Malaria morbidity, mortality and associated costs in Indonesia: analysis of the National Health Insurance claim dataset.

INTRODUCTION: Data on morbidity, mortality and cost for malaria-related hospitalisation are important for prioritising resources for malaria control strategies, but these data are often limited. The aim of this study was to understand the current malaria service delivery in Indonesia, including referral rates to hospitals, mortality outcomes and malaria-related costs at hospitals, using data from National Health Insurance claims. METHODS: Data were gathered from the recent Indonesian National Health Insurance dataset for claims made between 2015 and 2020. Cases were selected for any diagnosis with the international classification of diseases-10th revision codes for malaria-related diseases. Patients' sociodemographic status, repeated presentations to healthcare facilities, referral patterns and costs of treatment for the hospital settings were assessed by malaria species. Costs were reported in 2020 US$. RESULTS: Data were available for 12 970 episodes of malaria, which occurred in 8833 patients. Plasmodium falciparum accounted for 6019 (46.4%) episodes, and P. vivax for 4307 (33.2%) episodes. The incidence rates were 0.38 (95% CI 0.29 to 0.47) per person-years for P. falciparum and 0.33 (95% CI 0.19 to 0.52) for P. vivax. 46% of malaria cases initially presented at the hospital. Among these patients, the mean cost was US$16.2 (SD 4.4) for an outpatient consultation and US$228.7 (SD 122.6) for inpatient care. In total, 4.8% (623) of patients re-presented to the hospital within 30 days of a malaria episode, of whom 1.7% (219) required admission for inpatient care, which was estimated to cost US$230.0 (SD 105.5). The risk of mortality for inpatients with P. falciparum malaria was 2.1% (36/1718) compared with 1.2% (16/1359) for patients with P. vivax malaria; p=0.069. CONCLUSIONS: The National Health Insurance claim data provide detailed costing estimates. Integrating data from the existing malaria information system with the data from the National Health Insurance claims can provide important insights into the healthcare costs associated with the management of malaria that could help optimise national antimalarial policy.