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Dua Jalan Menuju Sehat — Mencegah atau Mengobati?

Di sebuah kantor dinas kesehatan provinsi, seorang kepala bidang program promotif dan preventif baru saja menerima laporan tentang tingginya kasus diabetes melitus tipe 2 di wilayahnya. Biaya klaim BPJS untuk pasien dengan komplikasi diabetes mencapai miliaran rupiah setiap tahun. Rapat pun digelar.

“Haruskah kita perkuat edukasi dan deteksi dini?” tanya kepala bidang. “Atau terus tingkatkan kapasitas pengobatan di faskes tingkat lanjutan?” Seorang analis kebijakan, Rafi, diminta melakukan studi kecil. Ia membandingkan dua skenario sederhana:

Skenario 1 (Kuratif): Fokus pada perawatan pasien diabetes setelah diagnosis, termasuk biaya pengobatan, kontrol gula darah, dan penanganan komplikasi.

Skenario 2 (Preventif): Implementasi program skrining dan edukasi gaya hidup sehat bagi masyarakat usia 35 tahun ke atas.

Dari data yang dikumpulkan, ia membuat simulasi:

Biaya rata-rata per pasien per tahun:

Kuratif: Rp5,5 juta (pengobatan dan komplikasi)

Preventif: Rp900 ribu (skrining, edukasi, monitoring awal)

Efektivitas (dalam QALY per 10 tahun):

Kuratif: 6,5 QALY (karena kualitas hidup berkurang oleh komplikasi)

Preventif: 7,5 QALY (karena pencegahan mencegah komplikasi parah)

> ICER untuk program preventif dibanding kuratif: (Biaya preventif – Biaya kuratif) / (QALY preventif – QALY kuratif) = (Rp900.000 – Rp5.500.000) / (7,5 – 6,5) = (–Rp4.600.000) / (1 QALY) = –Rp4,6 juta per QALY

Angka negatif pada ICER berarti: preventif bukan hanya lebih efektif, tapi juga lebih murah. Ini yang disebut sebagai dominant intervention dalam analisis cost-effectiveness.

Saat presentasi, Rafi menjelaskan, “Kita sering terpaku pada angka absolut pengobatan, karena dampaknya terasa langsung. Tapi pencegahan bekerja senyap, jangka panjang, dan sangat hemat biaya.”

Diskusi pun berkembang. Tantangannya tentu bukan hanya anggaran, tetapi bagaimana mengubah kebiasaan masyarakat, memastikan skrining dijalankan dengan baik, dan membuat perubahan gaya hidup menjadi kebiasaan nasional. Namun hari itu, satu hal menjadi jelas: mencegah bukan hanya lebih baik dari mengobati—ia jauh lebih cost-effective.

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