Journal of Health Economic and Policy Research (JHEPR)

Cost Analysis Of Type 2 Diabetes Mellitus Therapy In High-Income And Low And Middle-Income Countries: A Systematic Review

Raihana Nurul Izzah, Dwi Endarti, Tri Murti Andayani — Thu, 02 Apr 2026 00:00:00 +0000

Abstract

Introduction: Diabetes is currently a very serious health problem. There is an increase in the prevalence and incidence of type 2 diabetes mellitus, this disease causes suffering for sufferers and also causes the death of a person, which makes a large economic burden for both the community and health care facilities. This study aimed to analyze the total direct medical costs of type 2 diabetes mellitus therapy in high-income, low- and middle-income countries.

Methods: A systematic review was carried out following the PRISMA guidelines. The article search method was carried out by searching PubMed, ScienceDirect, and Springer for articles that analyzed the total direct medical costs of type 2 diabetes mellitus therapy. Nine articles are considered important to be discussed in this review, these nine articles were published between January 2014 and December 2023.

Result: The results showed that the two components that had the greatest impact on the direct medical costs of managing type 2 diabetes were inpatient services and medications. Direct medical costs ranged from the lowest to the highest at $343,93 for the Kenya study to $5.090,48 for the Spain study, while medication costs ranged from $34,23 for Indonesia to $645,52 for Bangladesh from the average annual direct costs per person. The most widely used drugs were oral hypoglycemic drugs, while the most expensive drugs were Combination of Oral and Insulin. Complications of diabetes resulted in increased expenditure of the total direct medical costs.

Conclusion: This review concludes that the studies reviewed indicate a considerable health financing burden in the care of type 2 diabetes mellitus. Efforts to prevent diabetes complications have the possibility of saving the cost of diabetes care.

Comparative Analysis of Drug Policy Prices and National Procurement Systems in Universal Health Coverage

Erlisa Irawati Putri, Chairun Wiedyaningsih, Roshinta Andien Damayanti — Thu, 02 Apr 2026 00:00:00 +0000

Background: Access to affordable essential medicines is a key prerequisite for achieving Universal Health Coverage (UHC), particularly in developing countries facing fiscal pressures and pharmaceutical market inefficiencies. However, the effectiveness of medicine pricing policies varies significantly between countries, depending on regulatory design, procurement capacity, and political commitment to universal access.

Aims: This study aims to analyse and compare drug pricing policies and national procurement systems in five Asian countries—Indonesia, the Philippines, Thailand, Malaysia, and India—in the context of UHC.

Methods: This study employs a comparative policy analysis approach, utilising secondary data from national regulations, official government reports, and academic literature.

Results: Thailand has demonstrated the most effective model, combining HTA, compulsory licensing, and a centralized GPO system, which reduces drug prices by up to 90%. India optimises generic procurement through the Jan Aushadhi programme, while Malaysia combines external price references with tiered enforcement policies. In contrast, Indonesia and the Philippines still face challenges in price compliance and distribution efficiency, due to institutional fragmentation and weak oversight.

Conclusion: This study underscores the importance of integrating robust regulatory strategies, effective procurement mechanisms, and rigorous monitoring systems to ensure affordability and equitable access to medicines. Cross-country learning can strengthen national pharmaceutical reforms and support policy integration in the ASEAN region.

Keywords: Drug prices, UHC, pharmaceutical procurement, Asian pharmaceutical policy.

Optimization of Boiling Time for Maximum Curcuminoid Yield in a Traditional Turmeric Tamarind Jamu Using UV-Vis Spectrophotometry

aditya raharjo — Thu, 02 Apr 2026 00:00:00 +0000

Introduction: Turmeric tamarind herbal drink (Jamu Kunyit Asam) is a popular traditional medicine in Indonesia, valued for the health benefits of curcuminoids from turmeric. However, traditional preparation methods, particularly boiling time, are not standardized, potentially leading to inconsistent curcuminoid content, which affects efficacy.

Objective: This study aimed to determine the effect of boiling time on the curcuminoid content in Jamu Kunyit Asam and to identify the optimal boiling time to achieve the maximum concentration.

Methods: Fresh curcuma rhizomes (Curcuma longa L.) and tamarind fructus (Tamarindus indica L.) were boiled at 90 ± 2°C. Samples were collected at 5, 10, 15, 20, and 30-minute intervals. Curcuminoids were isolated using liquid-liquid extraction with chloroform and quantified using a validated UV-Vis spectrophotometry method at a maximum wavelength of 423 nm.

Results: The analytical method was validated and showed excellent linearity (r = 0.9997), accuracy (92% recovery), and precision (%RSD = 0.89). The results demonstrated a non-linear relationship between boiling time and curcuminoid content. The concentration increased sharply to a peak of 57.602 ppm at the 10-minute mark, followed by a consistent decrease to 24.576 ppm by 30 minutes.

Conclusion: The optimal boiling time for maximizing curcuminoid content in Jamu Kunyit Asam is 10 minutes at 90°C. Boiling for less than 10 minutes results in incomplete extraction, while boiling longer leads to significant thermal degradation of curcuminoids. This finding provides a scientific basis for standardizing the preparation of this traditional herbal medicine to ensure optimal bioactive compound content.

COST EFFECTIVENESS ANALYSIS OF LETROZOLE VERSUS TAMOXIFEN IN EARLY-STAGE BREAST CANCER FOR POSTMENOPAUSAL WOMEN: SYSTEMATIC REVIEW

Thu, 02 Apr 2026 00:00:00 +0000

ABSTRACT

Background:
Breast cancer remains a major global health challenge, not only because of its clinical implications but also due to the increasing financial burden associated with its treatment. As such, cost-effectiveness analysis (CEA) plays a crucial role in supporting evidence-based decisions that optimize the use of healthcare resources. In postmenopausal women diagnosed with hormone receptor-positive early breast cancer, tamoxifen and letrozole are frequently prescribed endocrine therapies. Although letrozole has demonstrated superior efficacy in lowering recurrence rates and enhancing survival outcomes, its use is accompanied by higher treatment costs and a distinct profile of adverse effects.

Objectives:
This review aims to systematically examine and integrate current findings on the cost-effectiveness of letrozole versus tamoxifen in treating early-stage breast cancer in postmenopausal patients.

Methods:
A structured literature review was conducted in April 2025 across three major academic databases: PubMed, ScienceDirect, and SpringerLink. The selected studies were assessed for methodological rigor and potential bias using the CHEERS checklist. Five publications met the eligibility criteria and were included for data extraction and analysis.

Results:
All included studies reported that letrozole provided greater clinical benefit compared to tamoxifen in terms of reducing recurrence and extending disease-free survival in the target population. However, these clinical gains were linked to increased treatment costs and a unique spectrum of side effects. While letrozole was associated with a higher risk of bone and cardiovascular events, it posed a lower risk of endometrial cancer and thromboembolism than tamoxifen. Economic evaluations from various countries—namely China, Canada, the USA, the UK, and Germany—consistently found that letrozole led to greater quality-adjusted life years (QALYs). Moreover, its incremental cost-effectiveness ratios (ICERs) generally remained within acceptable national thresholds.

Conclusion:
For postmenopausal women undergoing adjuvant treatment for early-stage hormone receptor-positive breast cancer, letrozole offers a cost-effective alternative to tamoxifen. Despite its higher direct costs, its improved clinical efficacy supports its broader adoption in diverse healthcare systems.

Keywords: Letrozole, Tamoxifen, Cost-effectiveness, Early-Stage Breast Cancer, Postmenopausal.

Cost-Effectiveness Analysis of Rifampicin and Bedaquiline Use for Tuberculosis Treatment: A Systematic Review

wawang anwarudin — Thu, 02 Apr 2026 00:00:00 +0000

Introduction: Multidrug-resistant tuberculosis (MDR-TB), particularly rifampicin-resistant tuberculosis (RR-TB), remains a major challenge to global tuberculosis control and imposes substantial economic burdens on healthcare systems. Since 2020, the World Health Organization (WHO) has recommended the use of bedaquiline, a novel oral anti-tuberculosis drug, as part of an all-oral shorter regimen for the treatment of MDR-TB. This recommendation aims to improve treatment outcomes while reducing treatment duration and toxicity associated with conventional regimens.

Materials and Methods: This study employed a systematic review approach of peer-reviewed articles published between 2020 and 2026. A total of 14 studies were included in the analysis. The selected studies evaluated cost-effectiveness outcomes such as direct medical costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Various pharmacoeconomic modeling methods were applied in the included studies, including Markov models, decision tree analyses, and randomized controlled trials.

Result: Most of the reviewed studies reported that bedaquiline-based regimens are more cost-effective compared with conventional rifampicin-based therapy. The ICER values were generally below the national willingness to pay thresholds, indicating favorable economic value. In several studies, bedaquiline-based regimens even demonstrated cost-saving potential. In particular, the BPaL regimen (bedaquiline, pretomanid, and linezolid) showed shorter treatment duration, improved clinical outcomes, and lower relapse and resistance rates.

Conclusion: Bedaquiline represents a clinically effective and economically efficient treatment option for MDR-TB. Its implementation should be prioritized in national tuberculosis control programs, especially in low and middle income countries with a high TB burden. Further real-world implementation studies are necessary to support broader integration into healthcare systems.

Keywords: Bedaquiline, cost-effectiveness, MDR-TB, rifampicin, ICER