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All Journal Tropical Medicine Journal Jurnal Ilmu Kedokteran (Journal of Medical Science) Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Farmasi Klinik Indonesia Jurnal Ilmu Farmasi dan Farmasi Klinik (Journal of Pharmaceutical Science and Clinical Pharmacy) Jurnal Pengabdian Kepada Masyarakat (Indonesian Journal of Community Engagement) INDONESIAN JOURNAL OF PHARMACY Jurnal Farmasi Sains dan Komunitas JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Molucca Medica Indonesian Journal of Pharmacology and Therapy

Jarir At Thobari

Department Of Pharmacology And Therapy, Faculty Of Medicine, Public Health And Nursing, Gadjah Mada University, Yogyakarta, 55281, Indonesia

Author-ID : 403107

Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin and Aspirin for Stroke Prevention Atrial Fibrillation (SPAF) in the Indonesian healthcare setting Dwiprahasto, Iwan; Kristin, Erna; Endarti, Dwi; Pinzon, Rizaldy Taslim; Yasmina, Alfi; Thobari, Jarir At; Pratiwi, Woro Rukmi; Kartika, Yolanda Dyah; Trijayanti, Christiana
Indonesian Journal of Pharmacy Vol 30 No 1, 2019
Publisher : Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta, Skip Utara, 55281, Indonesia

Main drugs used in the prevention of stroke among atrial fibrillation (AF) patients are antiplatelets (aspirin) and oral anticoagulants (OAC). OAC therapy can be difficult to administer due to drug and food interactions, adds the burden of required blood monitoring, narrow therapeutic window, and requirements for dose titration. Rivaroxaban is a single-dose oral anticoagulant which does not require blood monitoring, dose titration or has dietary interactions. Phase III clinical data from the ROCKET trial have recently been reported the non-inferiority of rivaroxaban over warfarin for the prevention of strokes in AF patients. To develop an economic model evaluating the clinical and cost-effectiveness of rivaroxaban for the prevention of stroke in non-valvular AF patients in the Indonesian health care settings. We conducted cost effectiveness analysis from the perspective of payer (national health insurance). Effectiveness data used the international data from previous RCT and network metaanalysis studies. Costs data used local data of Indonesia from national health insurance’s reimbursement tariffs. Markov model was used, comprised of health and treatment states describing the management and consequences of AF. The main analysis was based on data from the phase III trials. Three months was used as cycle length. The time horizon was set at patients’ lifetime (20 years). Costs and outcomes were discounted at a 3% annual rate. Subgroup analysis and extensive sensitivity analysis was conducted. Willingness to pay (WTP) threshold in Indonesia was set as 3 times GDP of Indonesia in 2015, equal about IDR 133,375,000 per quality-adjusted life year (QALY). Base case rivaroxaban vs warfarin has ICER of IDR 141,835,063per QALY at the current cost of rivaroxaban IDR 23,500 and ICER of 130,214,687 per QALY at the proposed cost of rivaroxaban IDR 22,000. One-way sensitivity analysis showed that the key drivers of cost-effectiveness were the utility decrement applied to stable warfarin patients, discontinuation/subsequent discontinuation rates for rivaroxaban, and discontinuation/subsequent discontinuation rates for warfarin. The probabilistic sensitivity analysis suggested that rivaroxaban was cost-effective compared to warfarin in about 45% of cases at the WTP per QALY. Rivaroxaban with the proposed price of IDR 22,000 was considered to be more cost-effective when compared to warfarin.

PREDICTORS OF THE USE OF GASTROPROTECTIVE AGENTS IN PATIENTS USING NSAID IN YOGYAKARTA INDONESIA Ady Bagus Indrianto; Jarir At Thobari; Agung Endro Nugroho
Indonesian Journal of Pharmacy Vol 23 No 1, 2012
Publisher : Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta, Skip Utara, 55281, Indonesia

Non Steroid Anti-Inflammatory (NSAID) is one type of AntiInflammatory drug that is used to treat pain in patients of osteoarthritis (OA) and rheumatoid arthritis (RA). The use of NSAIDs can cause gastrointestinal side effects. To prevent the side effects, NSAIDs are prescribed in combination with gastroprotective agent (GPA). The aim of the study is to determine the factors considered in the GPA prescription by the doctors in patients who have risk factors for gastric disorder due to NSAIDs use. This study was performed using a cross-sectional observational design. The data were collected retrospectively during a period of January to December 2010. The subjects were OA and RA patients considering the inclusion and exclusion criteria. The data included patient characteristics (gender, age, occupation, payment method, the primary diagnosis), prescription of NSAID, prescription of GPA, history of gastrointestinal disease, NSAID prescription with corticosteroids, prescription with antiplatelet. The data were processed descriptively and quantitatively, and analyzed statistically using chi-square and log. regression with 95% Confidence Interval. The results showed that there were correlation between some predictor factors with prescription of gastroprotective agent. These factors were women patient, patient age of ≥ 65 years, oxicam prescribing, diclofenac sodium prescribing, prescribing >1 type of NSAIDs, prescription of NSAID concomitant with corticosteroids, prescription of NSAID concomitant with antiplatelet, patients with history of gastrointestinal, prescribing NSAIDs with duration of ≥ 3 months. Patient with a history of gastrointestinal disease was the most predictor influential factor, with OR (odds ratio) of 3.6 (95% CI: 2.79 - 4.66). Predictor factor of patients with a history of dyspepsia possessed the highest OR {OR=4,29 (CI 95%: 3.23–5.7)}. It means that patients with a history of dyspepsia prescribed NSAIDs would have greater risk of 4.29 times to get GPA prescription than patients without a history of dyspepsia. Prescribing NSAIDs > 1 DDD (defined daily dose) had p value of 0.777, which means there was no relationship between GPA prescription with NSAIDs > 1 DDD prescription.Key words: Gastroprotective Agent, Non-steroid anti-inflammatory, Osteoarthritis, Rheumatoid Arthritis

Co-Authors A.A. Ketut Agung Cahyawan W Ady Bagus Indrianto Agung Endro Nugroho Al Razi Sena Alfi Yasmina Alfi Yasmina Anggit Dewi Rahayu Anggoro Budi Hartopo Annisa Setiyaningrum Anwar Santoso Asal Wahyuni Erlin Mulyadi Ave Olivia Rahman Bambang Irawan Chandra, Lukman Ade Christi Mambo David Dwi Putera Deva Bachtiar Dimas Pramita Nugraha Dwi Indria Anggraini Dyah Aryani Perwitasari Endang Mahati Erna Kristin Faridatun Khasanah Fatma Othman Gdara Guntur Benedict Hutadjulu Hari Agus Sanjoto Hendrik Hendrik Indwiani Astuti Iwan Dwiprahasto Iwan Dwiprahasto Iwan Dwiprahasto Johan Kurnianda Jonathan Hasian Haposan Lucia Kris Dinarti Luhur Pribadi Lukman Ade Chandra Maemonah, Maemonah Mardiah Suci Hardianti Mustofa Mustofa Nailatul Arifah Ngatidjan Ngatidjan Pompini Agustina Sitompul Pratiwi, Woro Rukmi Pratiwi, Woro Rukmi Rafika Mutia Sari Rita Suhadi Rizaldy Pinzon Rizki Amalia Gumilang Sari, Rafika Mutia Shofya Indraguna Siahaya, Presli Glovrig Sitti Rahmah Umniyati Sutarman S Syahru Agung Setiawan Teguh Triyono Togi Junice Hutadjulu Tri Asti Isnariani Tri Murti Andayani Tri Murti Andayani Trijayanti, Christiana Ully Adhie Mulyani Umi Sa'adatun Nikmah Wahyu Damayanti Yanri Wijayanti Subronto Yati Soenaro Yati Soenaro Yati Soenarto Yolanda Dyah Kartika Zulpadly, M Fiqri

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