Economic evaluation of sildenafil for the treatment of pulmonary arterial hypertension in Indonesia.

BACKGROUND: This study aims to assess the cost-effectiveness and budget impact of adopting sildenafil to the benefits package for the indication of pulmonary arterial hypertension (PAH), compared to beraprost. METHODS: Based on a societal perspective, a model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years (LYs) and quality-adjusted life years (QALYs). RESULTS: The economic model calculated the incremental cost-effectiveness ratio (ICER) per QALY gained for using sildenafil as first-line therapy compared to beraprost for the patient in functional class (FC) II and III, i.e. USD 3098 and USD 2827, respectively. The results indicated that in spite of sildenafil being more expensive than beraprost, generic sildenafil could potentially be a good value for money since ICER per QALY is below one times gross domestic product (GDP) per capita in Indonesia. Furthermore, budget impact analysis estimated that the incremental budget needed within 5 years for including sildenafil compared to beraprost for PAH patients starting in FC II and FC III was USD 436,775 and USD 3.6 million, respectively. CONCLUSIONS: Compared to beraprost, sildenafil would be preferable for the treatment of PAH patients in FC II and FC III in Indonesia. The additional budget for adopting sildenafil compared to beraprost as the treatment of PAH in the benefits package was estimated at around USD 4.0 million.

The Applicable Dental Age Estimation Methods for Children and Adolescents in Indonesia.

Indonesia is an archipelagic country bordered by tectonically active zones with intense seismicity and volcanism. This condition is often associated with a high-risk situation of disasters in Indonesia. Forensic identification is a necessary procedure to reveal an individual's identity. An identity, including sex and age, is needed to build a conclusion of human identification. Dental age estimation is a subfield of forensic odontology which focuses on establishing an individual's age. Tooth development, biochemical, and postformation changes are the parameters for estimating dental age. This review discusses the applicable dental age estimation method for children and adolescents in Indonesia. Several articles that have previously studied dental age estimation in Indonesia were reviewed for this manuscript. On reviewing these articles, it was found that the Demirjian method, the Willems method, and the Al Qahtani method are useful in this population with higher accuracy than other methods.