Abstract

Type 2 Diabetes Mellitus (T2DM) represents a growing global health challenge with significant clinical and economic implications, notably in Indonesia. The burden is intensified by renal and cardiovascular complications, especially among National Health Insurance beneficiaries. This retrospective study evaluated the direct medical costs of hospitalized T2DM patients with such complications at a type B hospital from 2019 to 2022. Costs were analyzed from both healthcare provider and payer perspectives, covering medical services, medical support services, pharmaceuticals, and other support services. Of the 192 patients reviewed, most were male (57.8%), aged 45–64 years (72.4%), with hospital stays of 1–5 days (90,1%) and severity level E-4-10-I (100%). Renal complications incur higher treatment costs than cardiovascular complications, with medical support services dominating renal costs and medical services such as doctor and nursing procedures, examinations, and visits contributing most to cardiovascular costs. These results highlight the urgent need for preventive measures, early diagnosis, and innovative treatments to optimize T2DM management and reduce associated economic burdens.

References

1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels: International Diabetes Federation; 2019.

2. Badan Penelitian dan Pengembangan Kesehatan. Hasil Utama Riskesdas 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018.

3. Hidayat B, Ramadani RV, Rudijanto A, et al. Direct Medical Cost of Type 2 Diabetes Mellitus and Its Associated Complications in Indonesia. Value Heal Reg issues. 2022; 28: 82–89. DOI: 10.1016/j.vhri.2021.04.006.

4. Yulsam PY, Oenzil F, Efrida E. Insidens Riwayat Hipertensi dan Diabetes Melitus pada Pasien Penyakit Jantung Koroner di RS. Dr. M. Djamil Padang. J Kesehat Andalas. 2015; 4 (2): 535–539. DOI: 10.25077/jka.v4i2.295.

5. Tomic D, Shaw JE, Magliano DJ. The burden and risks of emerging complications of diabetes mellitus. Nat Rev Endocrinol. 2022; 18: 525–539. DOI: 10.1038/s41574-022-00690-7.

6. Jankauskas SS, Kansakar U, Varzideh F, et al. Heart failure in diabetes. Metabolism. 2021; 125: 154910. DOI: 10.1016/j.metabol.2021.154910.

7. Papazafiropoulou AK, Bakomitrou F, Trikallinou A, et al. Diabetes-dependent quality of life (ADDQOL) and affecting factors in patients with diabetes mellitus type 2 in Greece. BMC Res Notes. 2015; 8: 786. DOI: 10.1186/s13104-015-1782-8.

8. Einarson TR, Acs A, Ludwig C, et al. Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review. Value Health. 2018; 21 (7): 881–890. DOI: 10.1016/j.jval.2017.12.019.

9. Patty YFPP, Mufarrihah, Nita Y. Cost of illness of diabetes mellitus in Indonesia: A systematic review. J Basic Clin Physiol Pharmacol. 2021; 32 (4): 285-295. DOI: 10.1515/jbcpp-2020-0502.

10. Tuan Kiet Pham H, Tuyet Mai Kieu T, Duc Duong T, et al. Direct medical costs of diabetes and its complications in Vietnam: A national health insurance database study. Diabetes Res Clin Pract. 2020; 162: 108051. DOI: 10.1016/j.diabres.2020.108051.

11. Fitri E, Andayani TM, Suparniati E. Cost Analysis of Diabetes Melitus. J Manag Pharm Pract. 2015; 5 (1): 61–66. DOI: 10.22146/jmpf.30.

12. Rahayuningrum IO, Tamtomo D, Suryono A. Comparison Between Hospital Inpatient Cost and INA-CBGs Tariff of Inpatient Care in the National Health Insurance Scheme in Solo, Boyolali and Karanganyar Districts, Central Java. J Health Pol Manag. 2016; 1 (2): 102-112. DOI: 10.26911/thejhpm.2016.01.02.05

13. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia No. 3 Tahun 2023 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023.

14. Yuliastuti F, Andayani TM, Endarti D, et al. Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance. Pharm Pract (Granada). 2023; 21 (1): 2768. DOI: 10.18549/PharmPract.2023.1.2768.

15. Pradeepa R, Mohan V. Prevalence of type 2 diabetes and its complications in India and economic costs to the nation. Eur J Clin Nutr. 2017; 71 (7): 816-824. DOI: 10.1038/ejcn.2017.40.

16. Satibi S, Andayani TM, Endarti D, et al. Comparison of Real Cost Versus the Indonesian Case Base Groups (INA-CBGs) Tariff Rates Among Patients of High- Incidence Cancers Under the National Health Insurance Scheme. Asian Pac J Cancer Prev. 2019; 20 (1): 117–122. DOI: 10.31557/APJCP.2019.20.1.117.

17. Fajriyah N, Firmanti TA, Mufidah A, et al. A Diabetes Self-Management Education/Support (DSME/S) Program in Reference to the Biological, Psychological and Social Aspects of a Patient with Type 2 Diabetes Mellitus: A Systematic Review. J Ners. 2019; 14 (3): 55–64. DOI: 10.20473/jn.v14i3.16979.

18. Firman F, Lestari K. Analisis Pembiayaan Berdasarkan Lama Rawat Pasien BPJS Diabetes Melitus Tipe II Komplikasi Sirkulasi Perifer di RSU PKU Muhammadiyah Bantul. J Ekonom Kesehat Indonesia. 2024; 9 (1): 40-50. DOI: 10.7454/eki.v9i1.1119.

19. Friel KM, McCauley C, O’Kane M, et al. Can Clinical Outcomes Be Improved, and Inpatient Length of Stay Reduced for Adults With Diabetes? A Systematic Review. Front Clin Diabetes Healthc. 2022; 3: 883283. DOI: 10.3389/fcdhc.2022.883283.

20. Kumar R, Itumalla R, Perera B, et al. Patient knowledge about diabetes: Illness symptoms, complications and preventive personal lifestyle factors. Heal Psychol Res. 2022; 10 (3): 37520. DOI: 10.52965/001c.37520.

21. Liu L, Yu X, Deng J. Medical Expenses Analysis of Middle-Aged and Elderly Patients with Diabetes Mellitus in China. Int J Heal Econ Policy. 2021; 6 (1): 14-22. DOI: 10.11648/j.hep.20210601.12.

22. Soeatmadji DW, Rosandi R, Saraswati MR, et al. Clinicodemographic Profile and Outcomes of Type 2 Diabetes Mellitus in the Indonesian Cohort of DISCOVER: A 3-Year Prospective Cohort Study. J ASEAN Fed Endocr Soc. 2023; 38 (1): 68-74. DOI: 10.15605/jafes.038.01.10.

23. Garcia M, Mulvagh SL, Merz CNB, et al. Cardiovascular Disease in Women: Clinical Perspectives. Circ Res. 2016; 118 (8): 1273–1293. DOI: 10.1161/CIRCRESAHA.116.307547.

24. Parker ED, Lin J, Mahoney T, Ume N, Yang G, Gabbay RA, et al. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care [Internet]. 2023 Nov 1;47(1):26–43. Available from: https://doi.org/10.2337/dci23-0085

25. Wardhana MP, Gumilar KE, Rahmadhany P, et al. INA-CBGs claim versus total hospital cost: A vaginal delivery investigation at Airlangga University Academic Hospital, Indonesia. J Public health Res. 2020; 9 (4): 1999. DOI: 10.4081/jphr.2020.1999.

26. Herawati F, Irawati AD, Viani E, et al. Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia. Antibiot (Basel). 2022; 11 (3): 399. DOI: 10.3390/antibiotics11030399.

27. Asmirajanti M, Syuhaimie Hamid AY, Hariyati TS. Clinical care pathway strenghens interprofessional collaboration and quality of health service: A literature review. Enfermería Clínica. 2018; 28 (Suppl. 1): 240–244. DOI: 10.1016/S1130-8621(18)30076-7.

Download

Share

COinS