Cost-effectiveness comparison of antidiabetic drugs combination therapy metformin-glimepiride and acarbose-glimepiride
Authors: Tresnawati Nden Ajeng , Hany Yusmaini  , Mila Citrawati  , Erna Harfiani  
Published: January 2025

Background: Type 2 diabetes mellitus (DM) is one of the cardiometabolic diseases with the highest prevalence worldwide, including Indonesia. The increasing number of type 2 DMs is known to have become an economic burden on Indonesia's health sector. There are several options for treating type 2 DM, either with monotherapy or in combination. At present, metformin, sulfonylurea, and acarbose have become common drugs in the treatment of type 2 DM. Variations in antidiabetic drugs will cause differences in therapy cost and effectiveness.Objective: The purpose of this study is to analyze the cost-effectiveness of the combination therapy of metformin-glimepiride and acarbose-glimepiride antidiabetic drugs in patients with type 2 DM at RSUD Sumedang in 2021 based on the hospital's perspective.Method: This study collected data by documenting medical records and patient costs from January to December 2021 using a cross-sectional design on 60 samples.Results: Findings from the statistical analysis showed that the combination of metformin and glimepiride did not make a difference in GDS (mean difference 10.70 mg/dL-1; p-value = 0.457). The average total direct medical costs of the acarbose-glimepiride group were higher than that of the metformin-glimepiride group, and there was a significant difference between the average costs of the antidiabetic drugs (p-value = 0.000).Conclusion: The combination of metformin-glimepiride therapy is more cost-effective than acarbose-glimepiride, with an ACER value of metformin-glimepiride Rp. 3,037.48.Keywords: Acarbose, cost effectiveness analysis, glimepiride, metformin, type 2 DM
Intisari Latar belakang: Diabetes Melitus (DM) tipe 2 merupakan salah satu penyakit kardiometabolik dengan prevalensi tertinggi di seluruh dunia termasuk Indonesia. Peningkatan jumlah DM tipe 2 diketahui telah menjadi beban ekonomi bagi sektor kesehatan di Indonesia. Terdapat beberapa pilihan terapi dalam pengobatan DM tipe 2 baik secara monoterapi maupun kombinasi beberapa obat. Saat ini obat metformin, sulfonilurea, dan acarbose telah menjadi obat umum dalam pengobatan DM tipe 2 di Indonesia. Variasi terapi obat antidiabetik akan menyebabkan adanya perbedaan biaya dan efektivitas terapi. Tujuan: Tujuan penelitian ini untuk menentukan efektivitas biaya terapi kombinasi obat antidiabetik metformin-glimepirid dan acarbose-glimepirid pada pasien DM tipe 2 Instalasi Rawat Jalan di RSUD Sumedang Tahun 2021 berdasarkan perspektif rumah sakit.Metode: Penelitian ini menggunakan desain studi potong-lintang pada 60 sampel dengan pengambilan data dilakukan secara dokumentasi terhadap data rekam medis dan biaya pasien periode Januari-Desember 2021. Hasil: Hasil analisis statistik menunjukkan tidak terdapat perbedaan bermakna selisih GDS pada kombinasi metformin-glimepirid dan acarbose-glimepirid (rata-rata perbedaan 10,70 mg/dL-1; nilai-p=0.457). Rata-rata total biaya langsung medis kelompok acarbose-glimepirid lebih tinggi dibandingkan metformin-glimepirid serta terdapat perbedaan bermakna rata-rata biaya obat antidiabetik (nilai-p=0.000).Kesimpulan: Kombinasi terapi metformin-glimepirid lebih cost-effective dibandingkan acarbose-glimepirid dengan nilai ACER metformin-glimepirid Rp. 3.037,48.Kata Kunci: Acarbose, analisis efektivitas biaya, DM tipe 2, glimepirid, metfotmin