rp334.500. Biaya tidak langsung HD selama sebulan di RS B Rp165.530 dan di RS C Rp45.830. Rerata total biaya HD selama sebulan di RS B Rp6.149.285 dan di RS C Rp8.162.077. Menurut perspektif RS, tidak terdapat perbedaan biaya yang sebenarnya dikeluarkan oleh RS dengan kelas berbeda untuk menyelenggarakan HD. Pada hasil didapatkan bahwa rerata Hb pada RS B (M=10,26) berbeda secara signifikan dengan RS C (M=8,21), t(98)= 8,244, p= 0,000. Rerata IDWL pada RS B (M= 0,0403) tidak berbeda secara signifikan dengan RS C (M= 0,0438), t(98)= -1,326, p= 0, 188. Rerata EQ Indeks pada RS B (M= 0,7178) tidak berbeda secara signifikan dengan RS C (M= 0,7208), t(98)= -0,075 p= 0,94. Rerata EQVAS pada RS B (M= 64,74) tidak berbeda secara signifikan dengan RS C (M= 64,79), t(98)= -0,018 p= 0,986. Kesimpulan: Pada penilaian efektivitas HD tanpa melibatkan tambahan sumber daya, tidak terdapat perbedaan hasil secara signifikan diantara kedua kelas RS. Fakta bahwa pengeluaran yang lebih besar dari BPJS tidak mengakibatkan hasil kesehatan yang lebih baik biasanya diinterpretasikan sebagai bukti adanya inefisiensi. Biaya RS dengan kelas berbeda untuk menyelenggarakan HD pun tidak berbeda karena secara persyaratan sama. Perbedaan biaya medis langsung dari billing RS berkaitan dengan status kepemilikan RS dan perbedaan rerata Hb berkaitan dengan perbedaan akses terhadap koreksi anemia yang ada di kedua RS. Kata Kunci: Cost and Outcome Analysis, Hemodialisis, Kelas RS, Tarif BPJS

ABSTRACT Name : Firda Tania Study Program: Hospital Administration Title : Cost and Outcome Analysis of Hemodialysis on Chronic Kidney Disease (CKD) Patients at Class B and C Hospital in 2016 Background: Chronic kidney disease (CKD) is an increasing condition, which consumes a lot of cost and causes productivity lost. Since 2014, BPJS has covered most of hemodialysis (HD) in Indonesia with different tariff according to hospital’s classification. The research question is whether higher tariff paid to higher hospital class produced better outcome or otherwise reflecting inefficiency. The other question is whether hospital’s real cost to effectuate HD unit was different according to hospital’s class. Methods: This economic evaluation study was conducted in two hospitals with different classification; class B (B Hospital) and class C (C Hospital). Respondents were chosen from CKD patients undergoing hemodialysis in both hospital during Februari to April 2016. Costs from patient’s perspective were analyzed using quantitative method, while hospital’s perspective were analyzed using qualitative method. As outcomes, HRQOL assessed using EQ-5D instrument, mean IDWL & Hb. Differences in outcomes tested using T-test. Results: In this study, total respondents participated were 100 patients; 76 from B hospital and 24 from C hospital. According to patient’s perspective, HD direct medical cost monthly average was IDR 5.215.331 in B hospital and IDR 7.781.744 in C hospital, direct non medical cost monthly average was IDR 566.260 in B hospital and IDR 334.500 in C hospital and indirect cost monthly average was IDR 165.530 in B hospital and IDR 45.830 in C hospital, so total HD cost monthly average was IDR 6.149.285 in B hospital and IDR 8.162.077. According to hospital’s perspective, there were no difference in hospital’s real cost to effectuate HD unit. Outcome results found that mean Hb in B hospital (10,26) were significantly different from mean Hb in C hospital (8,21), t(98)= 8,244, p=0,000. While mean IDWL in B (0,0403) were not significantly different with mean IDWL in C (0,0438), t(98)= -1,326, p=0,188. Mean EQ Indeks score (0,7178) and EQ VAS score (64,74) in B hospital were not significantly different with mean EQ Indeks score (0,7208) and EQ VAS (64,79) in C hospital, t(98)=0,075, p=0,94 and t(98)=-0,018, p=0,986 respectively. Conclusion: This findings showed that in hemodialysis effectivity assessment which did not include the use of additional resources from standard (PMK No. 812/2010), there were no significant difference in outcome in two different class of hospitals. Higher CBGs tariff for higher class of hospital had not produced better health outcome, which usually interpreted as an evidence of inefficiency. Hospital’s real cost to effectuate HD unit were not different since the requirements were the same (PMK 812/2010). Difference in direct medical cost from hospital billing related to hospital’s ownership status and difference of mean Hb related to different access to anemia correction in both hospital. Keywords: Cost & Outcome Analysis, Hemodialysis, Hospital Class, BPJS tariff