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Vol. 3 No. 1 (2025)
Articles

Comparison Of Steroid-Resistant Nephrotic Syndrome Therapy In Children Using Alkylating Agents, Calcineurin Inhibitors, And Monoclonal Antibodies: A Cost-effective Perspective

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  • Ahmedz Widiasta,
  • Raden Aswin Rahadi,
  • Danang Pangestu Gusti Bagaskara,
  • Dedi Rachmadi,
  • Dany Hilmanto
Ahmedz Widiasta
Faculty of Medicine, Padjadjaran University, Indonesia
Raden Aswin Rahadi
School of Business and Management, Institut Teknologi Bandung
Danang Pangestu Gusti Bagaskara
School of Business and Management, Institut Teknologi Bandung
Dedi Rachmadi
Faculty of Medicine, Padjadjaran University, Indonesia
Dany Hilmanto
Faculty of Medicine, Padjadjaran University, Indonesia
DOI: https://doi.org/10.58229/jims.v3i1.293

Published 2025-03-10

Keywords

  • Steroid-Resistant Nephrotic Syndrome (SRNS),
  • Calcineurin Inhibitors (CNIs),
  • Cyclophosphamide (CPA),
  • Cost-effectiveness,
  • Chronic Kidney Disease (CKD)

How to Cite

Widiasta, A., Rahadi, R. A., Bagaskara, D. P. G., Rachmadi, D., & Hilmanto, D. (2025). Comparison Of Steroid-Resistant Nephrotic Syndrome Therapy In Children Using Alkylating Agents, Calcineurin Inhibitors, And Monoclonal Antibodies: A Cost-effective Perspective. Journal Integration of Management Studies, 3(1), 28–36. https://doi.org/10.58229/jims.v3i1.293

Abstract

Chronic kidney disease (CKD) poses significant medical and economic challenges, particularly in pediatric patients, with steroid-resistant nephrotic syndrome (SRNS) being a major contributor. Despite the financial support provided by Indonesia’s BPJS health insurance system, the rising prevalence of SRNS necessitates a reassessment of treatment strategies. This study retrospectively analyzed pediatric SRNS cases at Hasan Sadikin General Hospital, Bandung, from 2010 to 2019, focusing on the effectiveness and cost-efficiency of different treatment regimens, including calcineurin inhibitors (CNIs) and cyclophosphamide (CPA). Among 2,590 SRNS cases, CPA achieved a remission rate of 48.75%, whereas CNIs demonstrated superior efficacy, with tacrolimus (96.87%) and cyclosporine A (75.61%) achieving significantly higher remission rates in 2018–2019. Although CNIs incurred higher initial costs, they were more cost-effective in the long term. Rituximab (RTX) emerged as a promising alternative, with a 90% remission rate, offering potential savings by reducing disease progression and preventing more expensive treatments associated with advanced CKD. These findings highlight the necessity for a strategic shift in SRNS treatment protocols, emphasizing not only immediate costs but also long-term health outcomes and financial sustainability. Integrating RTX into standard treatment guidelines could enhance patient prognosis while optimizing healthcare expenditures. However, further research is needed to evaluate the long-term health impacts, expand the demographic scope, and refine cost-effectiveness analyses. A comprehensive approach to SRNS management, prioritizing both clinical efficacy and economic viability, is crucial to improving pediatric CKD outcomes and ensuring the sustainability of national healthcare resources.

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