Background This study aims to assess the cost-effectiveness and budget impact of adopting sildenafil to the benefits package for the indication of pulmonary arterial hypertension (PAH), compared to beraprost. Methods Based on a societal perspective, a model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years (LYs) and quality-adjusted life years (QALYs). Results The economic model calculated the incremental cost-effectiveness ratio (ICER) per QALY gained for using sildenafil as first-line therapy compared to beraprost for the patient in functional class (FC) II and III, i.e. USD 3098 and USD 2827, respectively. The results indicated that in spite of sildenafil being more expensive than beraprost, generic sildenafil could potentially be a good value for money since ICER per QALY is below one times gross domestic product (GDP) per capita in Indonesia. Furthermore, budget impact analysis estimated that the incremental budget needed within 5 years for including sildenafil compared to beraprost for PAH patients starting in FC II and FC III was USD 436,775 and USD 3.6 million, respectively. Conclusions Compared to beraprost, sildenafil would be preferable for the treatment of PAH patients in FC II and FC III in Indonesia. The additional budget for adopting sildenafil compared to beraprost as the treatment of PAH in the benefits package was estimated at around USD 4.0 million. Electronic supplementary material The online version of this article (10.1186/s12913-019-4422-5) contains supplementary material, which is available to authorized users.

Abstrak Penggunaan antibiotik profilaksis bedah yang tidak tepat dapat meningkatkan risiko terjadinya Infeksi Luka Operasi (ILO) dan resistensi obat. Penelitian ini bertujuan untuk menilai ketepatan penggunaan antibiotik profilaksis bedah pada bedah bersih di rumah sakit (RS) di Jakarta. Penelitian ini merupakan studi potong lintang di sebuah RS pemerintah di Jakarta. Data yang diambil berasal dari rekam medis pasien dewasa yang menjalani pembedahan dengan kriteria kelas luka bedah bersih. Data diambil pada periode 1 Januari hingga 31 Desember 2013. Analisis data dilakukan secara deskriptif berdasarkan pedoman penggunaan antibiotik baik nasional maupun internasional. Hasil penelitian menunjukkan 837 pasien menjalani bedah bersih pada periode tersebut. Bedah yang banyak dilakukan adalah bedah abdominal (30%) dan thorak-non kardiak (23,5%) dan lebih dari 96% merupakan bedah elektif. Jenis antibiotik yang paling banyak digunakan adalah siprofloksasin (56,5%). Keseluruhan kesesuaian antibiotik profilaksis adalah 27,7% tepat indikasi prosedur bedah dan hanya 0,5% yang tepat obat. Sebagai kesimpulan, ketepatan penggunaaan antibiotik profilasis di salah satu RS di Jakarta masih rendah. Penggunaan antibiotik yang tepat dapat menurunkan risiko ILO dan mengurangi biaya pengobatan dengan mengurangi peresepan yang tidak perlu dan durasi penggunaan antibiotik. Kata kunci: antibiotik, bedah bersih, ketepatan, profilaksis Abstract Inappropriate use of surgical prophylactic antibiotics can increase the risk of Surgical Site Infections (SSI) and drug resistance. This study aimed to assess the appropriateness use of surgical prophylactic antibiotics in clean surgery wounds in a hospital in Jakarta. This cross-sectional study was conducted at a government hospital in Jakarta. Data were collected from medical records of adult patients undergoing surgery with clean surgical wound criteria from January 1 to December 31, 2013. Data were analyzed descriptively based on guidelines for antibiotics use both nationally and internationally. The result showed 837 patients classified into the clean surgical wound during this period. The most common surgeries were abdominal surgery (39%) and non-cardiac thoracic (23.5%) and more than 96% were elective surgeries. The overall antibiotic prophylactic appropriateness showed 27.7% in surgical procedures and only 0.5% in choice of antibiotics. In conclusion, the appropriateness of surgery antibiotics prophylactic use in one of the hospitals in Jakarta was still low. Appropriate use of antibiotics can reduce the risk of SSI and cost treatment by reducing unnecessary prescribing and duration of antibiotics use. Keywords: antibiotic, appropriate, prophylactic, clean surgery

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Latar belakang: Salah satu penilaian keberhasilan Program Terapi Rumatan Metadon (PTRM) yang merupakanprogram rehabilitasi terhadap pengguna narkoba -- khususnya pengguna narkotika suntik -- adalah kualitashidup klien. Oleh karena itu perlu diidentifikasi beberapa faktor yang dominan mempengaruhinya. Metode: Penelitian dilakukan dengan desain potong lintang yang dilakukan di Puskesmas Kedung Badakdan Bogor Timur di Kota Bogor. Pengumpulan data dilakukan dengan wawancara dan pengisian kuesionerWHOQOL-BREF pada April-Juni 2018. Analisis dilakukan dengan menggunakan regresi linier multivariabel. Hasil: Responden dalam penelitian ini berjumlah 62 orang. Hasil penelitian menunjukkan rerata skor kualitashidup klien PTRM di Kota Bogor pada domain fisik sebesar 57,6; domain psikologis sebesar 57,5; domain sosialsebesar 63,6; dan domain lingkungan 63,9. Dibandingkan rerata skor populasi sehat di Indonesia, domain fisikdan psikologis lebih rendah daripada populasi tersebut, sedangkan domain psikologis tidak berbeda denganpopulasi tersebut. Adapun skor domain lingkungan lebih tinggi dibandingkan populasi sehat Indonesia. Faktoryang dominan dalam menentukan kualitas hidup pada domain fisik dan lingkungan adalah tingkat pendidikan,sedangkan domain psikologis adalah dosis metadon. Faktor yang dominan dalam menentukan kualitas hidupdomain sosial adalah adanya seseorang yang dapat diajak bicara. Kesimpulan: Semakin tinggi tingkat pendidikan klien, maka kualitas hidup klien pada seluruh domain akansemakin baik. Klien PTRM dengan tingkat pendidikan yang lebih rendah harus dipantau untuk meningkatkankualitas hidupnya. Penanganan klien dengan pendekatan individual dan dukungan sosial dari keluarga danteman diperlukan untuk meningkatkan motivasi serta kepatuhan klien dalam menjalani terapi metadon. (HealthScience Journal of Indonesia 2018;9(2):93-9) Kata kunci: Kualitas hidup, metadon Abstract Background: One of the objective in Methadone Maintenance Therapy (MMT) which is a rehabilitationprogram for injecting drug users is quality of life. The purpose of this study was to determine quality oflife among MMT patients. Methods: The cross sectional study was conducted in Kedung Badak Primary Health Care and BogorTimur in Bogor. Data were collected from interview and filling out WHOQOL-BREF questionnaire fromApril-June 2018. Analysis was performed using multiple linier regression. Results: Total subjects in this study was 62 subjects. The results showed mean scores for physical domainwas 57.6; psychological domain was 57.5; social domain was 63.6; and environmental domain was 63.9.Compared with Indonesian, MMT patient scores were higher in environmental domain and lower inphysical and psychological domain while social domain had no different with it. The dominant factor indetermining physical and environmental domain was level of education, while the psychological domainwas methadone dose, and the existence of someones to talk to was dominant factor for social domain. Conclusion: The higher level of education, will produce better quality of life in all domains. MMTpatients with lower level education must be monitored to improve their quality of life. It is suggested totreat patients based on individual approaches and support from family and friends is needed to motivateclients and adherence to the therapy. (Health Science Journal of Indonesia 2018;9(2):93-9) Keywords: Methadone, quality of life