Cost of Illness of Hospitalized Ischemic Stroke Patients on Antihypertensive Therapy: BPJS Ward Class and Time to Blood Pressure Target

Q: What are the key findings of this study?

Total inpatient costs for BPJS-insured ischemic stroke patients on antihypertensives did not differ by ward class (p=0.101) or therapy model (p=0.144), but correlated with length of stay (rho=0.552, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic stroke with antihypertensive therapy (n=37). Intervention: BPJS ward class (Class 1, 2, 3) and antihypertensive therapy model (monotherapy vs. combination; ARB, CCB, ARB+CCB) vs. Comparison across BPJS ward classes and antihypertensive therapy models/drug classes. Primary outcome: Total inpatient cost (IDR) across BPJS ward classes (ε² 0.131, p=0.101).

Q: What does this research mean for the field?

Inpatient cost burden for BPJS-insured ischemic stroke patients receiving antihypertensives is primarily driven by length of stay rather than ward class, drug class, or speed of blood pressure control. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Peri Peri; Saski Asyifa Nasution; Wahyudi Wahyudi

doi:10.35451/jfm.v9i1.3962

October 30, 2026JURNAL FARMASIMED (JFM)Open Access

Cost of Illness of Hospitalized Ischemic Stroke Patients on Antihypertensive Therapy: BPJS Ward Class and Time to Blood Pressure Target

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Key result

Inpatient costs in ischemic stroke correlate with stay duration, not ward class or antihypertensive regimen.

ε² 0.131
P=0.101
n=37

Why the study?

Ischemic stroke burdens Indonesia's National Health Insurance (BPJS), and the total inpatient cost and time to blood pressure target among patients on antihypertensive therapy across ward classes and therapy models required evaluation.

Does BPJS ward class or antihypertensive therapy model affect total inpatient cost and time to achieve blood pressure target (≤140/90 mmHg) in hospitalized ischemic stroke patients?

Key Points

To evaluate total inpatient costs across insurance ward classes and antihypertensive therapy models, and to describe the time required to reach target blood pressure in hospitalized ischemic stroke patients.
Retrospective cohort study analyzing medical records and billing data of BPJS-insured ischemic stroke inpatients at Dr. Pirngadi Regional General Hospital Medan from January 2023 to December 2024 (n=37 overall; n=36 for cost analyses).
Assessed total inpatient charges against ward class, antihypertensive regimen, and time to achieve a blood pressure target of ≤140/90 mmHg using Kruskal-Wallis, Mann-Whitney U, and Spearman correlation tests.
Median total inpatient cost was IDR 3,607,050 (range IDR 1,644,500–66,808,955), with no statistically significant differences across ward classes (p=0.101), therapy models (p=0.144), or drug classes (p=0.245), though class 1 had the highest cost after excluding one extreme outlier (p=0.048).
No patient reached the target blood pressure on day 1; 40.5% reached target within 2 days, 29.7% on day 3, 13.5% after day 3, and 16.2% did not achieve target during hospitalization.
Total inpatient cost showed a moderate positive correlation with length of stay (rho=0.552; p<0.001) but did not correlate with the time required to achieve target blood pressure (rho=−0.066; p=0.724).

Study Design

Type

Cohort (n=37)

Multicenter

No

Structured PICO

Does BPJS ward class or antihypertensive therapy model affect total inpatient cost and time to achieve blood pressure target (≤140/90 mmHg) in hospitalized ischemic stroke patients?

P

Population

37 BPJS-insured inpatients with ischemic stroke (62.2% female, 70.3% aged 51–70 years) receiving antihypertensive therapy at a regional hospital in Indonesia, followed for a median hospital stay of 4 days (range 3–9 days).

E

Exposure

Inpatient antihypertensive therapy stratified by model (monotherapy vs. combination therapy) and drug class (angiotensin receptor blocker [ARB], calcium channel blocker [CCB], or ARB+CCB combination) across BPJS ward classes (Class 1, Class 2, and Class 3).

C

Comparator

Comparison across BPJS ward classes (Class 1 vs. Class 2 vs. Class 3), antihypertensive therapy models (monotherapy vs. combination therapy), and antihypertensive drug classes (ARB vs. CCB vs. ARB+CCB).

O

Outcome

Total inpatient cost (direct medical cost of one inpatient episode billed to BPJS Kesehatan in IDR) and time (in days) to reach blood pressure target of ≤140/90 mmHg during hospitalization based on daily morning blood pressure measurements.surrogate

Main Result

Effect estimate: ε² 0.131

Absolute Event Rate: 4372250% vs 2774000%

p-value: p=0.101

In hospitalized BPJS-insured ischemic stroke patients, total inpatient costs are primarily driven by length of stay rather than antihypertensive drug class, ward class, or speed of blood pressure control, suggesting cost-containment efforts should focus on safely reducing hospital stay.

Limitations

Single-center study with a small sample size (n=37; cost analysis n=36), particularly in ward class 2 (n=4), limiting statistical power and resulting in wide 95% confidence intervals.
Retrospective cohort design reliant on medical record completeness, lacking data on stroke severity (e.g., NIHSS), complications, and specific medical procedures, which precluded multivariable analysis.
Time to blood pressure target was analyzed categorically rather than using time-to-event methods (e.g., Kaplan-Meier) that account for regimen changes.
Cost analysis was based on hospital billing charges rather than real unit costs and excluded direct non-medical and indirect costs.
Small sample size (n=37, with particularly small subgroup sizes such as n=4 in Class 2)
Single-center study at one hospital, limiting generalizability
Presence of an extreme cost outlier (IDR 66,808,955) influencing mean cost estimates and inter-class comparisons
Wide 95% confidence intervals for correlations and subgroup proportion differences
Lack of adjustment for stroke severity as a confounding factor

Implication

Length of stay drives inpatient costs more than ward class or therapy model; hypothesis-generating and should not yet change practice.

Abstract

Ischemic stroke is a catastrophic disease that burdens Indonesia’s National Health Insurance, and hypertension is its main modifiable risk factor. This study aimed to analyze the cost of illness, measured as total inpatient cost, of BPJS-insured ischemic stroke patients receiving antihypertensive therapy according to ward class and therapy model, and to describe the time needed to reach a blood pressure target of ≤140/90 mmHg. This retrospective cohort study used medical records and billing data of ischemic stroke inpatients at Dr. Pirngadi Regional General Hospital Medan from January 2023 to December 2024 (n=37; cost analysis n=36). Kruskal-Wallis, Mann-Whitney U, and Spearman correlation tests were applied. The median total inpatient cost is IDR 3,607,050 (range IDR 1,644,500–66,808,955) with a right-skewed distribution. Costs do not differ significantly across ward classes (p=0.101), therapy models (p=0.144), or drug classes (p=0.245); a sensitivity analysis excluding one extreme value indicates that class 1 tends to have the highest cost (p=0.048). No patient reaches the target on the first day; 40.5% reach it within 2 days, 29.7% on day 3, 13.5% after day 3, and 16.2% do not reach it during hospitalization. Total cost shows a moderate positive correlation with length of stay (rho=0.552; p<0.001) but not with time to blood pressure target (rho=−0.066; p=0.724). The inpatient cost burden of ischemic stroke under BPJS is determined more by length of stay than by antihypertensive drug class or the speed of blood pressure control; therefore, cost-containment efforts should focus on safely shortening hospital stay.

Discussion

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Cite This Study

Peri et al. (2026) conducted a cohort in Ischemic stroke with antihypertensive therapy (n=37). BPJS ward class (Class 1, 2, 3) and antihypertensive therapy model (monotherapy vs. combination; ARB, CCB, ARB+CCB) vs. Comparison across BPJS ward classes and antihypertensive therapy models/drug classes was evaluated on Total inpatient cost (IDR) across BPJS ward classes (ε² 0.131, p=0.101). Total inpatient costs for BPJS-insured ischemic stroke patients on antihypertensives did not differ by ward class (p=0.101) or therapy model (p=0.144), but correlated with length of stay (rho=0.552, p<0.001).

synapsesocial.com/papers/6ae682bde432e7a5c4ef36c2 https://doi.org/10.35451/jfm.v9i1.3962

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Cost of Illness of Hospitalized Ischemic Stroke Patients on Antihypertensive Therapy: BPJS Ward Class and Time to Blood Pressure Target

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cost of Illness of Hospitalized Ischemic Stroke Patients on Antihypertensive Therapy: BPJS Ward Class and Time to Blood Pressure Target

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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