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.

Bacground: Clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map, is the standardization of medical and surgical care process. It can be used to assure the quality of health service, to reduce risk, to control cost, and to increase efficiency of resources use. However, not all cases need clinical pathway. This study aimed to review systematically the effect of clinical pathway on length of stay and hospital cost. Subjects and Method: A systematic review was conducted by searching published articles from 2010 to 2019 from databases, including PubMed, ProQuest, and Cochrane. The inclusion criteria were articles published over the last 10 years, randomization, experiment, cohort, English, full text, and open access. Results: After screening based on inclusion criteria, 13 articles were included in this review. All of the studies investigated inpatient cases, with 10 out of 13 studies performed surgical cases, including of total hip arthroplasty, sphenopalatine artery ligation, pediatric appendictomy, total knee arthroplasty, endocrine operations, hepatic surgery, surgery for uterine fibroids, radical cystectomy, open pulmonary lobectomy and bilobectomy, non-surgical cases of asthma, and neonatal jaundice. All studies measured hospital length of stay. Nine studies looked at the effect on costs. Other effects include resource efficiency, surgical waiting time, complication, and readmission. Conclusion: Clinical Pathway has a positive effect in the reduction of hospital length of stay and costs. It can be carried out for surgical and non-surgical cases with monitoring and evaluation during implementation.

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Bacground: Clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map, is the standardization of medical and surgical care process. It can be used to assure the quality of health service, to reduce risk, to control cost, and to increase efficiency of resources use. However, not all cases need clinical pathway. This study aimed to review systematically the effect of clinical pathway on length of stay and hospital cost. Subjects and Method: A systematic review was conducted by searching published articles from 2010 to 2019 from databases, including PubMed, ProQuest, and Cochrane. The inclusion criteria were articles published over the last 10 years, randomization, experiment, cohort, English, full text, and open access. Results: After screening based on inclusion criteria, 13 articles were included in this review. All of the studies investigated inpatient cases, with 10 out of 13 studies performed surgical cases, including of total hip arthroplasty, sphenopalatine artery ligation, pediatric appendictomy, total knee arthroplasty, endocrine operations, hepatic surgery, surgery for uterine fibroids, radical cystectomy, open pulmonary lobectomy and bilobectomy, non-surgical cases of asthma, and neonatal jaundice. All studies measured hospital length of stay. Nine studies looked at the effect on costs. Other effects include resource efficiency, surgical waiting time, complication, and readmission. Conclusion: Clinical Pathway has a positive effect in the reduction of hospital length of stay and costs. It can be carried out for surgical and non-surgical cases with monitoring and evaluation during implementation.