The study analyzed real hospital data from May 2023 to May 2024, focusing on patients treated under Indonesia’s public health insurance scheme (BPJS). By comparing clinical outcomes and treatment costs between aspirin and clopidogrel, the researchers provide new evidence to guide hospitals and policymakers in selecting efficient therapies without compromising patient recovery.
Stroke and the Economic Burden on Healthcare
Ischemic stroke accounts for approximately 80–88 percent of all stroke cases. It occurs when blood flow to the brain is blocked, often due to a clot. In Indonesia, stroke is classified as a catastrophic disease because it requires intensive hospital care, prolonged treatment, and sometimes long-term rehabilitation.
For the national health insurance system, managing stroke treatment efficiently is essential. Even small differences in drug selection can translate into substantial financial impacts when applied across thousands of patients.
Aspirin and clopidogrel are widely used antiplatelet medications that prevent blood clots. Both are recommended in clinical guidelines, but they differ in price and pharmacological profile. The research team from Universitas Setia Budi evaluated which option delivers better value for money in real-world hospital settings.
How the Study Was Conducted
The researchers used a descriptive observational design with a retrospective approach. They examined medical records and financial data from 78 hospitalized ischemic stroke patients at Mataram City Hospital.
Key elements of the methodology include:
- Study period: May 2023 – May 2024
- Sample size: 78 inpatients diagnosed with ischemic stroke
- Treatment groups: Aspirin or clopidogrel
- Effectiveness measure: Glasgow Coma Scale (GCS) improvement
- Economic analysis: Cost-Effectiveness Analysis (CEA) using ACER and ICER indicators
The Glasgow Coma Scale (GCS) measures a patient’s level of consciousness. Higher post-treatment scores indicate better neurological recovery.
Costs were calculated across four hospital classes: VIP, Class I, Class II, and Class III, reflecting different accommodation levels within the hospital.
Patient Profile
The patient characteristics reflect common stroke risk patterns:
- 54 percent were over 60 years old
- 64 percent were male
- 40 percent had hypertension as a comorbidity
Clopidogrel was prescribed more frequently (79.49 percent of patients), while aspirin was used in 20.51 percent of cases.
Clinical Outcomes: Comparable Effectiveness
Both aspirin and clopidogrel showed positive clinical outcomes. All patients experienced improvement in GCS scores during hospitalization.
The highest GCS improvements were observed in:
- Aspirin, Class II: increase of 2.84 points
- Clopidogrel, Class III: increase of 2.45 points
Statistical analysis found no significant difference in neurological improvement between the two drugs. In practical terms, both therapies performed similarly in restoring patients’ level of consciousness.
Cost Analysis: Aspirin Consistently More Economical
Although clinical effectiveness was comparable, cost analysis revealed clear differences.
Average treatment costs per patient were as follows:
VIP Class
- Aspirin: IDR 4,982,370
- Clopidogrel: IDR 5,400,015
Class I
- Aspirin: IDR 2,981,704
- Clopidogrel: IDR 3,639,498
Class II
- Aspirin: IDR 4,829,446
- Clopidogrel: IDR 3,654,063
Class III
- Aspirin: IDR 3,106,291
- Clopidogrel: IDR 3,417,481
Using Average Cost-Effectiveness Ratio (ACER), aspirin consistently demonstrated lower cost per unit of clinical improvement.
Notably, the Incremental Cost-Effectiveness Ratio (ICER) in Class I and Class III showed negative values. A negative ICER indicates that the additional cost of clopidogrel does not produce proportionally greater clinical benefit.
The researchers also conducted sensitivity analysis by adjusting cost components by ±25 percent. The largest cost driver was room and hospitalization fees, not medication price alone. Even under different cost scenarios, aspirin remained the more economically favorable option.
Implications for Hospitals and National Health Policy
The findings from Universitas Setia Budi have practical implications:
- Hospitals can optimize drug selection by considering cost-effectiveness without compromising patient outcomes.
- BPJS sustainability may benefit from prioritizing therapies that offer similar clinical benefits at lower cost.
- Policy decisions can rely on local evidence, rather than international cost data that may not reflect Indonesian healthcare realities.
Akhmad Nurfahmi from Universitas Setia Budi emphasizes that treatment decisions should balance clinical outcomes and financial sustainability. According to Nurfahmi and colleagues, aspirin provides equivalent neurological improvement while reducing economic burden, making it a rational first-line option in many inpatient cases.
This research strengthens the role of pharmacoeconomic evaluation in Indonesian healthcare. As catastrophic diseases like stroke continue to strain public insurance budgets, evidence-based cost analysis becomes increasingly critical.
Author Profiles
Source
URL : https://journalfjst.my.id/index.php/fjst
This study confirms that, within the context of inpatient ischemic stroke treatment at Mataram City Hospital, aspirin delivers comparable clinical effectiveness to clopidogrel while offering superior economic efficiency—an important consideration for Indonesia’s evolving healthcare system.
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