Background: Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review aimed to assess the efficacy and safety of antihypertensive drugs in severe hypertension during pregnancy. Methods: A systematic review using the electronic databases MEDLINE (PubMed) and Cochrane Library was performed until August 2021. The risk-of-bias 2 tool was used to assess the risk-of-bias in each study included. Meta-analysis was conducted to assess heterogeneity and to estimate the pooled effects size. Results: Seventeen studies fulfilled the inclusion criteria and 11 were included in the meta-analysis. Nifedipine was estimated to have a low risk in persistent hypertension compared to hydralazine (RR 0.40, 95% CI 0.23–0.71) and labetalol (RR 0.71, 95% CI 0.52–0.97). Dihydralazine was associated with a lower risk of persistent hypertension than ketanserin (RR 5.26, 95% CI 2.01–13.76). No difference was found in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between antihypertensive drugs, except for dihydralazine, which was associated with more adverse effects than ketanserin. Conclusions: Several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, oral methyldopa, IV hydralazine, IV dihydralazine, IV ketanserin, IV nicardipine, IV urapidil, and IV diazoxide. In addition, nifedipine may be preferred as the first-line agent. There was no difference in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between the drugs, except for adverse effects in IV dihydralazine and IV ketanserin.

The present retrospective study aimed to determine the medication profile and estimate the treatment costs from medical records of new outpatients with schizophrenia, bipolar disorder, depression, and anxiety disorders from a healthcare perspective at a national referral hospital in Indonesia from 2016 to 2018. Methods: Medical records (including medical and administrative data) of 357 new outpatients with schizophrenia, bipolar disorder, depression, or anxiety disorders were collected from the hospital information system. The records of new outpatients with schizophrenia, bipolar disorder, depression, or anxiety disorders aged >18 years and had only received drugs for treatment were included. The medication profile was descriptively assessed, and estimated costs were calculated based on direct costs from a healthcare perspective. Results: Overall, 173 medical records were further analyzed. The main drugs administered to the new outpatients were atypical and typical antipsychotics for schizophrenia, atypical antipsychotics and mood stabilizers for bipolar disorder, antidepressants and atypical antipsychotics for depression, and antidepressants and benzodiazepines for anxiety disorders. The average annual treatment costs per patient were IDR 3,307,931 (USD 236) for schizophrenia, IDR 17,978,865 (USD 1,284) for bipolar disorder, IDR 1,601,850 (USD 114) for depression, and IDR 1,190,563 (USD 85) for anxiety disorders. Conclusion: The most commonly prescribed drugs for schizophrenia were haloperidol and risperidone; for bipolar disorders, sodium divalproex and risperidone; for depression, fluoxetine and sertraline; and for anxiety disorders, sertraline and lorazepam. Considering the high prevalence and estimated treatment costs for mental disorders, special attention is required to prevent an increase in their prevalence in Indonesia.

AbstrakTerapi antibiotik empirik merupakan salah satu penunjang keberhasilan dalam pengobatan sepsis. Penelitian ini bertujuan untuk mengetahui kombinasi antibiotik empirik yang paling efisien secara biaya (cost minimization) di antara sefotaksim-eritromisin dan sefotaksim-metronidazol yang digunakan pada sepsis sumber infeksi pernapasan yang dirawat di salah satu rumah sakit di Kota Bandung. Penelitian ini merupakan studi observasional dengan pengumpulan data secara retrospektif tahun 2010-2012. Data diambil dari rekam medis pasien rawat inap sepsis sumber infeksi pernapasan yang mendapat terapi antibiotik empirik sefotaksim-metronidazol atau sefotaksim-eritromisin dan daftar biaya dari bagian akuntansi rumah sakit. Biaya dihitung dari mulai pasien masuk rumah sakit dengan diagnosis sepsis sumber infeksi pernapasan sampai pasien sembuh dari sepsis. Antibiotik sefotaksimmetronidazol dan sefotaksim-eritromisin diasumsikan memiliki efek yang sebanding. Pasien dengan terapi empirik sefotaksim-metronidazol memiliki waktu tinggal di rumah sakit lebih lama (25 dibanding 11) dan memiliki total biaya rata-rata terapi lebih murah (Rp16.641.112,04 dibandingkan dengan Rp21.641.678,02) daripada pasien dengan terapi empirik sefotaksim-eritromisin. Hasil ini menunjukkan bahwa kombinasi antibiotik sefotaksim-metronidazol lebih efisien secara biaya dibandingkan dengan kombinasi sefotaksim-eritromisin.Kata kunci: Antibiotik empirik, cost minimization, eritromisin, metronidazol, sefotaksim, sepsis Cost Minimization Analysis of Empiric Antibiotic Used by Sepsis PatientRespiratory Infection Source Abstract Empirical antibiotics plays an important role in the therapy of sepsis. The aims of this study was to estimate and compare the cost of treating inpatient sepsis with respiratory infection, with cefotaximemetronidazole or cefotaxime-erythromycin antibiotics. Observational study of cost minimization analysis was conducted by retrospective data from 2010 until 2012. Data were collected from medical records of inpatients sepsis with respiratory infection and received empirical therapy cefotaximemetronidazole or cefotaxime-erythromycin and treatment's pricelist from department of accounting. Direct medical cost was calculated from empirical antibiotic costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The study considered the cost from preadmission because sepsis until the patient was fully recovered of sepsis. Cefotaxime-metronidazole and cefotaxime-erythromycin are assumed to have equivalent efficacy. Patients with empirical cefotaxime -metronidazole were found have longer length of stay (25 versus 11) and average total cost of treatment was cheaper (16.641.112,04 IDR versus 21.641.678,02 IDR). The findings demonstrate that combination of empirical antibiotic of cefotaxime-metronidazole is more efficient than cefotaxime-erythromycin.

Antibiotik dibutuhkan sebagai salah satu terapi dalam menunjang keberhasilan terapi febrile neutropenia. Beragamnya alternatif terapi antibiotik, menjadikan studi farmakoekonomi diperlukan agar didapatkan terapi yang efektif dan efisien. Tujuan penelitian ini adalah untuk mengetahui antibiotik yang lebih efisien dari segi biaya, yang digunakan dalam terapi febrile neutropenia di salah satu rumah sakit rujukan di kota Bandung selama periode 2011-2013. Penelitian ini merupakan studi observasi analisis, dengan pengambilan data secara retrospektif yang dilakukan pada bulan Februari 2014, melalui data rekam medis pasien rawat inap febrile neutropenia yang mendapatkan terapi antibiotik meropenem atau ceftazidime. Hasil penelitian menunjukkan bahwa walaupun secara statistik tidak menunjukkan perbedaan bermakna, rata-rata total biaya terapi menggunakan antibiotik meropenem adalah sebesar Rp11.094.147, sedangkan rata-rata biaya total perawatan kelompok antibiotik ceftazidime sebesar Rp7.082.523. Hasil penelitian ini diharapkan dapat membantu tenaga profesional kesehatan dalam manajemen terapi febrile neutropenia.

Community-acquired Pneumonia (CAP) merupakan penyakit infeksi yang memiliki mortalitas, morbiditas dan biaya yang tinggi. Studi farmakoekonomi diperlukan untuk menganalisis pemilihan kombinasi antibiotik yang bervariasi dengan mempertimbangkan biaya dan efektivitas. Penelitian ini bertujuan untuk menganalisis nilai cost-effectiveness kombinasi antibiotik azitromisin-seftriakson dan kombinasi azitromisin-sefotaksim pada pengobatan CAP di RSUP Dr. Hasan Sadikin Bandung serta menganalisis faktor yang paling berpengaruh terhadap nilai cost-effectiveness. Pengumpulan data dilakukan secara retrospektif dari rekam medis pasien dan Sistem Informasi Rumah Sakit (SIRS). Penelitian ini dilakukan pada bulan Maret-Juni 2019. Data biaya meliputi total biaya medik dari rumah sakit/healthcare perspective (biaya obat, alat kesehatan, tindakan, pemeriksaan, jasa dokter, dan rawat inap) dan total biaya dari Badan Penyelenggara Jaminan Sosial (BPJS)/payer perspective (tarif INA-CBG). Nilai efektivitas pada penelitian ini diukur dalam penurunan jumlah leukosit. Hasil menunjukkan nilai Average Cost-effectiveness Ratio (ACER) pada kombinasi azitromisin-seftriakson dari payer dan healthcare perspective secara berturut-turut adalah Rp2.987 dan Rp2.080 per penurunan 1 sel leukosit/ mm 3 , lebih tinggi dibandingkan kombinasi azitromisin-sefotaksim yaitu Rp2.853 dan Rp1.184 per penurunan 1 sel leukosit/mm 3. Berdasarkan hasil perhitungan Incremental Cost-effectiveness Ratio (ICER), diketahui penggantian kombinasi azitromisin-seftriakson oleh azitromisin-sefotaksim akan menghemat biaya sebesar Rp4.531 (payer perspective) dan Rp22.379 (healthcare perspective). Hasil uji sensitivitas menunjukan penurunan leukosit dan biaya rawat inap memiliki rentang yang paling panjang. Kombinasi antibiotik azitromisin-sefotaksim lebih cost-effective dibandingkan azitromisin-seftriakson. Faktor yang paling memengaruhi nilai ICER adalah penurunan leukosit dan biaya rawat inap.