Acta Med Indones. 2026 Jul;58(3):402-414.
ABSTRACT
BACKGROUND: Chronic heart failure (CHF) is the leading cause of morbidity and healthcare expenditure in Indonesia, largely due to recurrent hospitalizations. Multidisciplinary Programs (MDSs) have been introduced to provide clinical and economic advantages by reducing hospitalizations. This study aimed to compare direct medical cost trajectories between patients managed under MDP and standard care (SC) at a tertiary referral hospital.
METHODS: The retrospective cohort study was conducted at Dr. Cipto Mangunkusumo National Hospital and included 189 patients with CHF who completed at least eight consecutive outpatient visits. Patient demographics, clinical data, and direct medical costs were obtained from medical records and hospital billing data.
RESULTS: Patients in the MDP group were younger (median age 55 vs 60 years) and had a more frequent ischemic etiology compared with SC. Outpatient costs were higher in MDP, mainly due to medications and consultation fees, while inpatient costs were substantially lower, particularly for procedures, consumables, and ward charges. The total direct medical cost per patient was significantly lower in MDP compared with SC (Rp 19.4 million vs Rp 31.3 million), reflecting a 38% reduction.
CONCLUSION: Implementation of an MDP reduced overall direct medical costs by shifting expenditures toward outpatient management and lowering costly inpatient utilization. These findings support MDP as a feasible and cost-efficient strategy in resource-limited health systems.
PMID:42845080