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Endang Sunariyanti,1,2 Tri Murti Andayani,3 Dwi Endarti,4 Diah Ayu Puspandari5 1Doctoral Program in Pharmaceutical Science, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Universitas Muhammadiyah A.R.Fachruddin, Tangerang, Banten, Indonesia; 3Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia; 4Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia; 5Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Tri Murti Andayani, Department of Pharmacology and Clinic, Faculty of Pharmacy, Universitas Gadjah Mada, Sekip Utara, D. I., Yogyakarta, 55281, Indonesia, Email trimurtia@ugm.ac.idObjective: The cost of treating chronic kidney disease requires large funds. Chronic kidney disease financing ranks 2nd in BPJS as the highest financing. All cost components in the treatment of chronic kidney disease are considered high, so adjustments and efficiency are needed. This study aims to perform a cost analysis in chronic kidney patients. In this article, we will discuss the cost components in treatment and see whether there are differences in the cost of treatment in each hospital.Methods: The study used a cross-sectional design with a hospital perspective and was conducted in 6 hospitals selected based on class in different regions: Sardjito Central General Hospital (class A), Yogyakarta Regional General Hospital (class B) and PKU Muhammadiyah Hospital (private class) represent hospitals in regional 1. Meanwhile, Makassar Central General Hospital (class A), Labuang Hospital Baji (class B) and Faisal Islamic Hospital (private class) represent hospitals in regional 3. The study lasted for 14 months from October 2019-December 2020. The total sample involved in this study was 582 samples. The cost components analyzed include hemodialysis costs, serious procedures and operations, services, radiology, laboratories, blood transfusions, drugs, medical devices, hospitalization and supplies.Results: Chronic kidney patient profile data, calculations and cost components are presented descriptively. The Mann–Whitney test was used to see whether there were differences in costs between hospitals in each region. The results showed that the total cost of treating chronic kidney disease was higher in class A hospitals compared to class B and private class hospitals.Conclusion: The highest cost component is the cost of hemodialysis, followed by severe procedures and services. The highest total cost of hemodialysis reached Rp. Rp.840,132,546, heavy action Rp. 423,156,000 and services Rp. 792,155,000. The results of statistical tests showed that there were differences in the cost of treating chronic kidney disease in hospitals in regional 1 and regional 3 (p < 0.05).Keywords: cost of illness, chronic kidney, hemodialysis

The government has created the National Formulary (Fornas) as a tool for control of quality and cost control. Patients’ prescriptions should be based on the national Formulary during the era of national health coverage. If prescriptions complied with the national Formulary, the cost would reduce. This research aimed to determine the factor of non-conformity between prescriptions and the national Formulary measures it and explores the need for pharmaceutical cost containment. This study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method between 2014 and 2022. The search terms “Kesesuaian Fornas” were utilized on Google Scholar, Pubmed, ScienceDirect, and Scopus. The evaluation was organized by factor and subsequent action. Searches of the databases Google Scholar (2,246), Pubmed (0), ScienceDirect (1), and Scopus (0) yielded a total of 247 results. Following the selection procedure, 34 articles were included in the analysis. The average conformity of prescription with Fornas was 71.02%. Prescription adherence, drug availability, and formulary Conformity with Fornas were the primary factors in the conformity of prescriptions with the National Formulary. Conformity with the national Formulary for prescriptions can be enhanced through three primary actions: increasing prescription adherence, updating the Formulary, and procuring following the electronic catalog.

The quality of working life is crucial for improving work productivity, particularly among nurses, who often experience high levels of stress. This study aims to evaluate the quality of working life among nurses in Laos and identify the factors that influence it. A cross-sectional study was conducted among Laos nurses from August 2021 to July 2022. Data collection was conducted using an anonymous questionnaire distributed via the Internet. The Quality of Working Life version 2 (WRQoL-2) questionnaire, comprising 32 items divided into seven subscales, was employed to assess the quality of working life. Statistical tests such as t-tests, ANOVA, and Spearman correlation were applied to examine differences and correlations. A total of 326 participants were included, with an average age of 32.62±8.21 years. Among the seven subscales, the highest score was observed in the Job Career Satisfaction subscale (3.72±0.56), while the lowest score was found in the Safety at Work subscale (3.22±0.71). The overall mean score was 3.49±0.54. Significant differences in the quality of working life were observed among different groups categorized by age, job position, salary, and working hours. The WRQoL-2 questionnaire was found to be suitable for assessing the quality of working life in this study.

The global cosmetics industry is experiencing robust growth and Generation Z (Gen Z) is a potential customer source of this market. This research examines customers’ intentions to purchase cosmetic goods of Gen Z in Hochiminh city using perceived value factors as the antecedents of attitude in the model. A cross-sectional study, applying a convenient sampling method, was conducted to collect data from Gen Z people in January 2023. There were no specific cosmetics products included in the study. Descriptive analysis and Partial Least Square (PLS) method of Structural Equation Modeling (SEM) with SmartPLS 4.0.8.7 software were used to analyze the research data. The PLS-SEM analysis of 723 responses showed that attitudes toward purchasing cosmetic products are significantly positively impacted by perceived environmental value. A more positive attitude would result from increased brand credibility and product understanding of cosmetics. There was no evidence to support the impact of other perceived values (specifically, health, safety, social, spiritual, and ethical) on attitudes toward consumer behavior. Attitude was important in predicting willingness to pay (both direct and indirect). This study helps industry professionals to advance the qualities of cosmetic products by increasing and improving environmental value, product knowledge, and brand credibility. The eco-friendly pattern of production and marketing strategies focusing on product ingredients, manufacturing processes, and quality standards are necessary to enhance brand credibility and product understanding, align with consumer preferences and achieve greater success in the market.

Cervical cancer is the fourth most common type of cancer incidence in women. It has been recognized that Human Papillomavirus (HPV) is causative agent in the pathogenesis of cervical cancer. In 2022, 117 countries have included HPV vaccine in their national immunization program. Understanding participants’ decision regarding their children and themselves being vaccinated is important to ensure high coverage of the vaccine. This study aimed to conduct a systematic review of knowledge, acceptance, and willingness to pay for HPV vaccine. The required information was collected by searching with relevant keywords during OctoberDecember 2022 for articles published from 2013 – 2022 in PubMed, Scopus, ScienceDirect, and SpringerLink. The data were analyzed in Excel and reported descriptively. Finally, 22 studies were included to review. Most of the participants were female (96.44%) and the majority had health workers background (50.09%). The knowledge of mostly results was poor (40.9%). The acceptance of HPV vaccine was high, the range vary from 39–98.8%, especially for the vaccine with higher degree, longer duration of protection, lower out-of-pocket, and lower risk of side effects. Overall, the respondents’ attitude was positive toward vaccination. The most frequent method used for measuring WTP was CVM (54.54%). The average WTP range from 0.1– 17.51% to GDP per capita (9.9–745.25 USD). The cost was the primary reason that impact to the willingness to pay and acceptance. Results showed that the acceptance rate of HPV vaccination and WTP were relatively high when the vaccine was offered for free or reasonable price, even though their knowledge was poor. It is recommended to reduce the cost of vaccination program and to increase knowledge, awareness, and attitude of people.

Treatment adherence is essential for controlling blood pressure and preventing complications. The availability of information regarding factors related to adherence is needed to design appropriate interventions. However, this information is still limited. This study aims to evaluate medication adherence and identify the main factors associated with hypertension patients living in urban and rural areas. A crosssectional study was conducted in ten primary healthcare facilities in South Sumatra Province, consisting of 5 urban and 5 rural areas, totaling 458 hypertensive patients. Medication adherence was measured using the MGLS questionnaire, social support with the MSPSS, and level of knowledge with HK-LS. Data were analyzed using descriptive statistics, bivariate tests using chi-square, independent T-test, and mann-whitney tests, and then continued multivariate logistic regression analysis. Adherence to hypertension medication in urban (38.2%) and rural (23.6%) areas differed significantly (p=0.000). Medication adherence in urban areas was related to work (OR=4.787, p=0.000), social support (OR=5.054, p=0.000 ), and level of knowledge (OR=6.558, p=0.000). In rural areas, medication adherence is associated with social support (OR=4.696, p=0.000), knowledge level (OR=12.555, p=0.022), high/middle school education (OR =3.290, p=0.000), bachelor or above education (OR=12.871, p=0.000). Most patients are non-adherent to treatment hypertension in urban and rural areas. The factors most related to medication adherence in urban areas were employment status, social support, and knowledge about hypertension, while education, social support, and knowledge were the factors most related to adherence in rural areas. Interventions must be designed based on the information obtained to improve medication adherence.

A strategy for reducing healthcare costs of diabetic mellitus (DM) is by reducingbody weight and blood glucose through lifestyle-modification programs such as intensive lifestyle interventions, mealreplacement programs, and physical activity. A return on investment (ROI) analysis needs to be done to see a program’s effectiveness, which aims to make this program provide benefits, especially in the long term. In this systematic review, the authors describe ROI, the program, the program’s cost, adoption, and implementation. The authors searched the Science Direct, Pubmed, and SAGE databases using the following search terms: ‘Return on Investment’ AND ‘DiabeticMellitus’ and Programs”. Moreover, hand searching identifies further studies. This review includes eight articles, and most articles on lifestyle modification intervention have great ROI; several articles with public health workers have great ROI. The findings show that long-term and program intensity in a long time horizon plays a major role in outcomes and more significant ROI. Programs with lifestyle intervention fellow health workers or CHWs that helped deliver physical activity, education, and dietary had a good impact in lowering diabetes risk.

The cost-effectiveness of human papillomavirus (HPV) vaccine for non-cervical cancer including anogenital cancers and head and neck cancers has been evaluated in many countries. This is important for the decision-makers in health policy as they have a limited budget for an enormous option of health technology. The objective of this study is to systematically review the health economic studies in order to evaluate the cost-effectiveness of HPV vaccination for preventing non-cervical cancer including anogenital cancer and head and neck cancer. Approximately 496 articles were obtained from three databases (ProQuest: 430, Scopus: 40 and Pubmed: 29). The screening and selection of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The final articles were assessed by using the Consolidated Health Economics Evaluation Reporting Standards (CHEERS) checklist. Based on the review of fifteen articles, most articles concluded that HPV vaccination was cost-effective compared with current standard care. One study showed that HPV vaccination may be cost-effective if only the price is lowered. HPV vaccination is considerably a cost-effective solution to prevent non-cervical cancer based on the studies conducted in many countries particularly the ones with high income.

Background: In Indonesia, the cost of cancer treatment has been determined by the Indonesian Case Base Groups (INA-CBGs) based on a code called the INA-CBG's rates. However, a fair claim should be based on the severity of the disease and the class of treatment in the hospital, not on the rates of code. In fact, the real cost of therapy for cancer is influenced by several factors including stage, comorbidity, and severity (INA-CBGs coding, type of hospital, hospital class, treatment grade, side effects, and length of stay), so in many cases, there are reported differences between the real costs and the INA-CBGs rates charged to patients., Objective: This study aims to investigate the difference between real treatment costs and INA-CBG's rates for cases of lung cancer, cervical cancer, and breast cancer at a cancer center hospital in Indonesia., Methods: This work uses an observational study, and the data were taken retrospectively from hospital financial data and patient medical records. The data were then analyzed using a one-sample t-test to determine the difference between real costs and INA-CBGs costs., Results: The results showed that there was no significant difference between real costs and INA-CBG's cost on stage II lung cancer treatment in grade 2 with a sig. value of 0.683; code C-4-13-II in grade 3 with a sig. value of 0.151; and code C-4-13-III in grade 3 with a sig. value of 0.650; where the significance level (t alpha) is more than 0.05. Furthermore, the treatment costs for cervical cancer with codes C-4-13-I and C-4-13-II in grade 1 had sig. values of 0.155 and 0.720 respectively. Lastly, the treatment cost for breast cancer patients with codes C-4-12-II in grade 3 had a sig. value of 0.145 and code C-4-13-II in grade 3 showed a sig. value of 0.091., Conclusion: Although statistical evaluation showed a significant difference for some cases and not significant for other cases, in real conditions, there is a difference between the INA-CBGs and the real costs that must be evaluated by the government and stakeholders to provide justice for cancer patients., Competing Interests: The authors have no conflicts of interest regarding this research., (Copyright: © Pharmacy Practice.)

Background: Several studies showed the superiority of aromatase inhibitor (AI) as first-line therapy for patients with hormone-receptor (HR)-positive breast cancer (BC). For the clinician, studies in the real world are warranted to determine treatment based on the efficacy of each drug. We compared a 5-y disease-free survival (DFS) of each AI in terms of survival benefit. Materials and Methods: We evaluated 450 medical records of postmenopausal women who were diagnosed with HR-positive HER2-negative BC (stage I - III) at Dr. Sardjito General Hospital from January to December 2019. All patients had undergone surgery and chemotherapy or radiation therapy. Moreover, study participants received anastrozole, letrozole, or exemestane for at least one year. Kaplan Meier estimation survival curve was used to analyze the survival rate. Result: Of 79 patients meeting inclusion criteria, there were 21.52% distant metastases documented. Time to disease progression of anastrozole, letrozole, and exemestane was 49 months, 58 months, and 53 months, respectively. Letrozole was found better than anastrozole (hazard ratio (HR)=4.342, 95% CI 0.95-19.95; p=0.038). Letrozole versus exemestane (HR=2.757, 95% CI 0.53-14.33; p=0,206) and anastrozole versus exemestane (HR=1.652, 95% CI 0.56-4.84; p=0.351) were found not significantly different. 5-y DFS rate of letrozole was better found (87.5%) than exemestane (73.7%) and anastrozole (61.4%). Conclusion: 5-year letrozole administration could be proposed as first-line therapy for postmenopausal women with HR-positive HER2-negative BC. A considerable subject and long-term follow-up are needed for validation., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Tehran University of Medical Sciences.)

Background: The drug regimen for the treatment of multidrug-resistant tuberculosis (MDR-TB) has lower potency, is more costly, and has a greater risk of adverse effects than first-line anti-TB drugs. We aimed to compare the treatment outcomes of patients using standard shorter regimen (STR regimen) versus bedaquiline (BDQ)-containing individual regimen in a high TB-burden setting., Methods: This was a retrospective cohort study using secondary data from the medical records in the hospital. The study population were patients with MDR-TB who started treatment in 2016-2018. Treatment outcomes were classified as successful (cured/completed treatment) or unsuccessful (failure/death/loss to follow-up/not evaluated). Categorical data were presented as frequencies and percentage, whereas continuous data were presented as mean± standard deviations. Risk ratio (RR) was obtained by using the Chi-square statistical test with 95% confidence interval (CI) and P < 0.05 set as a significant result., Results: We included 99 patients out of 444 registered patients in 2016-2018. The overall success proportion was 41.4%. Success was more likely in patients who received BDQ regimen than those receiving STR regimen (52.9% vs. 35.4%, RR: 1.496, 95% CI: 0.948-2.362). Factors that influenced the treatment outcomes were smear status and sputum culture status., Conclusions: The success rate of the STR regimen and the BDQ regimen in this study is still below the national and global figures due to the high rate of lost to follow-up. The success was higher in the BDQ regimen, although not statistically significant. Further research is needed on adverse effects, quality of life, and costs during treatment., Competing Interests: None

Objective: Breast cancer is the most common cancer in Indonesia, with Indonesia's breast cancer mortality rate being the highest among Southeast Asian countries. This study aims to evaluate the cost-effectiveness and budget impacts of adding trastuzumab to chemotherapy versus chemotherapy alone for HER2-positive breast cancer patients in Indonesia., Methods: We performed a Markov model-based economic evaluation to assess cost-effectiveness, cost-utility, and budget impact. Utility data, direct medical costs, and indirect costs were obtained primarily from interviewing patients. Clinical effectiveness data, on the other hand, were obtained from systematic reviews and real-world data and represented through progression free survival, overall survival, and quality-adjusted life years (QALYs)., Result: From a healthcare provider's perspective, the total costs for the combined group were USD 14,516, while chemotherapy alone cost USD 7,489. While the cost-effectiveness analysis showed that the combination group had a higher total cost by USD 7,027, PFS was longer in the chemotherapy alone group, with a difference of 2.2 months. The ICER was USD 17,307 for every QALY gained. The total cost of adding trastuzumab over a 5-year period was USD 589 million., Conclusion: In conclusion, this economic evaluation suggests that the addition of trastuzumab to standard chemotherapy is not cost-effective in terms of PFS and OS compared with chemotherapy alone., .

Background: Cervical cancer is the second leading cause of death in Indonesia, causing a significant societal burden. This study aims to quantify the burden of cervical cancer in terms of years of life lost (YLL) and productivity cost to support the idea that cervical cancer has substantial economic implications., Methods: Using an epidemiological approach on the prevalence data of 2018, the productivity cost and YLL were estimated by calculating the number of cervical cancer deaths, life expectancy, annual earnings and employment participation rate. Cervical cancer mortality data were obtained from the Global Cancer Observatory (GLOBOCAN) 2018, life expectancy for Indonesia from the WHO Life Tables (2019), and the annual earnings and participation rate of Indonesia were retrieved from the National Statistics Bureau (2018)., Results: In 2018, there were 17,253 deaths due to cervical cancer in Indonesia, resulting in 246,350 YLL with a total productivity cost of Indonesian Rupiah (IDR)23,174 trillion. The age group of 50 years old-64 years old experienced the greatest loss of earnings (IDR12,149 trillion), followed by the 35 years old-49 years old (IDR8,944 trillion) and 20 years old-34 years old (IDR8,944 trillion) age groups., Conclusion: The productivity impact of loss of earning due to cervical cancer mortality is significant. This information may assist decision makers in allocating scarce resources among competing priorities., Competing Interests: Conflict of Interests None., (© Penerbit Universiti Sains Malaysia, 2022.)

Objectives: Breast cancer (BC) in women could decrease health-related quality of life (HRQoL). HRQoL becomes important to be assessed to design a relevant treatment that could improve patient outcomes. Furthermore, assessing HRQoL by measuring health state utilities becomes pivotal for health economic evaluation. This study aimed to describe the HRQoL of postmenopausal women with hormone responsive (HR+) HER2- BC using the EQ5D5L instrument in Indonesia., Methods: A cross-sectional study was conducted among 126 patients in Dr. Sardjito Hospital in Indonesia. The HRQoL was assessed by interviewing BC patients using the EQ5D5L questionnaire, and the utility index was calculated using the Indonesian value set. Information regarding clinical characteristic and socio-demographic were gained from patient medical records. One-way ANOVA and post-hoc Scheffe's test was performed to compare the utility score within the health state., Results: Of the 126 patients, a mean ± SD for the age of 59.2 ± 6.1 years. The major problems of patients were pain/discomfort (75.4%) followed by anxiety/depression (54.8%). The mean (SD) of EQ5D VAS was 76.64 (14.91). Mean (SD) of utility score was 0.87 (0.10), 0.77 (0.19) and 0.58 (0.44) for free metastasis (FM), locoregional metastasis (LM) and distant metastasis (DM), respectively. Poor QoL was observed at DM health state (p<0.05)., Conclusions: HRQoL of postmenopausal women with HR+ HER2- BC was low. The major reported problems were pain/discomfort and anxiety/depression., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: Since 2016, bevacizumab has been widely used to treat metastatic colorectal cancer (mCRC) in Indonesia. Nevertheless, the high cost of bevacizumab has raised the question of whether the therapy is considered cost-effective and should be included in the national health insurance system. This study aimed to assess the cost-effectiveness of bevacizumab plus chemotherapy versus chemotherapy alone for the treatment of mCRC patients., Methods: A Markov model was applied using the perspective of the Indonesian healthcare system to assess cost-effectiveness. The health outcomes were expressed in terms of quality-adjusted life years (QALY) using the validated EuroQoL-5D-5L instrument. Data for medical costs were collected from hospital billings in four hospitals located in three different cities in Indonesia. Meanwhile, data for utility were obtained from interviewing 90 patients who came to the hospital. We compared those mCRC patients who received chemotherapy alone either with FOLFOX or FOLFIRI, versus patients who received the addition of bevacizumab., Results: With the perspective of societal, the incremental cost-effectiveness ratio (ICER) of adding bevacizumab was USD 49,312 per QALY gained using secondary data and USD 28,446 per QALY using real world data., Conclusion: Using either a healthcare or societal perspective, the addition of bevacizumab for mCRC treatment was considered not cost-effective.

Objective: In Indonesia, no study has been published to evaluate the utility scores among children with pneumonia. This study aims to quantify the health-related quality of life (HRQOL) of children with pneumonia in Indonesia using the EuroQoL Descriptive System (EQ-5D-5L) value set for Indonesia., Methods: A hospital-based cross-sectional survey was conducted between September 2017 and March 2018. Children aged <14 years old who were hospitalized for pneumonia in 11 hospitals in Yogyakarta were recruited for this study. The EQ-5D-5L and visual analogue scale (EQ-VAS) were applied to the parents (proxy-assessment)., Results: A total of 384 patients were hospitalized with pneumonia. Among those patients, 338 (88.02%) were without congenital diseases; and 46 (11.98%) were with congenital diseases. The mean of utility scores in all patients was 0.67 ± 0.28, while the mean of visual analog scale (VAS) score was 67.66 ± 21.98. The mean of utility scores and VAS scores decreased among those with congenital diseases, which is 0.51 ± 0.51 and 65.41 ± 19.42, respectively. However, the utility score and VAS scores among patients without congenital diseases were higher than the category of all patients. Showing the number of,0.69 ± 0.23 and 68.0 ± 22.3, respectively., Conclusions: This study confirmed that children with pneumonia had a negative impact on HRQOL. The HRQOL could be used for future economic evaluation studies., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: This study aims to translate, culturally adapt, and validate the Short-Form 6D (SF-6D) instruments for measuring quality of life as outcome parameters in pharmacoeconomic studies., Methods: The forward-backward methods were applied to translate the SF-6D questionnaire. A preliminary Indonesian version of SF-6D questionnaire was field tested in samples of 470 adult general population. Test-retest reliability was assessed by using Spearman rank correlation coefficient and internal consistency with Cronbach α. Face validity was assessed descriptively based on the response of the respondents to all items in SF-6D. The construct validity test included internal construct validity and convergent validity, which was assessed by examining the correlation between the questionnaire and Euro-Quality of life-5D based on the scale of each domain. The known group method was used to test discriminant validity. Mann-Whitney U test was employed for comparing the utility score on dichotomous variables and Kruskal-Wallis H test was used for polychromatic variables., Results: The SF-6D was a valid and reliable questionnaire, indicated by the reliability coefficient of 0.725 and the value of each item ranging from 0.698 to 0.750. Construct validity indicated a strong correlation between physical functioning, role limitation, social functioning, pain, and mental health with the SF-6D utility score. Convergent validity showed a weak and moderate correlation between dimensions on SF-6D and Euro-Quality of life-5D., Conclusions: The SF-6D questionnaire has been translated into Indonesian version. The SF-6D questionnaire is valid and reliable. Known group validity shows that the SF-6D could differentiate utility scores by age group and history present illness., (Copyright © 2020 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

Background The quality of well being self-administered (QWB-SA) questionnaire is one of the generic instruments which can be used to measure the utility score to assess the quality-adjusted life years (QALYs) as an outcome parameter in pharmacoeconomics study. This research aimed to study the translation, cultural adaptation, and validation of the QWB-SA questionnaire in Indonesian language. Methods This research was conducted among the general population of 459 people in Yogyakarta city. The translation was done using the forward-backward method by independent linguists, and then reviewed by a team consisting of linguists, methodologists, and pharmacists. The psychometric evaluations included face validity, internal-construct validity, convergent validity, and known-group validity tests, while the reliability test was the test-retest of reliability with the Spearman's rank correlation and Pearson test. Results The translation results and cultural adaptations were modified from the aspect of idiomatic, semantic and conceptual equivalence of the items on the QWB-SA questionnaire. The internal-construct validity showed a very strong and moderate correlation among dimensions and the QWB utility index. The convergent validity showed moderate-to-weak correlation compared to the Euro-quality of life-5 dimension questionnaire. The reliability test showed the Cronbach alpha coefficient of 0.626, and the test-retest of reliability showed a strong and moderate correlation. Conclusions The QWB-SA questionnaire is valid and reliable, and can be used as an alternative to measure utility as a QALY's parameter in the health-economic evaluation.

Objective: Multiple myeloma (MM) with bone metastases causes a skeletal-related event (SRE), and decreases health-related quality of life (HRQoL). HRQoL needs to be evaluated for health technology assessment (HTA). Furthermore, HRQoL is calculated as a health state utility and is used in the Markov Model for HTA. Therefore, this study aimed to describe the HRQoL of MM patients with bone metastases, using The EuroQol five-dimension five levels (EQ -5D-5L) in Indonesia., Methods: a cross-sectional, multicenter study for MM patients with bone metastases (aged over 18 years old) that consulted a physician between November 2018 - May 2019 was conducted. The calculated HRQoL illustrated the health state utility, which was assessed using the EQ-5D-5L questionnaire, with the Indonesian value set. In addition, Mann-Whitney analyses were performed to determine the difference in utility scores at different points within the Durie-Salmon staging system and skeletal condition., Results: in 93 patients who completed the questioner, pain was their major concern with prevalence of over 60% (all levels inclusive). Moreover, the mean utility of patients in stage II and III were 0.735 (SD = 0.205) and 0.383 (SD = 0.555), and those without SRE was 0.753 (SD = 0.213) while patients with SRE was 0.302 (SD = 0.562). Therefore, the lessened values were observed at stage III and SRE condition (p<0.05)., Conclusion: MM patients with bone metastases have poor HRQoL, with pain as the most frequently reported challenge, which is associated with an advanced stage of MM and SRE event.

Background: The national health insurance of Indonesia has implemented the Indonesian Case Base Groups (INA-CBGs) tariff rates for healthcare payment. However, there is still problem of difference between the real cost of healthcare and the INA-CBGs tariff rates. This study aimed to evaluate the real cost of healthcare in comparison with the INA-CBG’s tariff rates and to analyze factors associating with the real cost. The study focus on healthcare cost of non-chemotherapy expenditure among patients of high-incidence cancers having chemotherapy covered by the national health insurance. Methods: The study was conducted from the perspective of healthcare provider. Costs data was obtained from hospital billing of Sanglah hospital, a referral hospital in Bali Provincein the period of January – July 2014. The data involved 383, 161, and 152 of in-patient breast cancer cases, cervical cancer cases, and nasopharyngeal cancer cases, respectively. Descriptive statistic was used to analyze patients characteristics, one sample t-test was used to analyze the mean difference of healthcare cost based on real cost and INA-CBG’s tariff rates, and finally, bivariate analysis was used to examine relationship between patients’ characteristics and the real cost. Results: The study shows there were significant differences of non-chemotherapy expenditures based on the real cost and INA-CBG’s tariff rates, in which the costs were lower for the real cost. Factors which significantly associated with the real cost were number of procedure, type of hospitalized room, and length of stay. Conclusions: The study supports the necessary of evaluation of the INA-CBG’s tariff rates to adjust to the real healthcare expenditure. On the other hand, the hospital needs to evaluate the service quality of patient treatment by optimizing budget allocated by the health insurance., (Creative Commons Attribution License)

Obesity is one of the risk factor of non-communicable diseases, one of them is cancer. It may lead to the escalation of mortality. Indonesia is the top 10 country with the highest prevalence of cancer burden due to obesity. The chance of cancer caused by obesity is estimated epidemiologic descriptive and prevalence-based estimation with obesity attributable cancer mortality and Premature Mortality Cost as indicators. Obesity-related cancer mortality is calculated by multiplying Obesity Attributable Fractions (OAFs) rate by cancer death rate, which OAFs rate obtained by calculating obesity prevalence data and relative risk of each disease. Premature Mortality Cost was calculated by multiplying obesity-related cancer mortality, life expectancy, and Indonesian average income. The highest total mortality’s rate for obesity-related cancer and overweight-related cancer are colon cancer (929 deaths), ovarian cancer (599 deaths), and pancreatic cancer (190 deaths). The highest value of Premature Mortality Cost are IDR 61,118 million for ovarian cancer, IDR 56,651 million for colon cancer, and IDR 15,472 million for pancreatic cancer. The estimation of cancer burden due to obesity shall be done to help the government determines the health programs and decrease the number of cancer burden due to obesity in Indonesia., (Creative Commons Attribution License)