Cost-Effectiveness analisys on the implementation of clinical pathway of pediatric treatment for dengue hemorrhagic fever in PKU Muhammadiyah Hospital Yogyakarta

Abstract

Dengue Hemorrhagic Fever (DHF) remains a concerning global problem, especially in Indonesia. This issue particularly deals with the current practice of therapeutic management for pediatric DHF inpatients that does not follow the standard clinical pathway, resulting in increased treatment costs. On this account, a clinical pathway is expected to minimize these costs and reduce patient's length of stay (LoS). However, a cost-effectiveness analysis prior to its implementation in DHF treatments for pediatric patients at PKU Muhammadiyah Hospital, Yogyakarta, is necessary. A retrospective cohort study and cost-effectiveness analysis were carried out from the hospital's (provider) perspective. The research involved two groups based on the adherence of the treatments to the clinical pathway, namely the conformity group and non-conformity group, and collected data on direct medical costs of the pediatric DHF treatment and LoS of both groups from 2016 to 2017. The Incremental Cost-Effectiveness Ratio (ICER) of both groups and the Risk Ratio (RR) were calculated as the outcome. The results confirmed that from the 200 patients involved, 138 of which (69%) received treatments conforming to the clinical pathway, while the therapies given to the remaining 62 patients (31%) deviated from it, with a p-value of 0.000 and RR of 1.58. The average calculated costs for these two groups were IDR 1,144,024 + 556.372 and IDR 1,989,723 + 1,296,899, respectively, while the ICER was IDR 826,917. In conclusion, when implemented on pediatric DHF treatments at PKU Muhammadiyah Hospital, Yogyakarta, clinical pathways can shrink LoS by up to 1.58 times and, consequently, save the cost by IDR 919,238 per one-day reduction off of the average LoS.