Preparation for Final Exam & Target => Pokoknya B+ gamau B apalagi B-

Remed
20 June 2022 9:03

Berserah, Yes! Menyerah, Tidak! Tidak! Tidak! Komando!!!! Oo.. Jesus I surrender. Semangatttt love C. Cost Benefit Analysis (secara biaya => bermanfaat)
God, love People nya..
○ Membandingkan manfaat dari intervensi. (bandingin program A dengan program B
Goal: Belajar dari PPT Ale, Belajar dari Buku Rascati, Belajar dari Soal,
contohnya)
Methods: Mencatat. ○ Outcome medis dikonversi menjadi nilai mata uang.
○ Sulit menentukan harga dari manfaat yang didapat.
○ Componen of CBA
A. CMA (Cost Minimization Analysis)
 Membandingkan biaya intervensi yang paling murah. => hanya dapat diaplikasikan untuk
membandingkan intervensi dengan outcome yang ekivalen.
 Cases
○ CMA-ANTI-NAUSEA
 Because of problems with Chemotherapy-Induced nausea => the recommended
administration directions were to split monthly dose needed for each cycle in half
and administer each half 5 days apart.
 NoNausea (an antinausea medication) could make the full monthly dose of
Oncoplatin be given at one visit.
 Clinical effectiveness measures of the chemotherapy treatment were shown to be
the same for the two methods of administration.
 Objective => comparing the cost of Oncoplatin given in two doses with Oncoplatin
combined with NoNause administered in one dose.
 Methods. =>
Over a 6-month period (February ○ Measuring Indirect and Intangible Benefit
2007 to July 2007), patients from two oncology ○ Methods of measuring productivity and intangible cost => Human capital & Willingness-
clinics were enrolled in this study and randomized to-pay (WTP) approaches
to receive either the split dose of Oncoplatin Various methods have been developed to estimate the monetary value of health benefits
(25 mg/m2 on days 1 and 5) or the single => the 2 most common => WTP and HC.
dose of Oncoplatin (50 mg/m2) plus the oral ○ Human Capital Method =>
antinausea medication (35 mg of NoNausea). ○ The HC approach is one way to measure indirect benefits. HC estimates wage and
 Cost => productivity losses because of illness, disability, or death
Costs for intravenous infusions and ○ There are two basic components to calculating HC: wage rate and missed time
physician or clinic visits were estimated using
the 2007 Physicians’ Fee Reference.
(days or years) because of illness.
○ Wage rate calculations
 Result =>
Although the medication costs are higher in the group □ A yearly wage rate (income per year) would be calculated for a program or
with NoNausea, this increase is offset by a decrease intervention that would reduce long-term disability or death
in administration and office visit costs For example, a pneumococcal vaccination program might result in
 Direct medical costs associated with the once-per-cycle dose of Oncoplatin plus preventing premature death. Thus, it would be appropriate to use a yearly
NoNausea were lower than when the monthly dose was split. wage rate and assess the value of the number of years saved because of
the intervention.
□ A daily wage rate (income per year divided by number of days worked per year)
may be calculated for a program or intervention targeted at an acute or chronic
illness with short-term disability.
□ Average days of person works =>
Number of days in a year (365) - Number of weekend days (104) -
Number of vacation days (14) - Number of sick-leave days - 5 240.
○ Missed time (Days or Years) Because of Illness

○ If a yearly wage rate is calculated, then assessment of the number of years lost
 Sensitivity Analyses itu apa ya? because of a disease or illness must be made.
 Another example of a CMA analysis includes measuring the costs of receiving ○ If a daily wage rate is calculated, an
the same medication in different settings assessment of the number of missed days because of illness must be calculated

B. Cost-Effectiveness Analysis (Secara Outcome kesehatan =>

Bermanfaat). ○

 Membandingkan efektivitas dari intervensi

 Outcome tidak perlu dikonversi menjadi nilai mata uang.
 Unit klinis yang digunakan dalam perbandingan harus sama => tekanan darah.
Multiplying the daily wage rate times the number of missed days results in the value
 Cost Effectiveness Grid of lost productivity.
In other words, the value of 20 days lost from work is $3,340, and the value of 7 days
lost from work is
$1,169. The difference between before and after the program is $2,171, which is the
cost savings or the indirect benefit of the program or intervention
○ Willingness to Pay Method
○ ○ Hypothetical Scenario

○ Cost-effectiveness grid can be used to illustrate the definition of Cost-Effectiveness.

○ To determine whether a therapy or service is cost-effective,
both the costs and the effectiveness must be considered □
○ Cell C => If the new drug is less effective and more costly.
○ Cell F => If the new treatment has the same effectiveness but cost more
○ Cell I => The new drug is more expensive and more effective (a very common finding)
○ Cell E => same price and same effectiveness as the standard product.
For the middle cell E, other factors may be considered to determine which medication
might be best. => faktor apa saja?
 ○ Cell C => If the new drug is less effective and more costly.
○ Cell F => If the new treatment has the same effectiveness but cost more
○ Cell I => The new drug is more expensive and more effective (a very common finding)
○ Cell E => same price and same effectiveness as the standard product.
For the middle cell E, other factors may be considered to determine which medication
might be best. => faktor apa saja?
○ Cell A and I => Conduct ICER. (Incremental Cost-Effectiveness Ratio) ○ Bidding Vehicles (tawar menawar)
○ ICER is Calculated to determine the extra cost for each extra unit of outcome. □ Open ended Questions => What's the maximum amount that you would be willing
 It's left up to the readers to determine whether to pay for a 1-hour consultation with a pharmacist?
they think the new product is “cost-effective” on the basis of value judgment □ Close ended Questions => Would you be willing to pay $60 for a 1 hour
Consultation with a pharmacist?
 Cost-effectiveness plane □ Bidding game => Would you be willing to pay $60 for a 1 hour Consultation with a
pharmacist?
 If yes, how about $80?
 If no, how about $40?
□ Payment Card
What is the maximum amount that you would be willing to pay for a 1-hour
consultationwith a pharmacist? Please circle your choice.
$150 $90 $30
$130 $70 $10
○ $110 $50 $0
□ The main advantage of the WTP approach is that it is a method to place a dollar
value on intangible benefit
□ The disadvantages => It is difficult for people to place a dollar value
on a health benefit, the respondent may not understand the value market (e.g,
pharmaceutical care program) being presented.

○ Step in Conducting CBA

1. Specify adaptation investment options to be compared
2. Define the lenses and scope of impacts
○ Quadrant 1=> If an alternative is more expensive and more effective than the standard □ Ideally, the ‘ lense ’ to be used is of a “social welfare planner” who
comparator, this point will fall in quadrant I, and the
aims to maximise the net benefits of the society within the scope of
tradeoff of the increase in costs for the increase in benefits would need to be
analysis.
considered
3. Classify and assess the benefits and the Costs
○ Quadrant 2=> If an alternative is less expensive and more effective, the point would
4. Provide qualitative analysis of non monetised impacts ( optional)
fall in quadrant II, and the alternative would dominate the standard comparator.
5. Choose discount rate and calculate Net Present Value of investment Options
○ Quadrant 3 => If the alternative was less costly and less effective, the point would fall
6. Perform sensitivity analysis
in quadrant III, and again a tradeoff would have to be considered.
7. Analyse the results and provide recommendation
○ Quadrant 4 => If an alternative was more expensive and less effective,
the point would fall in quadrant IV, and the alternative would be dominated by the
standard comparator.
○ Apa itu trade off?
○ Calculation
○ Net Benefit/Net Cost
 Examples of ways to present Cost and Effectiveness Results
○ □ Net benefit => total benefit-cost.
□ Net Cost => Total Cost-Total benefit.

○ Benefit to Cost/Cost to Benefit

□ Benefit/cost => >1
□ Cost/Benefit => <1
○ Calculation Example
□ Soal
Proposal A: Cost = $1000; Benefit = $2000
Proposal B: Cost = $5000; Benefit = $7500

○ Is drug C cost-effective compared with drug B? That
depends if the evaluator believes the extra cost is worth the extra health benefit
○ Bagaimana cara kita mengevaluasi ICER? Sehingga kita bisa melihat obat ini itu cost-
effective.
○ Yg gua tangkep => benefitnya tuh harus lebih dari cost nya kalau Cost-Benefit
Analysis.
○ Cost Benefit Analysis of a Roseolitis Vaccination for Senior Pharmacy
Students in the United States.

○ Effectiveness =>
measuring the results or outcomes of medications used to
treat stomach ulcers may be based on the patient’s reports of symptom reductions or
based on follow-up endoscopies.
○ Outcomes measures:
 Symptomps free days
 % Healed (Patient in whom endoscopy indicated that the ulcer was healed).
○ Cost-consequence analysis? What's that?
 LOOK AT METHODS 1 ○
○ ICER is used to answer => In clinical practice, the question is infrequently,
“Should we treat the patient or not?” or “What are the costs and outcomes
of this intervention versus no intervention?” More often, the question is, “How
does one treatment compare with another treatment in costs and outcomes?” To
answer this more common question.
○ the ICER is the ratio of the difference
in costs divided by the difference in outcomes.
○ ICER => are calculated by dividing the
difference in costs by the difference in health benefits (outcomes).
○ From the previous example of ulcer treatment, when comparing drug B with
drug A, and when comparing drug C with drug A, these comparisons would fall into
cell G of the grid, indicating dominant cost-effectiveness for both drug B and drug C
compared with drug A.
○ Drug C compared with drug B
○ this comparison would fall into cell I of the grid, indicating that ICER
should be calculated
○ In this example, using drug C compared with using drug B would cost $6.40 more
for every extra SFD or 3,200 more for every
extra healed ulcer
○ Is drug C cost effective compared with drug B? That
 ○ this comparison would fall into cell I of the grid, indicating that ICER
should be calculated
○ In this example, using drug C compared with using drug B would cost $6.40 more
for every extra SFD or 3,200 more for every
extra healed ulcer
○ Is drug C cost-effective compared with drug B? That ○
depends if the evaluator believes the extra cost is worth the extra health benefit
○ Jadi CEA itu ga cuman liat harga murah atau obat nya lebih efektif.
Tapi harus pilih yg termurah dengan efektif yang terbaik
○ With Cost-effectiveness plane => Following up on the ulcer example, points in
the cost-effectiveness plane would fall into quadrant II (dominant) for both drug B
compared with drug A and drug C with drug A
○ .
 Apa sih bedanya Cost-Consequence Analysis, Cost-effectiveness ratio, ICER dan Cost- ○ Productivity costs were estimated using the
effectiveness plane, Cost-effectiveness Grid?
HC approach
○ Jadi CCA, CEA itu buat pemetaan dulu habis itu nentuin Cost-effectiveness apa
engganya lewat CE plane atau CE Grid. Kalau hasilnya perlu diadain ICER. Ya itulah
diadakan ICER nya.

 Incremental Net benefit (INB)

○ As mentioned previously, there are some limitations associated with the calculation
and interpretation of CERs. It has been suggested that a newer technique, incremental
net benefit (INB) analysis, may overcome some of these restrictions
○ A newer technique termed incremental net benefit (INB) analysis has been
suggested to overcome some of these limitations
○ INB = (l × Δ Effects) − Δ Costs
○ l => Willingness to pay ○
○ If the INB is above zero, the intervention is deemed cost-effective. If it is below
zero, it is not cost-effective.
○ the l is assumed to represent society’s willingness to pay for a unit of health
(e.g., a symptom-free day or quality-adjusted life-year) that is constant across
disease categories and patient populations.
○ Although this framework was created to reduce statistical restrictions of ICERs
(e.g., the difficulty in assessing uncertainty estimates or confidence intervals for
these ratios)

D. COST-UTILITY ANALYSIS

 QALY-Intervensi
○ QALY => Quality Adjusted Life Years
 Cost Utility Analysis => Teknik Analisis untuk Utility atau Kepuasan atas kualitas
hidup yang diperoleh dari suatu Intervensi Kesehatan. Pada CUA outcomenya itu
○ => Tahun yang dapat dinikmati dalam keadaan sehat sempurna (Bebas dari
Kecacatan)-umumnya diekspresikan dalam QALY/DALY.
 Keutungan =>
○ Menggunakan QALY sebagai ukuran outcome, AUB dapat digunakan untuk
membandingkan beberapa kondisi maupun intervensi kesehatan yang berbeda
○ QALY lebih berguna untuk pengukuran kondisi kesehatan jangka panjang (penyakit kronis)
daripada kondisi kesehatan jangka pendek (penyakit akut)
○ Pengukuran outcome tidak perlu menggunakan unit moneter.
 Kekurangan
○ Pengukuran QALY bersifat Subjektif
○ Konsep tidak mudah dimengerti.
○ Menetapkan apakah biaya per QALY memiliki arti => bukan hal mudah.
○ Deltas SFD sama Delta Cost itu dari ICER sebenernyaa
 Pada Dasarnya, Intervensi Kesehatan berpengaruh terhadap 2 hal
○ INB = (Willingness to pay x Δ effect) - Δ cost
○ Usia harapan hidup (UHH), yaitu panjang usia yang diharapkan [dalam tahun], sejak
 Primary vs Intermediate Outcome terdiagnosis penyakit.
○ Primary Outcome: ○ Kualitas hidup terkait-kesehatan (HRQoL, health-related quality of life), yaitu kualitas
1. Prefereed Outcome cured terkait keberfungsian fisik, mental, emosional, dan sosial
2. Eradication of Infection  Instrumen tervalidasi
3. Life years saved.
 Intermediate Outcome
1. Alternative outcome
2. Laboratory measure of disease marker.
 Efficacy => Apakah Intervensi bekerja
 Effectiveness => Apakah Intervensi Efektif. ○
 Additional notes from learning Rascati's book
○ Outcome => Cures, lives saved/blood pressure reductions
 Some researchers consider cost-utility analysis (CUA) to be a special subset of
CEA that uses units such as quality-adjusted life years (QALYs) to collapse different
types of outcomes into one unit of measure . as we know the outcomes could be  Pengukuran pada AUB
variable (like effectiveness in lengthening the time until the diseasae progresses, side
effect, etc)
 Cost-Consequence Analysis => The cost and various Outcomes are listed but no ratios
are conducted.
 Cost effectiveness ration=> ratio of resources used per unit of clinical benefit
 ICER => Ratio of the difference in cost divided by the difference in outcomes.
 If incremental calculations produce negative numbers, this indicates that one
treatment, the dominant option, is both more effective and less expensive than the
other, dominated option => jadi kalau negatif, itu lebihh bagus gitu?
 CEA OUTCOMES ○
○ Primary/final outcomes => cure of the disease, the eradication of an infection, or
life years saved are preferred units of measurement.
○ Intermediate or surrogate Outcomes => Laboratory measures or disease
markers (e.g, cholesterol levels or blood pressure measurements)
 I love u Valerie Devina
 Randomized clinical trials => Gold Standard for determining if a medication is
efficacious
 Efficacy => if a drug can work under relatively ideal condition
○ If data from randomized controlled trial (RCTSs) are used, the term Cost-Efficacy
analysis may be more appropriate.
 Effectiveness => If a drug does work in real world practice.
 Yg diwawancara harus pasiennya => Pada keadaan tertentu, karena pasien tidak mampu
 results from RCTs should be used with caution in pharmacoeconomic analyses. =>
memberikan jawaban yang obyektif [anak-anak, pasien dengan kognitif yang terganggu],
  Efficacy => if a drug can work under relatively ideal condition
○ If data from randomized controlled trial (RCTSs) are used, the term Cost-Efficacy
analysis may be more appropriate.
 Effectiveness => If a drug does work in real world practice.
 results from RCTs should be used with caution in pharmacoeconomic analyses. =>
Both costs and outcomes may be different under RCT conditions compared with when
used in the general population.
 Researchers should be sure to exclude protocol-driven costs such as
frequent monitoring of patients or laboratory tests that are conducted more
often than in usual practice
 They should also conduct sensitivity analyses to account for possible differences
between RCT results and results that may be seen in a broader array of patients.
 Jadi basicly kita gabisa menjual keuntungan kesehatan dimasa mendatang ya? Kalau
kek metode2 nyari Cost Utility itu cuman metode aja, ga ada berkaitan dengan menjual
keuntungan dimasa mendatang? Karena orang lebih memilih memperoleh kesehatan
dimasa sekarang dibanding di masa depan.
 lack of standard rules for CEA research.
 2. Tentukan metode untuk penetapan utilitas
 Sensitivity analysis was conducted => to test the robustness of our results
 Itu dari Composite Article 2 => ngapain masih dikasih ICER ya? Kan less cost and
higher effectiveness
 QUESTION/EXERCISES FROM THE LAST CHAPTER OF CEA
 Calculate a CER
□ Option 1: $100/40% = $2.5 per percent effectiveness
□ Option 2: $50/60% = $0.8333 per percent effectiveness
□ Option 3: $150/90% = $1.6667 per percent effectiveness
 Calculate an ICER Comparing Option 1 with Option 2 => berarti ICER itu ga hanya
dipakai ketika Cost effectiveness grid nya jatuh di kotak A dan I ya? => kenapa
begini ya?
□ 100-50/40-60 = $-2,5 per extra percent effectiveness => APA ARTI ICER
YANG NEGATIVE?
 Calculate ICER comparing option 1 with option 3
□ 100-150/40-90 = $0 per extra percent effectiveness
 Kasus JKN from Mr.Prih
 Yg diwawancara harus pasiennya => Pada keadaan tertentu, karena pasien tidak mampu
memberikan jawaban yang obyektif [anak-anak, pasien dengan kognitif yang terganggu],
wawancara dilakukan pada orang terdekat. Tetapi, setidaknya sebagian hasil wawancara sulit
diharapkan untuk betul-betul akurat.
 Health-adjusted life years
○ Quality-adjusted life years.
○ Secara matematis, QALY adalah jumlah tahun pertambahan usia dikalikan dengan
kualitas hidup yang dapat dinikmati
○ Disability-adjusted life years
○ Hasil yang diharapkan dari suatu intervensi kesehatan yang terkait dengan
[penurunan] disabilitas. DALY dihitung sebagai pertambahan usia [dalam tahun] dari
hasil intervensi yang disesuaikan nilainya dengan perubahan disabilitas yang
diderita.
 Langkah untuk Perhitungan QALY
1. Buat Deskripsi untuk setiap disease state
○ Example about description of Diabetic Retinopathy
○ You have an illness that affects your blood sugar levels. You need to take medication
every day and test your blood. If your blood sugar level drops below a certain level,
you are in danger of becoming seriously ill. You sometimes experience blurry vision,
and you have some problems with your central vision. You have trouble reading,
especially fine or small print and sometimes have trouble seeing things clearly at
night. You feel anxious that your sight will get worse in the future. You feel somewhat
depressed about your level of vision and the risk that you might develop further
complications.
i. Rating Scale
Kelebihan dan kekurangan Rating Scale
Metode Rating Scale [RS] adalah yang termudah, tetapi pengukuran utilitas
dengan instrumen yang sering disebut “Visual Analog Scale” [VAS] ini bersifat
tidak langsung. Metode juga kurang akurat karena, pada pengisian yang bersifat
subyektif itu:
•Responden cenderung untuk tidak memberikan nilai yang terlalu tinggi [bahkan
jika QoL mereka baik sekali] maupun kelewat rendah [kalaupun ada disabilitas]
•Responden cenderung mengalami adaptasi dengan semakin terbiasanya pasien
tersebut dengan disabilitas yang dideritanya
•Jika [karena suatu hal] digunakan responden non-pasien, akurasi hasil akan
semakin rendah [karena responden tidak memiliki pengalaman subyektif terkait
hal yang ditanyakan
□ Contoh kasus:
Masalah pada perspektif pasien…
Stensman pada Scan J Rehab Med 1985; 17: 87–99
•Instrumen: VAS pada EuroQoL EQ-5 D
•Responden: 72 anak-anak
36 anak dengan kursi roda
36 anak “normal” dengan latar belakang setara [kontrol]
•Rerata skor utilitas:
Anak dengan kursi roda0,80
Anak normal [control]0,83
□ An instrument
called the Visual Analog Scale (VAS) is similar to the RS, but it does not
have any markings between the best and worst scores, and subjects are told to
mark an “X” somewhere between the two extremes to indicate their
preferences
□ Most
people would agree that mild seasonal allergies would not decrease a person’s
quality of life as much as being in a coma for the year.
ii. Standard Gamble
□ Gamble = Resiko.
 ii. Standard Gamble
□ Gamble = Resiko.

□ How much are risk on death are you prepared to take for a cure?
□ Standard gamble tuh kek gini ga sih? Kita pengen tau seberapa orang itu
menghargai hidupnya lewat ditawarin kehidupan yang lebih baik tapi dengan
mempertaruhkan resiko kematian. Semakin dia mau mengambil resiko
kematian yang tinggi untuk kehidupan yang lebih baik. Let say 55%
kemungkinan untuk meninggal.
□ Standard gamble => ada tablet yg bisa bikin kamu sempurna , tapi kalau gagal kamu
mati. Kemungkinanan berhasil 60% dan gagal 40% dari situ akan didapatkan
utilitasnya, bagaiamana dia mengharapkan hidupnya.

Kalau keadaannya menderita banget, dia mau minum untuk yg gagalnya 90%.
Artinya dia cuman menilai utility cuman 10%.
□ Jadi hasil utility itu hasil sebelum atau sesudah intervensi ya? Kayaknya penilaian
utility itu untuk kondisinya saat itu ya?
□ Ini ada obat dalam bentuk pil, bisa bikin kamu bikin sehat sempurna ,tapi
resikonya kalau gagal kamu mati. Kalau kemungkinan berhasilnya 100%, pasti
mau. Kalau kemungkinan berhasilnya 50%. Pasti gamau. Terus dinaiikin sampe
kemungkinan berhasil yg sampe dia terima. Dia akan menilai pengobarnan lebih
serius. Sehingga bisa dapat angka seberapa besar dia menghargai keadaannya.
Kalau disuruh bayangin, hasilnya bisa beda.
□ Kita bisa bandingin mana QALY yang lebih tinggi antara intervensi A dan B. dan
bisa bandingkan biaya juga. Kalau QALY tinggi dan biaya murah => maka itu
dipilih. Hasil lebih baik dengan biaya lebih mahal => dihitung ICER.

iii. Time Trade-Off

□ Time trade off. => cth: ini ada obat bisa bikin kamu lari2 punya pacar, cuman
ngurangin umur. Mau ga umur mu jadi tinggal 10 tahun? Gimana kalau tinggal
12? Disitu dia disuruh banyangin, untuk sehat sempurna dia mau ngorbanin
berapa tahun? Pengorbnanan itu diukur sebagai trade off. 18/20 => 0,9. itulah
utilitasnya dia.
□ Kita bisa pakai kalau laki2 usia harapan hidup laki2 indonesia 69 tahun. Misal
pasien laki2 terdiagnosis suatu penyakit pada usia 40 tahun dan penyakit bukan
penyakit mematikan. Berarti usia harapan hidup nya 29. dari situ bisa
mendapatkan usia harapan hidup rata2. sehingga bisa mendapat QALY rata2
□ Pada time trade off => orang suruh bayangin kalau keadaan mu seperti ini, usia
harapan hidupmu 40 tahun. Gmna kalau UHH kamu tinggal 30, kamu korbanin 10?
Oke saya mau korbanin 2 tahun, jadi 38. 38/40 x100 => time trade off value
□ As with the SG method illustrated
above, these calculations are for chronic diseases or conditions, and
calculations for a temporary health state are more complex and can be found
elsewhere

i. Comparison of the three methods

□ RATING SCALE
 Advantages:
1. Determine utilities is that many disease
states or conditions can be described to each subject
2. this method can be conducted via a questionnaire without face-to-
face interaction
3. People are familiar with indicating preferences on these types of
scales, and it is less cognitively demanding than the other two
methods.
 Disadvantages
1. it does not incorporate time into the utility score as easily as the
other two methods.
2. It also may be biased in that people do not tend to cluster their values
at the extreme ends of the scale but spread them throughout the
range given, even if some health states are very similar in their
values. In addition, respondents are not asked to make preference
choices between options
□ STANDARD GAMBLE
 Advantages
1. Gold standar and based economic theory
 Notes: Needs face to face administration or an iterative process
□ Time Trade Off
 Advantages
 it is more adaptable to diseases states than the SG, and it
incorporates the time in the disease state or condition more easily
than the RS.
 Notes: Needs face to face administration or an iterative process
□ Unfortunately, the average utility scores for each disease state or condition may
differ depending on which method is used. RS scores have been shown to be
consistently lower than either SG or TTO scores, and TTO scores are sometimes
lower than SG scores.

3. Pilih Subjek yang akan menetapkan utilitas

 differ depending on which method is used. RS scores have been shown to be
consistently lower than either SG or TTO scores, and TTO scores are sometimes
lower than SG scores.

3. Pilih Subjek yang akan menetapkan utilitas

○ In the literature, health care professionals are often asked to determine utility
scores. This may be based on practicality because these professionals have had
Experience with the disease states and are easily accessible for interviews.

4. QALY = Utility x usia harapan hidup

 Kalau QALY tinggi dan biaya murah => maka itu dipilih
 Addition notes from Rascati's book
○ Outcomes in CUA => Usually measure with Quality Adjusted Life Year(QALY). Other
outcome units that are seen less frequently include Disability Adjusted Life Years (DALYs)
& Healthy-year equivalents (HYEs)
○ Utilities => patient preferences (which incorporates both the quality (morbidity) and
quantity (mortality) of life.
○ Morbidity => a diseased condition or state, the incidence or prevalence of a disease
or of all diseases in a population.
○ Mortality => the quality of being mortal, Death rate.
○ Utility => used in a general way in other disciplines to indicate personal or group
preferences
○ What kind of a measure that incorporate both length of life and quality of life?
○ CUA may be a good choice for comparing treatments in health conditions do not have an
impact on patients length of life, but only on the quality of their life.

○ To estimate utility weights for various conditions or “health states” between

perfect health and death, two broad methods are used to elicit, or generate, these
scores: direct elicitation and indirect elicitation.
○ Direct elicitation => Rating Scale, Standard gamble and time tradeoff
○ Indirect elicitation => using Standardized weightings (e.g. EQ-5D and SF-6D
Surveys).
○ Utility => A measure of the relative preference for various options or satisfaction gained =>
pengukuran dari kecenderungan memilih sesuatu untuk berbagai opsi atau kepuasan
yang didapatkan. => misalkan ada coklat cadbury, Coklat ucok, coklat silverqueen. Kamu
plih yang mana? Oh gua pilih coklat cadbury karena lebih bkin kenyang. => nah ini utility
(pilihan berdasarkan kenikmatan yang diterima)
○ Utilitas itu adalah persepsi dari pasien, tentang manfaat intervensi kesehatan yg dia terima.
○ Menurutmu seberapa besar obat itu dalam mengurangi penyakitmu? Gabisa jawab dia.
Manfaat gabisa diukur langsung. Yg bisa diukur itu adalah peningkatan kualitas hidup.

Peningkatan kualitas hidup => dimensi yang berpengareuh terhadap kualitas hidup. Dimesinya
ada dimensi fisik, sosial dan psikologi. Fisik yang diukkur itu mobilitas, dia bisa bergerak
kemana2 ga. Kemudian rasa sakit, dia bebas ga dari sakit ga? Psikologi => bebas dari stress
dan kecemasan. Untuk mengukur quality of life dari bermacam macam dimensi itu. Itu ada 3
kelompok kuisioner yang dapat digunakan. Yang satu adalah kuisioner yang spesisifik pada
penyaki
○ Utilitas (kegunaan, faedah, manfaat) dimaksudkan untk mengukur manfaat pada orang
dengan kondisi yang berbeda.

○ Kak Valerie, mau kemana sayang? Mau ke pennsylvania gaa? Nanti kita jalan2 bareng ya
sayang..

○ Preference => lebih pilih yang mana?

○ Jadi kalau misalkan ketika ditawarin intervensi2 tersebut tapi orang udah menikmati dan
menghargai hidupnya, ya jadi pemerintah gaperlu memberikan intervensi tersebut ga sih
dalam program nasional?
 ○ Preference => lebih pilih yang mana?
○ Jadi kalau misalkan ketika ditawarin intervensi2 tersebut tapi orang udah menikmati dan
menghargai hidupnya, ya jadi pemerintah gaperlu memberikan intervensi tersebut ga sih
dalam program nasional?

 Discounting & Standarization

 Discounting => memprediksikan nilai uang dimasa depan itu.

Misal diprediksi 5 tahun kedepan ada alat kesehatan itu 10 jt. Nah 10 juta di 2032 itu berapa sih
nilai nya di sekarang.

Rumus discounting = cost : (1+p)n

Answer from Mr.Prih: Contoh:

5.000.000 tahun 2030 diakhir tahun. Kira2 ditahun 2022 nilainya berapa?
Ø Untuk melihat suatu program itu layak
Misal discount ratenya 5% jadi berapa
Kalau program itu biaya nya itu untuk meningkatkan 1 QALY tidak lebih dari 3 GDP =>
itu masih layak ditanggung. Indonesia GDP per kapitanya sekitar 4000 dollar. 5.000.000:(1x5%)8= 3.384.196
Peningkatanan 1 QALY tidak lebih dari 12.000, suatu negara mampu menanggung.
 Rumus Standardization = cost x (1+p)n
Ketika mau memutuskan, harusnya kan semua berlaku. Kalau kurang dari 3 QALY =>
akan lebih visible dari pada yang pas 3 QALY. Untuk meningkatkan 1 QALY ga sampe 3 ○ n itu tahun nya. Berapa tahun inflasinya segitu
GDP => itu biayanya lebih visible ○ P itu rate inflasi nya.
. Dibanding 3 pas GDP. ○ Contoh perhitungan liat table 2.3 rascati.

Semakin banyak orang yang bisa tertolong => itu semakin Visible. Ketika memilih  Latihan soal 2020
program mana yang harus dibiayai, itu liat nya yang mana. Tapi ketika ada beberapa
program, kita harus liat ituu.. Selain diliat yang semakin banyak, bukan hanya diliat
yang paling banyak pasiennya. Tapi diliat mana yang paling banyak bisa selamtin
orang dari catastrophic spending

Ø Kalau DM dan kanker. Penderita kanker lebih sedikit tapi mahal misal. Untuk
meningkatkan 1 QALY, sama2 3GDP karna DM kan lebih murah tapi banyak.

Biasanya penyakit2 mahal lebih dapat prioritas dibanding penyakit murah. Karena
kalau ga dibantu => orang akan mengalami keseulitan ekonomi. Pengeluaran ○
kesehatan lebih besar dari pengeluaran => itu catastrophic spending ( medical
spending of a household exceeds a certain level of capacity to pay

Jadi pengluaran kesehatan kalau mencapai 30% atau lebih dari pada katastropik.
Artinya masalah kesehatan udah mengalami ancaman. Termasuk kebutuhan protein
anak2.

Ø Nah JKN dirancang untuk mencegah itu. Supaya kalau ada orang yang skiat. Anakn
bisa tetap sekolah sehingga SDM masa depan ga terancam.

Kalau asuransi komersial, benefit yang didapat tergantung dari premi yang dia bayar. Kalau
asuransi sosial ga tergantung premi yang dibayar.