THE DETERMINATION OF UTILITY INDICATOR IN SPUTUM SMEAR-POSITIVE PULMONARY TUBERCULOSIS WITH COMORBID DIABETES MELITUS PATIENT USING MARKOV MODEL

• Main Author: Rahmatina, Erba
• Format: Theses
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/47089
• Institution: Institut Teknologi Bandung

Diabetes Melitus (DM) is a risk factor for Tuberculosis (TB). DM increases the risk of Tuberculosis treatment failure, relaps, and death. This study aimed to determine the utility of sputum smear-positive pulmonary TB patient with or without comorbid DM, and sputum smear-positive pulmonary TB-DM patient with certain fasting blood glucose status and type of antidiabetic drug used in ten years. The result of this study was expected to assist the selection of antidiabetic drug which had the highest expectation in terms of supporting TB treatment success. This was a retrospective study through assessment of patients’medical records in Balai Besar Kesehatan Paru Masyarakat (BBKPM), Bandung from the period of Januari 2009 until June 2015. The follow up was also done by phone on June 2016 to confirm some data and final state of patients’TB treatment. Markov model was utilized to simulate the long-term TB outcome influenced by the DM, fasting blood glucose status, and type of antidiabetic drug. The output of Markov simulation was the utility which was the numeric valuation of a health state based on the preference of being in that state relative to optimum health. In this study, utility represented the individual total utility in ten years. Sensitivity analysis was conducted to evaluate the influence of parameter used to the utility. Based on the Markov model, comorbid DM, fasting blood glucose status, and type of antidiabetic drug used influenced utility and expectation of TB treatment success. The simulation of TB patient without comorbid DM resulted in a higher utility and expectation of TB treatment success compared to the simulation of TB patient with comorbid DM (utility: 8.38 versus 7.9). The simulation of TB-DM patient with controlled blood glucose status resulted in a higher utility and expectation of TB treatment success compared to the simulation of TB-DM patient with uncontrolled blood glucose status (utility at Intensive Phase: 8.59 versus 7.88; utility at the end of Continuation Phase: 8.59 versus 7.86). The simulation of TB-DM patient with insulin used at Intensive Phase resulted in a higher utility and expectation of TB treatment success compared to the simulation of oral antidiabetic or combination of insulin and oral antidiabetic used (utility: 8.59 versus 7.34 versus 8.53). The simulation of TB-DM patient with insulin used at the end of Continuation Phase resulted in similar utility and expectation of TB treatment success with the simulation of combination of insulin and oral antidiabetic used but higher compared to the simulation of oral antidiabetic used (utility: 8.59 versus 8.59 versus 7.72). Based on the probability transitions, utility, and total number of patients in steady state condition, the use of insulin either at Intensive or the end of Continuation Phase, achieved the highest expectation in resulting a successful TB tretment outcome. During the Intensive Phase, insulin was the optimum medication to use. At the end of the Continuation Phase, either insulin or combination of insulin and oral antidiabetic were the optimum ones to use with a higher utility and expectation of successful TB treatment outcome compared to the oral antidiabetic. In general, sensitivity analysis showed that utility was most sensitive to the changes of incremental utility of Cured status, discount rate, and transition probability from Cured status to Cured status (no recurrence) .