STUDI COST EFFECTIVENESS ANALYSIS (CEA) TATALAKSANA BATU GINJAL UKURAN BESAR (>2 cm) DENGAN ESWL DAN OPERASI TERBUKA DI RUMAH SAKIT BALI MANDARA

Abstract

Kidney stones are one of the most common urological diseases and can cause serious complications. Management of large kidney stones (>2 cm) can be done with Extracorporeal Shockwave Lithotripsy (ESWL) or open surgery. However, there is still debate about which method is more cost-effective, especially in a health system that uses BPJS Kesehatan. Therefore, this study aims to compare the cost-effectiveness between ESWL and open surgery at Bali Mandara Hospital using the Cost Effectiveness Analysis (CEA) approach. This study uses a mixed-method approach with a sequential explanatory design. Quantitative data were taken from cost records, medical records, and patient outcomes at Bali Mandara Hospital for the period 2021–2023. Qualitative data were obtained through interviews with patients and doctors. The analysis was carried out using the Cost Effectiveness Analysis (CEA) method to compare the costs and effectiveness between ESWL and open surgery. The results of the study based on ACER and ICER analysis, ESWL has a higher cost with a higher effectiveness ratio than open surgery. On average, ESWL patients have shorter hospital stays and fewer complications than open surgery patients. However, ESWL requires more sessions to achieve similar stone-free outcomes as open surgery. ESWL is a more cost-effective option for the management of large kidney stones (>2 cm) than open surgery, especially from the perspective of hospital and patient costs in terms of being closer to cost efficiency because the difference in rates between hospitals and BPJS is small. Open surgery is still needed in complex cases or cases that fail with ESWL.