The Use of DLBS3233 Bioactive Fraction in Type 2 Diabetes Mellitus Management in Indonesia: A Cost-Effectiveness Analysis of Real-World Evidence

Diabetes has a significant clinical and economic impact to the society. Inlacin (DLBS3233 bioactive fraction) is a phytopharmaceutical for diabetic patients that can be used as an additional therapy for maintenance purposes. Therefore, Cost-Effectiveness Analysis (CEA) for Inlacin needs to be done to provide an overview of its potential. Aims of this study was to define the cost-effectiveness of phytopharmaceuticals on type 2 diabetes mellitus management in Indonesia. This study was performed using societal perspectives with observational-based cost-effectiveness analysis.The clinical and economic data were retrospectively collected (2007-2022) from a total of 137 participants, of whom 66 were Inlacin Group and 71 were Non-Inlacin Group. The clinical data consisted of HbA1c level, effectiveness, utility, and Visual Analogue Score (VAS), while the economic data consisted of Direct Medical Cost, Direct non-Medical Cost, and Indirect Cost. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) gained was estimated to determine the cost-effectiveness. Deterministic sensitivity analysis was conducted to assess the impact of parameter uncertainty. In the base case, inlacin provided a more economic and more effective treatment than non-inlacin with a total cost of IDR 6,837,195 (USD 434.42 ) vs IDR 7,870,056 (USD 5004.17) and a total QALYs of 0.490 vs 0.464. The ICER of IDR 39,535,349 (USD 25,259.62 ) is considered cost effective according to the willingness to pay threshold (2021 3x Indonesian GDP is Rp.201,504,163 = USD 12,813.45). The most influential drivers of cost-effectiveness in deterministic sensitivity analysis were the changes of the total cost of Inlacin, the price of medicine on non-Inlacin group, and the direct medical cost of non-Inlacin group. Based on the current price in Indonesia, inlacin can be considered a cost-effective option, although this depends heavily on the willingness to pay threshold. Further Markov Modeling studies with inlacin are needed to inform the decision-making process.