Cost minimization of cardiovascular disease (CVD) drugs in primary healthcare centers in Bandung, Indonesia
The implementation of the National Healthcare Insurance (NHI) Program has increased the role of Primary Healthcare Center in Indonesia. This program is focused on health promotion, prevention of the disease, curative care, and rehabilitative services at an affordable cost through the insurance system. In this program, cardiovascular disease (CVD) is one of the main focuses, because its high prevalence and the mortality rates for this disease was also high. This study aimed to assess the NHI program on cost minimization of drugs on cardiovascular diseases in all primary healthcare centers (PHCs) in Bandung. This was a cross-sectional study using retrospective data in all PHCs in Bandung. In this study, two settings were compared: (i) before the implementation of NHI (2013); and (ii) after the implementation of NHI (2014), by performing cost-minimization analysis. The use of Defined Daily Dose (DDD) and Drug Utilization (DU) were also taken into account with two thresholds of 75% and 90%. The implementation of NHI has decreased the number of CVD drug consumption (36.8%). Before the implementation of NHI, the cost related to CVD drug utilization (%) would be 72.84% and 90.76% in the segment of DU75% and DU90%, respectively. After the implementation of NHI, the cost would increase by up to 87.58% and 94.82% for both segments, respectively. In particular, the cost/DDD after the implementation of NHI also would increase by up to 80.37%% and 59.9%% for DU75% and DU90%, respectively. In conclusion, after the implementation of NHI, the cost related to CVD in all PHCs in Bandung is higher than before the implementation. It was estimated that the differences in drugs availability and prescribing pattern before and after the NHI program has influenced the CVD drugs utility in PHCs.
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