Cost-Effectiveness Analysis of Two or Three Dosage Forms of N-Acetylcysteine in ICU Patients with Pneumonia

July; Sri Teguh Rahayu; Aura Febri  Khairani

doi:10.35451/s13m6d29

Authors

July Universitas Esa Unggul Jakarta
Sri Teguh Rahayu Universitas Esa Unggul Jakarta
Aura Febri Khairani Universitas Esa Unggul Jakarta

DOI:

https://doi.org/10.35451/s13m6d29

Keywords:

N-Acetylcysteine , cost-effectiveness , pneumonia, ICU, clinical improvement

Abstract

Background: Pneumonia is an acute infection of the lung tissue caused by various microorganisms, exposure to chemicals, or physical lung damage. The mucolytic N-acetylcysteine (NAC), administered in varying numbers of dosage forms, is frequently used as an adjunctive therapy in the management of pneumonia. Objective: This study evaluated the cost-effectiveness of N-acetylcysteine (NAC) mucolytic therapy using two versus three NAC dosage forms in ICU patients with comorbid pneumonia, by analyzing clinical improvement, ICU length of stay, and drug costs. Methodology: A retrospective observational study was conducted at the Prof. Dr. dr. Mahar Mardjono National Brain Center Hospital, involving medical record data from 88 pneumonia patients, who received two or three NAC dosage forms. Result: Of the patients, 51.1% had a length of stay (LOS) exceeding 9 days, with a higher proportion in the three-dosage-form group (73.7% vs. 45.0%, P = 0.083). Medical records and radiological findings indicated greater clinical improvement in the three-dosage-form group (31.6% vs. 16.0%, P = 0.001). The Average Cost-Effectiveness Ratio (ACER) was Rp20,932 for two dosage forms and Rp27,961 for three dosage forms per 1% effectiveness, demonstrating a lower cost per unit of effectiveness for two dosage forms. The Incremental Cost-Effectiveness Ratio (ICER) was Rp35,169 per 1% additional effectiveness, with an additional cost of Rp548,637 for a 15.6% effectiveness increase in the three-dosage-form group. Conclusion: Therapy with three dosage forms of N-acetylcysteine yields better clinical improvement compared to two dosage forms, but is associated with a longer ICU length of stay and higher drug costs.

Downloads

Download data is not yet available.

References

[1] Menteri Kesehatan RI. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Pneumonia pada Dewasa. 2023.

[2] Kementerian Kesehatan RI. Survei Kesehatan Indonesia (SKI) 2023 dalam Angka. 2023.

[3] Valentino A, Endriani R, Ameini F. Gambaran Kejadian Pneumonia pada Pasien Pasca Kraniotomi di Ruang Rawat Intensif RSUD Arifin Achmad Provinsi Riau Periode Januari 2015 sampai Desember 2019. J Ilmu Kedokt 2021; 14: 111.

[4] Anita DC, Kardi. Faktor yang Berkontribusi pada Kejadian Pneumonia Nosokomial. In: The 13th University Research Colloqium 2021. 2021, pp. 864–871.

[5] Mildawati R, Faizah NR. Faktor yang Memengaruhi Biaya Riil pada Pasien JKN Pneumonia Komuniti Pediatrik Rawat Inap di RSUD dr. Moewardi. J Dunia Farm 2021; 5: 108–119.

[6] Sihombing YR, Romauli Anna teresia Marbun, Friska Novita Pasaribu, et al. Evaluation of the Use of the Drug in Patients Acute Respiratory Tract Infection (Ari) Non Pneumonia at Puskesmas Sigumpar. J Farm 2023; 6: 9–16.

[7] Irma novrianti I. Profil Penggunaan Obat pada Pasien Infeksi Saluran Napas Akut (ISPA) pada Pasien Anak Usia 5-10 Tahun. J Farm 2025; 7: 248–253.

[8] Winarni G, Utami A, Pratama MW. Evaluasi Penggunaan Obat Batuk pada Pasien Pneumonia Rawat Inap Di Rumah Sakit X Tangerang Selatan. Pros SEMLITMAS Disem Penelit Pengabdi Masy 2024; 1: 252–258.

[9] Monica C, S A, Dalilla S. Evaluasi Drug Related Problems (DRPs) Antibiotik pada Pasien Pneumonia Rawat Inap Anak Rumah Sakit Umum Daerah Deli Serdang. J Farm 2021; 3: 63–68.

[10] Dipiro JT, Yee GC, Posey M, et al. Pharmacotherapy. A Pathophysiologic Approach. Eleventh Edition. 2020.

[11] Tenório MCDS, Graciliano NG, Moura FA, et al. N-acetylcysteine (NAC): Impacts on Human Health. Antioxidants; 10. Epub ahead of print 1 June 2021. DOI: 10.3390/antiox10060967.

[12] Hanum PS, Hanifa Q. The Effectiveness of High-Dose N-acetylcysteine in Severe Covid-19 Patients. Keluwih J Kesehat dan Kedokt 2021; 3: 22–34.

[13] Kementerian Kesehatan RI. Pedoman Teknis Analisis Farmakoekonomi di Indonesia. 2016.

[14] Shubhangi Gupta, Shiwangi Periwal, Bankim Chandra Nandy, et al. an Overview of Challenges, Importance and Evaluation of Pharmaeconomics: Role of Pharmacist’S in Health Care System. J Biomed Pharm Res 2020; 9: 33–43.

[15] Tonin FS, Aznar-Lou I, Pontinha VM, et al. Principles of Pharmacoeconomic Analysis: The Case of Pharmacist-Led Interventions. Pharm Pract (Granada) 2021; 19: 1–10.

[16] Shi T, Denouel A, Tietjen AK, et al. Global and Regional Burden of Hospital Admissions for Pneumonia in Older Adults: A Systematic Review and Meta-Analysis. Journal of Infectious Diseases 2019; 222: S570–S576.

[17] Ahmed AMA, Elkaki MME, Albadri AKE, et al. Prevalence of Hospital Acquired Pneumonia in Intensive Care Units in Khartoum State (From April 2019 to September 2019). J Clin Biomed Res 2021; 2021: 1–4.

[18] Corica B, Tartaglia F, D’Amico T, et al. Sex and Gender Differences in Community-Acquired Pneumonia. Internal and Emergency Medicine 2022; 17: 1575–1588.

[19] Rastiti L, Kristina SA, Andayani TM. Analisis Biaya Penyakit Pneumonia pada Pasien Dewasa di Rumah Sakit Cost of Illness Analysis in Pneumonia Among Adult Patients : a Hospital Perspective. Maj Farm 2023; 19: 527–534.

[20] Fong KM, Ng GWY, Leung AKH, et al. High-dose Intravenous N-Acetylcysteine in Mechanically Ventilated Patients with COVID-19 Pneumonia: A Propensity-Score Matched Cohort Study. J Intensive Care Med; 40. Epub ahead of print 22 November 2024. DOI: 10.1177/08850666241299391.

[21] Rahmandani A, Sarnianto P, Anggriani Y, et al. Analisis Efektivitas Biaya Penggunaan Obat Antivirus Oseltamivir dan Favipiravir pada Pasien Covid-19 Derajat Sedang di Rumah Sakit Sentra Medika Cisalak Depok. Maj Farmasetika 2021; 6: 133.

[22] Issaura I, Azizah NF, Faizah RN, et al. Analisis Farmakoekonomi (Cost Effectiveness Analysis) Penggunaan Terapi Infus Imunoglobulin Intravena (IVIG) pada Kasus Coronary Virus Disease (Covid-19). Maj Farm 2022; 18: 90.