Report by Anggi Kusuma Putri
[Unpad Media Channel] A Professor of Universitas Padjadjaran Faculty of Pharmacy, Prof. Auliya A. Suwantika, laid out how the allocation of the health budget could be more effective if it were approached using pharmacoeconomics. Pharmacoeconomics is important in the prioritization process in the health sector.
“In helping prioritization, pharmacoeconomics has a few roles. The state has a limited budget, and pharmacoeconomics could affect the prioritization process so that allocating the limited budget became more effective and efficient,” said Prof. Auliya in the Satu Jam Berbincang Ilmu event held online by the Unpad Board of Professors on Saturday (20/1/2024).
Aside from the limited budget, Prof. Auliya also pointed out that Indonesia’s healthcare system faces other challenges, such as caring for the chronically ill and elderly, a currently unrealized universal healthcare system, and the growing need for health interventions.
“Newly discovered medicine are increasing in numbers, so are vaccines. This also becomes a challenge for a so-so health budget,” said Prof. Auliya.
Prof. Auliya added that, through prioritization using pharmacoeconomics, the government could widen the scope of their services so it reached vulnerable, marginalized, and remote communities.
Prioritization could also increase the impact of services by improving the efficiency of healthcare service provision, as well as helping to improve protection from financial risks, especially for the poor and vulnerable, by reducing cost sharing.
Prof. Auliya also explained that, generally, there are four criteria to be observed when going through prioritization. They are burden of disease, cost effectiveness, acceptability, and fairness. Fairness in particular has not been focused on so far.
“The criteria for effectiveness emphasizes the importance of efficiency and affordability to take on a health issue. These include whether the intervention are absolutely affordable and the relative cost put upon the health sector, groups, and individuals. In principle, the cost of an intervention or service should be economically appropriate and sustainable,” explained Prof. Auliya.
Prof. Auliya also described how, in prioritizing, the application of pharmacoeconomics could assist evidence-based policymaking. A case study he had done was an analysis of the cost effectiveness of the PPKM (Covid-19 lockdown in Indonesia) in handling the pandemic.
The results of his dynamic model simulation showed that continuous enforcement of the PPKM was proven to decrease the number of Covid-19 cases and flatten the curve of Covid-19 spread.
“In conclusion, the continuous implementation of PPKM, with varied levels in each region, was a cost efficient intervention if the participation of the public reached at least 50%. Our study results were referred to in making policies in handling the Covid-19 pandemic in Indonesia,” explained Prof. Auliya.
Prof. Auliya also explained that the application of pharmacoeconomics could also help the development and research into more effective pharmaceutical products. He had conducted a case study analyzing the effectiveness of cost in researching and developing innovative pharmaceutical products. By observing the scenario wherein the research and development budget was raised so the final quantity increased, it could be concluded that that is still a cost-effective intervention.
“Aside from making them into a publication, our results also advocated for the government to apply state equity participation to pharmaceutical BUMNs (state-owned enterprises),” said Prof. Auliya.
Efficiency in Procuring Pharmaceutical Products
Prof. Auliya also elaborated on how the procurement of pharmaceutical products could be made more efficient with the application of pharmacoeconomics. Another case study he pointed to analyzed the cost effectiveness of introducing PCV, a vaccine for pneumonia. During its time, the results of the study also became a basis to advocate for the government to change their policies.
“According to our study, PCV vaccinations constituted a very cost-effective intervention if applied in Indonesia. The best case scenario was using UNICEF-priced PCV13. But procuring them through UNICEF brought up issues with policies not allowing for procurement through international institutions. However, should the policies be changed, there is a potential to save as much as 2,8 trillion rupiahs,” he explained.
Furthermore, prioritization through pharmacoeconomical study could also assist in suggesting new interventions as a nation-wide program. Prof. Auliya recounted a case study he had done, analyzing the cost-effectiveness of dengue vaccination with pre-vaccination screening using a static mathematical model.
“The study showed that dengue vaccinations with pre-vaccination screening could potentially prevent 278 thousand dengue cases per year, and potentially save around 531 billion rupiahs in cost,” he exclaimed. (arm/ICP)*
