Cost-effectiveness analysis of the use of antibiotics for typhoid fever inpatients in RSUD Bayu Asih Purwakarta
Abstract
Typhoid fever is an infectious disease caused by Salmonella typhi, commonly treated with antibiotics to promote recovery and prevent complications. This study aimed to evaluate both the therapeutic effectiveness (clinical outcomes such as fever resolution and hospital stay duration) and the cost-effectiveness (economic efficiency of antibiotic use) in inpatients with typhoid fever at RSUD Bayu Asih Purwakarta (Bayu Asih District Hospital, Purwakarta) in 2023. A retrospective descriptive design was applied using 75 medical records from January to December 2023. Results showed that levofloxacin had the highest therapeutic effectiveness, reflected by the shortest hospitalization (3.5 days), whereas ceftriaxone was the most cost-effective, with an Average Cost-Effectiveness Ratio (ACER) of Rp. 194,858.78 per treatment. The Incremental Cost-Effectiveness Ratio (ICER) analysis indicated that the additional cost required for levofloxacin compared to ceftriaxone was disproportionate to the clinical benefit gained. In conclusion, while levofloxacin provides faster recovery, ceftriaxone remains the preferred option considering its superior cost-effectiveness. These findings emphasize the need to balance clinical outcomes and economic efficiency when determining antibiotic policies for typhoid management.
References
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10.47191/IJMSCRS/V3-I10-20.
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[12] R. J. G. Arnold, Pharmacoeconomics : From Theory to Practice, 1st Edition. CRC Press, 2016. doi: 10.1201/9781420084405.
[13] H. Y. Nguyen-Thi et al., “Evaluation of the impact before and after the application of an antimicrobial stewardship program at Dong Thap General Hospital, Vietnam, from 2017 to 2021,” Infection Prevention in Practice, vol. 5, no. 4, Dec. 2023, doi: 10.1016/J.INFPIP.2023.100311.
[14] M. G. D. Harun, S. A. Sumon, I. Hasan, F. M. Akther, M. S. Islam, and M. M. U. Anwar, “Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review,” Antimicrob Resist Infect Control, vol. 13, no. 1, Dec. 2024, doi:
10.1186/S13756-024-01369-6.
[15] L. Lim, L. Kassym, A. Kussainova, B. Aubakirova, and Y. Semenova, “Optimizing antibiotic stewardship and reducing antimicrobial resistance in Central Asia: A study protocol for evidence-based practice and policy,” PLoS One, vol. 20, no. 1 January, Jan. 2025, doi: 10.1371/JOURNAL.PONE.0307784.
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[18] R. Yuniarti, D. Paryanti, and A. Tejaningsih, “Analysis of financial performance and services performance before and during the Covid-19 Pandemic (Case Study at Bayu Asih Hospital Purwakarta),” Turkish Journal of Physiotherapy and Rehabilitation, vol. 32, no. 2021, 2021.
[19] D. Husereau et al., “Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations,” BMJ, vol. 376, Jan. 2022, doi: 10.1136/BMJ-2021-067975.
[20] E. von Elm, D. G. Altman, M. Egger, S. J. Pocock, P. C. Gøtzsche, and J. P. Vandenbroucke, “The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.,” Lancet, vol. 370, no. 9596, pp. 1453–1457, Oct. 2007, doi: 10.1016/S0140-6736(07)61602-
X.
[21] R. J. G. Arnold, Pharmacoeconomics: From Theory to Practice, 1st Edition. Boca Raton: CRC Press, 2009. doi: 10.1201/9781420084405.
[22] W. Limpitikul and P. Singchungchai, “Cost effectiveness in treatment of typhoid Costs and Effectiveness of Ciprofloxacin and Ceftriaxone in Treatment of Typhoid Fever in Children in Thailand,” Public Health Research, vol. 3, no. 1, pp. 192–197, 2013.
[23] A. Giri, A. Karkey, S. Dongol, and B. Basnyat, “Azithromycin and cefixime combination versus azithromycin alone for the out-patient treatment of clinically suspected or confirmed uncomplicated typhoid fever in South Asia: a randomised controlled trial protocol,” Wellcome Open Res, vol. 6, no. 207, 2021, Accessed: Sep. 29, 2024.
[Online]. Available: https://wellcomeopenresearch.org/articles/6-207/v2
[24] R. S. Kuddah and S. W. M. Husnah, “Clinical profile in adult typhoid fever in patients at hospital X, East Jakarta, Indonesia, January–March 2018,” Medical Technology and Environmental Health, pp. 160–171, Aug. 2020, doi: 10.1201/9781003016700-28.
[25] Y. Yunita and A. Soyata, “Problems of drug therapy in patients with tyfoid fever at the ınstallation of At-Taqwa Islam Hospital Gumawang Belitang Period January-December 2021,” Jurnal Farmasi Klinik dan Sains, vol. 2, no. 2, p. 14, Dec. 2022, doi: 10.26753/JFKS.V2I2.1003.
[26] M. L. Alvarez, F. Wurgaft, and J. Espinoza, “Fecal-Oral cycle and hygiene habits in families of school children who had typhoid fever,” Pediatric Research 1988 23:6, vol. 23, no. 6, pp. 649–649, Jun. 1988, doi: 10.1203/00006450-198806000-00036.
[27] F. Oktaviana et al., “Efektivitas terapi antibiotika demam tifoid pada pediatrik di Rumah Sakit X Kota Kediri,” Journal Syifa Sciences and Clinical Research (JSSCR), vol. 3, no. 2, pp. 63–70, Aug. 2021, doi: 10.37311/JSSCR.V3I2.11688.
[28] F. Khanam et al., “Typhoid fever in young children in Bangladesh: clinical findings, antibiotic susceptibility pattern and Immune Responses,” PLoS Negl Trop Dis, vol. 9, no. 4, p. e0003619, Apr. 2015, doi: 10.1371/JOURNAL.PNTD.0003619.
[29] S. Dahiya et al., “Current antibiotic use in the treatment of enteric fever in children,” Indian J Med Res, vol. 149, no. 2, pp. 263–269, Feb. 2019, doi: 10.4103/IJMR.IJMR_199_18.
[30] D. Thaver, A. K. M. Zaidi, J. Critchley, A. Azmatullah, S. A. Madni, and Z. A. Bhutta, “A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis,” BMJ, vol. 338, no. 7707, p. 1371, Jun. 2009, doi: 10.1136/BMJ.B1865.
[31] N. M. D. P. Dewi, “Analisis cost effectiveness penggunaan antibiotik kloramfenikol, seftriakson dan sefiksim sebagai terapi demam tifoid anak (studi dilakukan di ınstalasi rawat ınap Rumah Sakit Karsa Husada Kota Batu),” Universitas Brawijaya, Malang, 2019.
[32] H. Kurniawati and Marianti, “Quantitative antibiotic use profile in typhoid,” Sriwijaya Journal of Medicine, vol. 3, no. 3, pp. 113–118, Oct. 2020, doi: 10.32539/SJM.V3I3.87.
[33] S. K. Kasiakou, G. J. Sermaides, A. Michalopoulos, E. S. Soteriades, and M. E. Falagas, “Continuous versus intermittent intravenous administration of antibiotics: a meta-analysis of randomised controlled trials,” Lancet Infectious Diseases, vol. 5, no. 9, pp. 581–589, Sep. 2005, doi: 10.1016/S1473-3099(05)70218-8/ASSET/05FDAA37-AD3E-4DF1-8CB2-06F1DF5646DE/MAIN.ASSETS/GR4.SML.
[34] K. Wal Hazimah, M. Priastomo, R. Rusli, L. Penelitian dan Pengembangan Kefarmasian, and F. Tropis, “Analisis efektivitas biaya penggunaan antibiotik pada pasien demam tifoid di RS SMC Periode 2017,” Jurnal Sains dan Kesehatan, vol. 2, no. 2, pp. 107–114, Dec. 2019, doi: 10.25026/JSK.V2I2.126.
[35] D. Thaver, A. Zaidi, J. Critchley, S. Madni, and Z. Bhutta, “Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever),” Cochrane Database of Systematic Reviews, no. 2, Apr. 2005, doi: 10.1002/14651858.CD004530.PUB2/INFORMATION/EN.
[36] M. Zakir, M. Khan, M. I. Umar, G. Murtaza, M. Ashraf, and S. Shamim, “Emerging trends of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella typhi in a tertiary care hospital of lahore, pakistan,” Microorganisms, vol. 9, no. 12, p. 2484, Dec. 2021, doi: 10.3390/MICROORGANISMS9122484/S1.
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Published
2025-11-19
How to Cite
PURKON, Dicki Bakhtiar et al.
Cost-effectiveness analysis of the use of antibiotics for typhoid fever inpatients in RSUD Bayu Asih Purwakarta.
JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 23, n. 2, p. 359-372, nov. 2025.
ISSN 2614-6495.
Available at: <http://jifi.farmasi.univpancasila.ac.id/index.php/jifi/article/view/1679>. Date accessed: 19 nov. 2025.
doi: https://doi.org/10.35814/jifi.v23i2.1679.
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