Drug Utilization Review terhadap Penggunaan dan Biaya Obat Antihipertensi pada Pasien Polifarmasi di Sembilan Rumah Sakit Kabupaten Kulon Progo Tahun 2024–2025

Afif Rakha Murtadha; Reary Nurtaqwim Syuhri; Raras Sekar Kinasih; Antokalina Sari Verdiana; Susi Ari Kristina

doi:10.31004/koloni.v5i3.1370

Authors

Afif Rakha Murtadha Magister Manajemen Farmasi, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0009-0008-9582-1528
Reary Nurtaqwim Syuhri Magister Manajemen Farmasi, Universitas Gadjah Mada, Yogyakarta, Indonesia
Raras Sekar Kinasih Magister Manajemen Farmasi, Universitas Gadjah Mada, Yogyakarta, Indonesia
Antokalina Sari Verdiana Kedeputian Bidang Aktuaria BPJS Kesehatan, Indonesia https://orcid.org/0009-0003-9381-247X
Susi Ari Kristina Manajemen dan Komunitas Farmasi, Fakultas Farmasi, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0003-4248-6830

DOI:

https://doi.org/10.31004/koloni.v5i3.1370

Keywords:

hypertension, antihypertensive drugs, polypharmacy, Drug Utilization Review

Abstract

Hypertension is a chronic disease that requires long-term treatment and is often accompanied by the use of multiple medications, particularly in patients with comorbidities. This study aimed to evaluate the utilization patterns and costs of antihypertensive drugs among patients with polypharmacy in nine hospitals in Kulon Progo Regency during 2023–2025 using a Drug Utilization Review (DUR) approach. The study employed a retrospective, descriptive, observational design with aggregate longitudinal analysis of prescription and National Health Insurance (JKN) claims data from September 2023 to December 2025. Samples were selected through total sampling of polypharmacy prescriptions, defined as those containing ≥6 generic drugs and at least one antihypertensive. Drug utilization was analyzed using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) classification and the Drug Utilization 90% (DU90%) method. Of 9,336 participants, most were female (54.0%) and aged ≥60 years (51.0%). Polypharmacy was most commonly found in prescriptions containing six drugs. Antihypertensive drugs included in the DU90% segment were candesartan (39.10%), amlodipine (33.44%), bisoprolol (12.42%), and furosemide (12.19%). The highest accumulated drug cost was recorded at Hospital 1, at IDR 10,652,208,824, followed by Hospitals 3 and 2. These findings indicate variation in antihypertensive drug utilization among patients with polypharmacy, suggesting the need for periodic evaluation of treatment rationality, adherence to the National Formulary, and optimization of generic drug use to support efficient JKN healthcare expenditure.

References

Apriliany, W., Pramukantoro, G. E., & Wijayanti, T. (2023). Analisis PenggunaancObatcAntihipertensi pada PasiencProgram Rujuk Balik ( PRB ) di Apotek Kabupaten “ A ” Dengan Metode ATC / DDD dancDU 90 %. 10(1), 97–103.

Bond, R. M., Purewal, V., Cameron, N., Tobb, K., Adedinsewo, D., Isiadinso, I., & Phillips, K. (2026). Hypertension in Women Across the Life Cycle: Unique Aspects and Challenges. Current Hypertension Reports, 28(1). https://doi.org/10.1007/s11906-026-01362-x

Budiyanti, N. A., Wediyaningsih, C., & Andayani, T. M. (2022). Pengaruh Konseling Apoteker terhadap Kepatuhan dan Kualitas Hidup Pasien Hipertensi Program Rujuk Balik di Apotek. Majalah Farmaseutik, 18(3), 300. https://doi.org/10.22146/farmaseutik.v18i3.66591

DiDomenico, R. J., Marrs, J. C., Bress, A. P., Denfeld, Q. E., Dobesh, P. P., Effron, M. B., Goyal, P., Onyebeke, C., Peterson, J. K., & Petrovic, M. (2026). Deprescribing in Patients With Cardiovascular Disease Experiencing Polypharmacy: A Scientific Statement From the American Heart Association. Circulation, 299–318. https://doi.org/10.1161/CIR.0000000000001459

Faisal, S., Khotib, J., Wibisono, C., Hamidah, K. F., Utomo, F. N., & Zairina, E. (2025). Factors contributing to the prevalence of potential drug-drug interactions among hospitalized elderly patients in a tertiary hospital in Eastern Java, Indonesia. Medical Journal of Indonesia, 34(3), 174–180. https://doi.org/10.13181/mji.oa.257888

Farida, Y., Widayanti, A. W., Andayani, T. M., & Probosuseno. (2025). Medication-related Burden and Experience With Medications in Indonesian Older Adults With Chronic Diseases: A Mixed-method Study. Journal of Preventive Medicine and Public Health, 58(2), 188–198. https://doi.org/10.3961/jpmph.24.374

Fravel, M. A., & Ernst, M. (2021). Drug Interactions with Antihypertensives. Current Hypertension Reports, 23(3), 14. https://doi.org/10.1007/s11906-021-01131-y

Isnaini, M., Widiarti, W., & Khairinisa, M. A. (2024). Analysis of Cost-Effectiveness of Antihypertensive Therapy in Hypertension Patients at A-Ihsan Regional Public Hospital in 2023. Pharmacology and Clinical Pharmacy Research, 9(1), 1–10. https://doi.org/10.15416/pcpr.v9i3.54705

Jang, S., Lim, J., Moon, A., Lee, J. Y., Ah, Y. M., Lee, H. J., Lee, S. Y., Kim, J. H., & Jang, S. (2026). Clinical and Economic Outcomes of Korea’s National Polypharmacy Management Program for Hospitalized Older Adults: 90-Day Readmission and Healthcare Costs. Drugs and Aging, 0123456789. https://doi.org/10.1007/s40266-026-01325-6

Kusumawardani, L. A., Andrajati, R., & Nusaibah, A. (2020). Drug-related Problems in Hypertensive Patients: A Cross-sectional Study from Indonesia. Journal of Research in Pharmacy Practice, 9(3), 140–145. https://doi.org/10.4103/jrpp.jrpp_20_16

Kusumawati, F., & Rahayu, E. (2023). Analisis kendala pengadaan obat program rujuk balik (PRB) di fasilitas kesehatan tingkat pertama (studi kasus pada puskesmas BLUD di Kabupaten Indragiri Hilir).

Martawinata, S., & Soewondo, P. (2023). ANALISIS KETERSEDIAAN OBAT PROGRAM RUJUK BALIK ( PRB ) KASUS HIPERTENSI DI KOTA PALEMBANG TAHUN 2023 Analisis Ketersediaan Obat Program Rujuk Balik ( PRB ) Kasus Hipertensi di Kota Palembang Tahun 2023 PENDAHULUAN Dalam tiga puluh tahun terakhir , terjadi.

McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., & Ferro, C. J. (2024). 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal, 45(38), 3912–4018. https://doi.org/10.1093/eurheartj/ehae178

Nafrialdi, Jamal, A. K., Hardi, H., & Widyastuti, R. (2025). Polypharmacy and the Risk of Adverse Drug Reactions in the Elderly at a Tertiary Referral Hospital in Indonesia: Assessing the Applicability of the GerontoNet Score.

Ruksakulpiwat, S., Schiltz, N. K., Irani, E., Josephson, R. A., Adams, J., & Still, C. H. (2024). Medication Adherence of Older Adults with Hypertension: A Systematic Review. Patient Preference and Adherence , 18(April), 957–975. https://doi.org/10.2147/PPA.S459678

Szeto, C.-C., Sugano, K., Wang, J.-G., Fujimoto, K., Whittle, S., Modi, G. K., Chen, C.-H., Park, J.-B., Tam, L.-S., & Vareesangthip, K. (2020). Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations.

Tesfaye, Z. T., Horsa, B. A., & Yismaw, M. B. (2026). Impact of pharmacist-led deprescribing interventions on medication related outcomes among older adults: a systematic review and meta-analysis. BMC Geriatrics, 26(1). https://doi.org/10.1186/s12877-025-06964-9

Turana, Y., Tengkawan, J., & Soenarta, A. A. (2020). Asian management of hypertension: Current status, home blood pressure, and specific concerns in Indonesia. Journal of Clinical Hypertension, 22(3), 483–485. https://doi.org/10.1111/jch.13681

Wildan, M. M., Rahayuningsih, N., & Salasanti, C. D. (2015). Karakteristik Pasien dan Penggunaan Obat Hipertensi di Beberapa Sarana Kesehatan. Annals of Tourism Research, 3(4), 45. http://www.ncbi.nlm.nih.gov/pubmed/25926610%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4492060%0Ahttp://www.sciencedirect.com/science/article/pii/S0160738315000444

Wildayanti, W., Wijayanti, T., & Andayani, T. M. (2023). Drug utilization pattern and cost estimates of antihypertensive drugs in pharmacies BPJS Kesehatan back-referral program in Kudus Regency. Jurnal Ilmiah Farmasi, 19(1), 31–43. https://doi.org/10.20885/jif.vol19.iss1.art3

Yaacoub, S., Bardawil, C., Yammine, R., Dakroub, A. H., & Eid, A. H. (2026). Sex-Biased Pharmacotherapeutic Disparities in Hypertension. Drugs, 86(8), 1261–1284. https://doi.org/10.1007/s40265-026-02326-w