Drug cost analysis of outpatients with cardiovascular disease under the national health insurance scheme

Abstract

Background: Cardiovascular disease is one of the catastrophic diseases that absorbs the most health budgets. Reimbursement of healthcare costs from the National Health Insurance Agency is done through the case-based groups (INA-CBGs) and fee-for-service (non-INA-CBGs) methods based on e-catalogue drug prices. Drug costs are a concern. Objective: To evaluate drug prescription compliance to the national formulary, total drug cost and drugs cost included in the INA-CBGs package. Method: This observational study used retrospective prescription data from the outpatient Cardiology Clinic. A quantitative analysis was conducted for prescription compliance with formulary and drug costs. Result: Out of the 4,443 prescriptions, the prescription alignment with the national formulary was 98%. The difference between the total e-catalogue and the actual drug costs was IDR4,818,252 (0.9%) (p > 0.05). Drug costs constitute 19% of the INA-CBGs package. Conclusion: Drug prescribing is quite efficient with 98% compliance with the formulary and drug costs constitute 19% of the INA-CBGs package.