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"Reusing single-use medical devices is a very important and complicated process since the implementation requires both operational and technical skills, even for professional users. The aim of our study was to determine the cost effectiveness and efficiency of reusing single-use medical devices. The study was a cross-sectional study conducted between July and December 2013. It compared two groups of patients who underwent endoscopic retrograde chalangiopancreatography (ERCP) examination at the digestive endoscopy center, Cipto Mangunkusumo Hospital, Jakarta. Patients in the first group received new single-use medical devices; while patients in the other group received the re-used single-use medical devices. Reprocessing for reusing single-used medical devices was conducted according to standard procedures of decontamination and sterilization. Reusing medical devices were more commonly found (50.9%) in ERCP procedures than using new medical devices (49.1%). There was no significant difference on operator satisfaction between using the re-used and new medical devices (p=0.062). There was lower average cost for reusing medical devices IDR 198,818,250.00 VS idr 594,354,000.00; P=0.000); percentage of success rate for reusing was lower than new medical devices (80% vs 90,6%;p=o0.203). There was also no significant difference regarding the negative impact such as fever or infection of reusing medical devices compared to using new medical devices (p=0.676). This study has shown good effectiveness in terms of operator satisfaction, success rate and impact on patients. The cost for reusing medical devices is more efficient than using new medical devices."

"Alat kesehatan sekali pakai sering digunakan berulang kali di rumah sakit demi mengurangi biaya pengeluaran rumah sakit dan limbah medis. Rumah Sakit Universitas Indonesia (RSUI) merupakan rumah sakit yang melakukan praktik penggunaan berulang alat kesehatan sekali pakai yang memiliki risiko penularan infeksi yang membahayakan keselamatan pasien. Praktik ini perlu dievaluasi fungsi dan sterilitasnya agar dapat menjamin keselamatan pasien di RSUI. Sebelum digunakan kembali, alat kesehatan dilakukan pemrosesan ulang melalui pembersihan, disinfeksi, dan sterilisasi dengan prosedur lengkap yang dilakukan di Central Sterile Supply Department (CSSD). Penelitian ini bertujuan untuk mengidentifikasi alat kesehatan sekali pakai yang digunakan kembali di RSUI dan cara sterilisasi yang digunakan, mengevaluasi fungsi dan sterilitas alat kesehatan yang digunakan kembali. Penelitian ini merupakan penelitian deskriptif observasional dengan desain cross-sectional, peneliti melakukan observasi ke CSSD, membagikan formulir penilaian fungsi alat kepada pengguna alat, dan mengirimkan beberapa sampel alat untuk diuji sterilitasnya di Laboratorium Kesehatan DKI. Setelah melakukan observasi, teridentifikasi 10 alat kesehatan sekali pakai yang di-resterilisasi menggunakan Low-Temperature Steam Formaldehyde (LTSF). Dari kesepuluh alat, hanya 5 alat yang dapat dievaluasi fungsi dan hanya 6 alat yang dapat dievaluasi sterilitasnya. Hasil menunjukkan bahwa seluruh alat yang dievaluasi dapat berfungsi dengan baik dan steril hingga beberapa kali penggunaan.

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Single-use medical devices are often used repeatedly in hospitals to reduce hospital expenses and medical waste. UI Hospital implements the reuse of single-use medical devices that has infection risk which may harm the patients. This practice needs to be evaluated for its function and sterility to ensure patient safety at UI Hospital. Before medical devices are reused, it needs to be reprocessed through cleaning, disinfection, and sterilization with complete procedures that must be followed at the Central Sterile Supply Department (CSSD). The aim of this research is to identify the single-use medical devices that are reused and the sterilization method employed, evaluate their function and sterility. This research is a descriptive observational study with a cross-sectional design, the researcher observed CSSD, distributed medical devices function assessment forms to the users, and sent several samples of devices to DKI Health Laboratory for sterility testing. Observation results showed that ten identified single-use medical devices were re-sterilized using Low-Temperature Steam Formaldehyde (LTSF). However, only five out of ten devices could be evaluated for their function, and only six could be evaluated for sterility. The results concluded that the evaluated devices still functioned properly and were still sterile for several times of use."

"Salah satu indikasi peningkatan pelayanan kualitas rumah sakit adalah apabila penggunaan obat di rumah sakit dilakukan secara rasional, dengan manajemen pelayanan farmasi yang efektif sehingga dapat dicapai efisiensi biaya obat bagi pasien. Penelitian ini bertujuan untuk melihat gambaran seberapa besar inefisiensi biaya obat pada pasien rawat inap peserta askes dan faktor-faktor yang mempengaruhinya. Proporsi efisiensi biaya obat dihitung dengan mengurangi jumlah biaya obat pasien sesuai resep dokter dengan jumlah biaya obat yang riil terpakai oleh pasien. Sedangkan detenninan inefisiensi biaya obat yang diteliti adalah faktor internal yakni karakteristik dokter yang meliputi usia, jenis kelamin, masa keija dan tingkat pendidikan dokter, selain itu juga faktor ekstemal karakteristik pasien yang meliputi kelas perawatan, diagnosa penyakit serta komplikasi penyakit. Dalam hal ini dilakukan juga penelitian untuk mengetahui faktor yang paling dominan mempengaruhi timbulnya inefisiensi biaya obat. Data diperoleh dengan menggunakan data sekunder yaitu data rekam medik pasien dan data personalia dan dilanjutkan secara kualitatif dengan wawancara mendalam dengan responden dokter yang merawat pasien rawat inap peserta askes pada tahun 2008. Besar popu1asi pada penelitian ini adalah 2172 rekam medik dan besar sampel 231 rekam medik yang dipilih secara acak. Metode analisis yang digunakan adalah univariat, bivariat dengan uji t dan uji anova serta analisis multivariat dengan regresi linier ganda. Kemudian dilanjutkan secara secara kualitatif dengan cara wawancara mendalam dan sebagai respondennya adalah 5 orang dokter yang merawat pasien askes tahun 2008. Hasil penelitian menunjukkan teijadi inefisiensi biaya obat DPHO sebesar 25.15% dan inefisiensi biaya obat Non DPHO sebesar 5.46%. Faktor internal yang mempengaruhi inefisiensi biaya obat adalah umur, masa keija dan tingkat pendidikan dokter, sedangkan faktor eksternal adalah diagnosa penyakit (kebidanan). Dari penelitian ini disarankan perlunya kebijakan pimpinan rumah sakit tentang retur obat yang tidak terpakai, diterapkannya sistem One Unit Dose Dispensing secara paripurna, dilakukannya penyegaran tentang perkembangan ilmu kedokteran, standar operasional prosedur serta peraturan-peraturan yang diperlakukan di rumah sakit. Selain itu disarankan agar apotik askes menyediakan obat FPHO secara lengkap.

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One of the indications of improvement in the quality of hospital services is the rational utilization of medicine, through the effective management of pharmaceutical services with the purpose to gain an efficient medicine cost for the patient. The purpose of the study is to identify the proportion of inefficiency medicine cost for inpatient health insurance patient's as well as its determinant.

The proportion of inefficiency cost based on medicine dispensing minus the actual cost of medicines spent by the patient. While the study on the pattern determinant of dispensing is the internal factor, namely, the physician's characteristics covering age, gender, term of service, and the level of educational background, including the patient's characteristic as the external factor, covering the hospital class level, diagnose and complication of the disease. A study is also done to identity the most dominant factor that influences the inefficiency of medicine cost The data is obtained from secondary data, which is the patient's medical record and personnel data, continued with the qualitative method through in depth interviews with the physicians as respondent who treated health insurance patients who were hospitalized in 2008.

The total study population include 2172 medical records and total sample 231 medical records taken at random. The analysis method is univariate, bivariate using t-test and anova tests, and a multivariate analysis with a multiple linier regression, continued with the qualitative method of in depth interviews. Respondents are 5 physicians who treated health insurance patient in 2008.

Results of the study indicates that the proportion of inefficiency in the DPHO cost is 25,15% and the inefficiency of non DPHO cost is 5.46 %. The internal faktor influencing the inefficiency of medicine cost includes age, term of service and lebel of the doctor's educational background, while the predominating external factor inefficiency of medicine cost is the diagnose of the desease (gynecology)."

"As healthcare costs rise in the United States, debate is ongoing over how to obtain better value for dollars spent. In this context, the use of cost-effectiveness analysis (CEA) is more compelling than ever. This book, written by the Second Panel on Cost-Effectiveness in Health and Medicine, reviews key concepts and analytic challenges in CEA. The authors endorse the original Panels concept of a reference case and support its recommendation that analysts take a broad societal perspective; in addition, they recommend a healthcare sector perspective for a second reference case, as well as an important new framework, the Impact Inventory, for detailing costs and effects. The revisions draw on advances in the field and include three new chapters that capture research on decision modeling, methods for evidence synthesis, and ethical considerations. The volume also includes two new worked examples (Appendix A and Appendix B) to illustrate ways to implement the authors recommendations."

"Medical science has always promised -- and often delivered -- a longer, better life. But as the pace of science accelerates, do our expectations become unreasonable, fueled by an industry bent on profits and a media desperate for big news? Hope or Hype is a taboo-shattering look at what drives the American obsession with medical "miracles," exposing the equipment manufacturers and pharmaceutical companies; doctors and hospitals too quick to order surgery; the politicians; the press; and our own "technoconsumption" mindset."

"Hipoalbuminemia dapat terjadi pada pasien kanker payudara, yang merupakan prognosis yang buruk untuk survival pasien tersebut, sehingga perlu dikoreksi dengan infus albumin. Tujuan penelitian adalah menganalisis biaya dan efektivitas beberapa produk albumin pada pasien kanker payudara stadium lanjut, dan menganalisis apakah faktor umur, komorbiditas, stadium kanker, jumlah lokasi metastasis, metastasis di hepar, dan kemoterapi mempengaruhi laju peningkatan albumin pasien kanker payudara stadium lanjut. Penelitian ini menggunakan metoda potong lintang yang dilakukan secara retrospektif terhadap data sekunder pasien yang dirawat periode juli 2010 sampai juni 2012 di Rumah Sakit Kanker Dharmais, Jakarta. Teknik pengambilan sampel adalah total sampling. Data yang diperoleh sebanyak 47 siklus, terdiri dari 18 siklus produk A, 17 siklus produk B, dan 12 siklus produk C. Rata-rata biaya langsung medis perhari produk A, produk B, dan produk C adalah Rp 1.843.470, Rp 1.813.792, dan Rp 1.687.219. Rata-rata laju peningkatan albumin perhari produk A, produk B dan produk C adalah 0,5 g/dL, 0,4 g/dL dan 0,4 g/dL. Hasil perhitungan Incremental Cost Effectiveness Ratio (ICER) produk B dan produk C terhadap produk A adalah Rp 296.780 dan Rp 1.562.510 perlaju peningkatan albumin perhari. Berdasarkan oneway analisis sensitivitas, ketahanan hasil analisis telah teruji, albumin produk A tetap lebih cost effective. Analisis multivariat menunjukkan bahwa faktor umur, komorbiditas, stadium kanker, jumlah organ metastasis, metastasis hepar dan kemoterapi tidak mempengaruhi laju peningkatan albumin.

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Hypoalbuminemia can occurs on cancer patients, which is a poor prognosis for survival of these patients, so that needs to be corrected with albumin infusion. The purpose of these research is to analyze the cost effectiveness use of some products of albumin in patients with advanced breast cancer, and to analyze whether the factors of age, comorbidity, stage of cancer, the number of locations metastasis, hepatic metastasis, and chemotherapy affect the rate of albumin increased in advanced breast cancer patients. This study used cross-sectional method with a retrospective review towards secondary data of patients who was treated from July 2010 to June 2012 at the Dharmais Cancer Hospital. The sampling technique was the total sampling. 47 cycles of therapy was collected, consist of 18 cycles of product A, 17 cycles of product B, and 12 cycles of product C. The average direct medical costs per day of product A, product B, and product C was Rp 1,843,470; Rp 1,813,792 and Rp 1,687,219 respectively. The average of daily albumin increased rate of product A, product B and product C was 0.5 g / dL, 0.4 g / dL and 0.4 g / dL respectively. Calculation of Incremental Cost Effectiveness Ratio (ICER) product B and product C to product A showed additional costs Rp 296,780 and Rp 1,562,510 if product A was selected. One way sensitivity analysis confirmed the robustness of the results, albumin of product A was more cost effective. Multivariate analysis showed there was no significant correlation between interference factors with albumin increased rate. "