Cost of Hypertension Disease in Kediri Regency

Atika Binti Utari, Thinni Nurul Rochmah

Faculty of Public Health, Universitas Airlangga Mulyorejo, Surabaya, Indonesia

atika.binti-13@fkm.unair.ac.id

Keywords: Cost of Illness, Hypertension, Individual perspective.

Abstract: The incidence of hypertension is the highest non-communicable diseases in Kediri District. The prevalence

of hypertension in Kediri District is 27.9 %. Their increasing prevalence is threatening to cause significant

damage both to individuals and society. From the individual perspective, it is therefore necessary to

consider the economic impacts associated with hypertension diseases, and identify interventions that can

reduce the burden of these diseases. This cost of illness study aims to measure cost of hypertension disease

in Kediri District from individual perspective. This research is a quantitative research with cross sectional

method. Primary data collection is done by interviewing 100 hypertension sufferers in Kediri District. The

results estimated the direct costs is 6.220.470 rupiahs per capita and the indirect costs is 6.164.081 rupiah

per capita. Cost of illness caused by hypertension is about 12.384.551 rupiahs per capita. It can be

concluded that the cost of hypertension disease is very high. So it can be recommended to increasing

promotive and preventive efforts to reduce the incidence of hypertension disease

1 INTRODUCTION

Health problems in Indonesia is quite complex

which in the last ten years Indonesia had triple

burden disease. Infectious diseases are still very

high, but on the other hand occurring of an

increasing number of non-communicable diseases

and new emerging diseases. According to WHO

(2014), mortality rate from non-communicable

diseases will continue to increase worldwide. In

2030, estimated there are 52 million deaths from

non-communicable diseases. One of the non-

communicable diseases which counted as a public

health problem is hypertension. Not only happened

in developing countries but also happened in

developed countries.

Hypertension is commonly called by silent killer

because the symptoms are not known for sure. The

symptoms that appear can be vary depend on each

individual and almost the same as other diseases. In

addition, hypertension is also a risk factor for

deathly diseases such as stroke and coronary heart

disease. Riskesdas (2013) showed that nationally

25.8% of populations of Indonesia suffered from

hypertension.

The number of incidence of hypertension in

Kediri District increased from year to year. In 2016

the incidence of hypertension got a first place for

non-communicable disease in Kediri District.

Hypertension prevalence rate even reached 27.9 %.

This number was higher than the hypertension

prevalence rate of eastern Java which was 26.2 %.

Some of high and unreliable incidence of

hypertension can cause a loss not only economically

but also on productivity and complications of other

diseases. Increasing the number of incidence of

hypertension can have an impact on economic

burden, productivity loss and the complication

appearances.

So that important to conduct a study concern to

the costs which is covered by patient during illness.

According to Jo C (2014) Cost of illness is a study to

estimate the magnitude of the economic costs borne

by an illness. The purpose from this study is to

measuring cost of illness of hypertension that was

experienced by a patient with hypertension in Kediri

District from individual perspective.

2 METHODS

This research was a quantitative research with cross

sectional design. Population in this research was

total patient of hypertension in Kediri District in

2017 that is equal to 435,628 people. The sample

was calculated by using Slovin formula to obtain a

272

Utari, A. and Rochmah, T.

Cost of Hypertension Disease in Kediri Regency.

In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 272-276

ISBN: 978-989-758-335-3

large number of sample as many as 100 people who

has hypertension.

The sample in this research taken by cluster

random sampling. The first stage technique of

sampling began with determining the cluster by

using the working area of the Primary Health Care.

There was a consideration in selecting the working

area where to be sampled to represent the

population. That was by selecting the existing

primary health care in rural and mobile areas. 2

working area where to be chosen that meet the

criteria are Kandangan Primary Health Care (rural

village) and Pare Primary Health Care (crowded

area).

Data were collected randomly by door to door

way on patient who has hypertension in Pare

Primary Health Care and Kandangan Primary Health

Care. Instrument that used in this research is

questionnaires. the study was conducted from May

to July 2017. The cost of illness in this study used an

individual point of view. Variables to calculate the

cost of illness consists of direct cost and indirect

cost. Tool for data analysis in this research used

Ms.Excel.

3 RESULTS

According to WHO (2009) the cost of illness can be

divided into direct cost and indirect cost. Direct cost

is costs that are directly related to treatment of

hypertension, while indirect cost is costs that are not

directly related to the treatment of hypertension

borne by the patient during treatment for the illness.

3.1 Direct cost

Direct cost is costs that are directly related to the

treatment of hypertension. This cost is paid by

patients who has hypertension to check-up their

health. According to Istiqomah (2016) Direct cost is

divided into two categories, they are routine cost and

incidental cost. Routine Cost is the average of direct

cost that is routinely paid by patient as long as the

patient has the illness. This cost is calculated for one

year.

The cost which is a routinely direct cost is the

outpatient expense and other medical expenses.

Outpatient costs be obtained from the average

expenses for outpatient treatment by the patients for

one year. While other medical costs are showing the

average expenses of other treatments which is paid

by patients for one year. The other treatments which

being intended is a treatment that is not performed in

health services, like buying medicine in pharmacy

by themself or buying traditional medicine.

Incidental direct cost is a direct costs which paid

at any time during the treatment for the illness. Costs

that include incidental direct costs in this study is the

cost of hospitalization. The cost of hospitalization is

an average expenses for inpatient treatment for

hypertension patients.

The average of routine direct cost during illness

was derived from the multiplication of routine direct

cost over for a year with the average duration time

of illness. The average duration of illness of the

patient was calculated by reducing life expectancy of

Kediri District population which is 72 years old by

the age of the first time respondent has the illness

which is 55 years old. So the average value of the

duration of illness is 17 years.

The following is a calculation result of direct

cost that can be seen in Table 1.

Tabel 1: Direct Costs on Hypertension Patients in Kediri

District

Statement

Cost (Rupiahs)

INCIDENTAL COST

Average of Inpatient Treatment

178.500

ROUTINE COST

Average of Outpatient Treatment

297.870

Average of Other Treatments

57.540

Average of Routine Direct Cost

355.410

Average of Routine Direct Cost

during Treatment for The Illness

(17 years)

6.041.970

TOTAL DIRECT COST

6.220.470

Based on Table 1 it can be concluded that the

direct costs which paid by hypertensive patients is

Rp 6.220.470, -. The biggest component in direct

costs is in a routine direct cost that is the expenses

for outpatient treatment.

3.2 Indirect Cost

Indirect cost is costs that are not directly related to

the treatment of hypertension which paid by the

patient for the illness. Istiqomah (2016) state that

indirect cost is divided into two categories: routine

indirect costs and incidental indirect costs. Routine

indirect cost is an indirect cost which routinely paid

by the patient as long as the patient has the illness.

While incidental indirect cost is indirect costs which

Cost of Hypertension Disease in Kediri Regency

273

paid by the patient at any time as long as the patient

ill.

Routine indirect costs consist of outpatient

transport cost, outpatient productivity loss, and

outpatient companion productivity loss. While the

incidental indirect costs consists of inpatient

transportation cost, inpatients productivity loss, and

inpatient companion productivity loss.

Transportation cost represent transportation costs

incurred when visiting health services for the

treatment. Transportation cost is obtained by

multiplying the number of visits with the average of

one-way cost to the intended health service. The cost

of aids is a cost incurred to purchase aids as long as

patient suffers from hypertension. While the

productivity loss is the cost of productivity loss due

to the absences of the patient for leaving the job or

normal activities to undergo treatment. The cost is

obtained by multiplying the percentage of total

absences in a month with an average monthly

income.

Tabel 2. Indirect Cost on Hypertension Patients in Kediri

Distric

Statement

Cost (Rupiahs)

INCIDENTAL COST

Average of Transportation of

inpatient care

48.440

Average of Productivity Loss on

patients of inpatients care

64.268

Average of Productivity Loss on

patient company of inpatient care

67.980

Average of Incidental Indirect Cost

180.687

ROUTINE COST

Average of Transportation of

Outpatient Care

162.020

Average of Productivity Loss on

patients of outpatients care

120.655

Average of Productivity Loss on

patient company of outpatient care

69.290

Average of Routine Indirect Cost

351.964

Average of Routine Indirect Cost

During the Illness (17 years)

5.983.394

TOTAL INDIRECT COST

6.164.081

Based on Table 2 it can be seen that amount of

indirect cost is 789,272, -. The largest component of

the routine cost is productivity loss costs for

outpatients and outpatient transport.

After the calculation of direct and indirect

costs, it can calculate the cost of illness for each

individual patients who has hypertension follows:

Cost of

Illness

= Direct Cost + Indirect Cost

(1)

= 6,220,470 + 6,164,081

= 12.384.551 rupiahs

Based on the above calculation can be concluded

that the value of cost of illness which is borne and

covered by hypertension patient in Kediri District is

Rp 12.384.551, -.

4 DISCUSSION

According to WHO (2014) nearly 45% burden of

disease that occurring in low-income and middle-

income countries is caused by non-communicable

diseases. Hypertension is one of them which counted

as the major risk factors for global disability, death

and disproportionate impacts in low-income and

middle-income countries. Two-thirds suffer from

hypertension. In 2010 estimated that 9.4 million

deaths and 162 years are lost due to hypertension

worldwide. The prevalence of hypertension

continues to increase worldwide and it is estimated

to affect more than 500 million people by 2025.

Based on the health profile of Kediri District,

Hypertension is a non-communicable disease with

the highest number of cases in 2016.

This study showed that the routine direct cost of

hypertension in one year is obtained from outpatient

and other medical expenditure every month. Besides

outpatient visits in health services, some patients

also buy their own medicines at pharmacies, buy

traditional medicines and other alternative

treatments. The results showed there was a cost for

other treatments of Rp 57,540 per month.

Besides identifying the direct costs, cost of

illness analysis also needs to identify indirect costs.

In this study, indirect cost consist of outpatient and

inpatient transportation costs and productivity loss

during outpatient and inpatient care.

The value of transportation costs incurred by the

patient is influenced by the frequency of visits to

health services. The higher frequency of visits then

the higher also the cost of transportation cost. In this

study the patient uses a variety of transportation to

go to health services. For the example is

motorcycles, cars, public transportation or walk.

This study also found that some patients who live in

crowded population areas (working area of Pare

Primary Health care) go to health services by riding

a bicycle or walking. This is because the location of

health services is easily accessible. While

transportation in patients in rural areas (working area

INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association

274

Kandangan Primary Health Care) go to health

services by motorcycle.

Components that affect the value of patient

productivity loss is the frequency of visits and

income per month. This study found that the

percentage of unemployment patient is 22%. This is

because of most of them are elderly sufferers, so

they have no job and the final effect is the

productivity loss becomes low. If anyone at his

productive age suffer from hypertension, his work

activities will be distrubed due to the illness. In the

other hand, the work’s time will be reduced when he

had to undergo the treatment such as outpatient care

and hospitalization. According to Hyder et al (2012)

productive age is generally associated with people

aged 15

-64

years. At that age, people is

considered to spend more of his life to move and

work. At the under 15

years and age above 64

years it is considered a dependent in domestic life.

The elderly sufferer, who usually have entered

the age of retirement and not working, have lower

productivity loss than patient on productive age. At

this age, the patient has entered an old age that

caused organ function’s decreased. The process of

degeneration and disease suffered will increase the

severity of the illness. Therefore, the patient will

need the help from the others while visiting health

services for outpatient and inpatient.

When someone who has no money suffered from

hypertension, the cost of the treatment will depend

on his family. If the income is low then it will make

the economic situation of the family worse off.

Because of that, the JKN program will help public

ensure the health needs in order to remain the public

to check his health so it won’t get worse.

Based on research conducted by Catherine

(2016) it is estimated that the value of Dissability

Adjusted Life Years in almost all the world due to

high blood pressure ranks second after the risk of

illness due to diet. According to Chataut et al (2011)

in a study conducted in Nepal in 2011 mentioned

that gender and old age are independent factors or

hypertension risk factors that can not be changed. In

other hand, there are many risk that preventable.

Such as healthy diet, healthy lifestyle.

Based on the results of the research can be

concluded that the indirect costs which paid by

patients is not really different with the direct costs.

But in reality there are still many people who are

unaware that besides the direct costs of the

treatment, there are another economic losses such as

expenditures for transportation costs and

productivity loss.

5 CONCLUSION

The results showed that the cost of illness of

hypertension in Kediri District is Rp 12.384.551 per

capita. This means that every individual who suffers

from hypertension will bear the economic burden

which is Rp 12.384.551. Based on the analysis it can

be concluded that during suffered from hypertension

there are much of indirect costs that must be covered

by patient due to the illness. The indirect costs

which paid by patients is not really different with the

direct costs. But in reality there are many people

who do not realized that hypertension can caused the

economic loss which is indirectly affect the

economic conditions of households, regional even a

country.

The point is to make awareness to public for

increasing preventive and promotive of hypertension

disease. Preventive and promotive efforts need a

Government support. It can be done by increasing

the budget for the promotive and preventive efforts

to make more activity programs to reduce the

prevalence of hypertension. Preventive and

promotive efforts also require commitment and

active participation from the human resources of

health sector and the public to ensure the programs

can be done well.

REFERENCES

Catherine P, B., Gregory A, R., Andrew E, M., 2016. The

Global Burden of Disease Study and the Preventable

Burden of NCD.[e-journal] 11(04): 393-397, Tersedia

di http://ac.els-cdn.com/S2211816016307608/1-s2.0-

S2211816016307608-main.pdf?_tid=5eee7b0a-60a2-

11e7-9521-

00000aab0f02&acdnat=1499163795_7bc21522a748d

64c71b45caafbf79635 [diakses tanggal 4 Desember

2016]

Chataut J, Adjikari R.K.,Sinha N.P., 2011.Prevalence And

Risk Factors for Hypertension in Adult Living in

Central Development Regiaon in Nepal.Kathmandu

University Medical Journal, [e-journal] 33 (1) pp. 8-

13. Tersedia di: http://www.kumj.com.np/issue/33/13-

18.pdf [5 Juni 2017]

Hyder, A. A., Puvanachandra, P., & Morrow, R. H.

(2012). Measuring the Health of Populations:

Explaining Composite Indicators. Journal of Public

Health Research, 1(3), 222–228.

http://doi.org/10.4081/jphr.2012.e35

Istoqomah, AN.2016. Analisis Burden of Disease Akibat

Hipertensi Pada Masyarakat dengan Status PBI JKN

Cost of Hypertension Disease in Kediri Regency

275

di Kabupaten Pamekasan. Skripsi.Universitas

Airlangga

Jo C. 2014. Cost of Illness Studies: Concepts, Scopes, and

Methods. Clinical and Molecular Hepatology Journal.

[e- journal]. Vol 20: 4. Available from:

http://dx.doi.org/10.3350/cmh.2014.20.4.327.

[Accessed 5

, July 2017]

Riset Kesehatan Dasar, 2013. Riset Kesehatan Dasar.

Jakarta: Badan Penelitian dan Pengembangan

Kesehatan.

World Health Organization (WHO). 2009. WHO: Guide to

Identifying The Economic Consequences of Disease

and Injury. Geneva: WHO Departement of Health

System Financing Health System and Services.

World Health Organization (WHO).2014. Global Status

Report of Non Communicable Disease 2014.WHO.

Switzerland. Available from:

:http://apps.who.int/iris/bitstream/10665/41864/1/0965

546608_eng.pdf [6

, June 2017]

INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association

276