Cost-Effectiveness Analysis Of Metformin Use In Type 2 Diabetes Mellitus Patients In Hospitals: A Systematic Literature Review
Article Sidebar
Main Article Content
Abstract
Type 2 diabetes mellitus (T2DM) places a significant economic burden on Indonesia, necessitating the selection of cost-effective pharmacological therapies. Metformin has long been recommended as first-line therapy, but evidence of its cost-effectiveness across Indonesian hospitals remains fragmented and methodologically diverse. This study aimed to conduct a systematic review and synthesize evidence regarding the cost-effectiveness of metformin use in T2DM patients in Indonesian hospitals. The study used a systematic literature review design based on the PRISMA framework. Articles published since 2020 and obtained from Google Scholar, PubMed, and Publish or Perish were assessed using the PICO criteria (Population: T2DM patients in hospital; Intervention: metformin; other antidiabetic therapies; Outcome: cost-effectiveness). In total, six national studies were selected, covering both inpatient and outpatient settings. Data were extracted descriptively, while cost-effectiveness results (primarily the Average Cost-Effectiveness Ratio/ACER) were analyzed narratively. Across all reviewed studies, metformin consistently demonstrated lower ACER values than comparator therapies (e.g., glibenclamide, glimepiride, gliquidone, and acarbose-based combinations), suggesting better cost-efficiency with equivalent or higher clinical effectiveness. Conclusion: Metformin is a cost-effective first-line therapy for T2DM patients in Indonesian hospitals, making it worthy of being maintained as the primary choice in clinical practice and hospital formularies.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
American Diabetes Association (2023) Standards of Medical Care in Diabetes—2023. Available at: https://diabetes.org.
Ariawan, D., Wibowo, Y. and Maulida, V. (2022) 'Cost-effectiveness analysis of metformin and glibenclamide therapy in patients with type 2 diabetes mellitus at Sukoharjo Regional Hospital', Jurnal Ilmiah Farmasi.
Centers for Disease Control and Prevention. (2018). National Diabetes Statistics Report 2018. US Department of Health and Human Services. Retrieved from https://www.cdc.gov/diabetes/data/statistics/statistics-report.html
Crowley, MJ, Diamantidis, CJ, McDuffie, JR, Cameron, CB, Stanifer, JW, Mock, CK, & Williams, JW (2017). Clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease: a systematic review. Annals of Internal Medicine, 166(3), 191–200.
Drummond, MF, Sculpher, MJ, Claxton, K., Stoddart, GL and Torrance, GW (2015) Methods for the Economic Evaluation of Health Care Programmes. 4th edn. Oxford: Oxford University Press.
Hadiq, M., Rahmatillah, R. and Nurfajriah, N. (2022) 'Cost-Effectiveness Analysis of Metformin and Metformin–Glimepiride in Patients With Type 2 Diabetes at Nene Mallomo General Hospital', Pharmacoeconomics and Outcomes Journal.
International Diabetes Federation (2021) IDF Diabetes Atlas. 10th edn. Brussels: IDF. Available at: https://idf.org.
Ministry of Health of the Republic of Indonesia (2022) National Report on Riskesdas 2022. Jakarta: Health Research and Development Agency.
Marzuki, M., et al. (2023) Cost-effectiveness analysis of metformin and glimepiride therapy in patients with type 2 diabetes mellitus at Dr. Darsono Regional Hospital, Pacitan. Journal of Health Sciences.
Meliawati, M., Lumenta, M. and Karundeng, A. (2023) 'Cost-Effectiveness Analysis of the Use of Metformin and Glimepiride in Patients with Type 2 Diabetes Mellitus Inpatient at the Hospital Robbert Wolter Monginsidi Manado City', Jurnal Ilmiah Kesehatan..
PERKENI (2021) Guidelines for the Management and Prevention of Type 2 Diabetes Mellitus in Indonesia 2021. Jakarta: Indonesian Endocrinology Association.
Putri, RN, Kristina, SA, & Endarti, D. (2020). Economic burden of diabetes in Indonesia: A systematic review. Pharmacoeconomics Indonesian Journal, 3(1), 12–20. https://doi.org/10.14710/pi.v3i1.29559
Rena, G., Hardie, DG and Pearson, E.R. (2017) 'The mechanisms of action of metformin', Diabelogia, 60(9), pp. 1577–1585. doi:10.1007/s00125-017-4342-z.
Tao, W., Zeng, Z., Dang, H., Lu, B., Chuong, L., Yue, D., ... & Meng, Q. (2021). Towards universal health coverage: lessons from 10 years of healthcare reform in China. BMJ Global Health, 6(3), e004486. https://doi.org/10.1136/bmjgh-2020-004486
Wiwin, W. and Marlinda, L. (2021) 'Cost and effectiveness analysis of metformin and gliquidone in type 2 diabetes mellitus patients at the Outpatient Installation of Hospital X', Journal of Clinical Pharmacy.
Wuryandari, N., Winarno, R. and Pramono, Y. (2021) 'Cost-effectiveness analysis of combination oral antidiabetic therapy in type 2 diabetes mellitus patients at Madiun City Hospital in 2020', Journal of Health Science and Technology.