INTRODUCTION:

Health care costs, especially drug costs, continue to increase due to increasing numbers of patients, changes in treatment patterns, and the emergence of expensive new drugs¹. Hospitals as centers of curative and rehabilitative services play an important role in the treatment of diseases², including gastritis, which is an inflammation of the gastric mucosa due to irritation or infection³. Gastritis has a high prevalence both globally and nationally. WHO reports 1.8–2.1 million cases of gastritis per year globally⁴, while in Indonesia the prevalence reaches 40.8%⁵. In Samarinda, gastritis is among the top 10 most common diseases based on data from the 2018 and 2019 Riskesdas. Management of gastritis generally involves the use of antacids, PPIs, H2 antagonists, and antibiotics⁶. The development of antisecretory agents in therapeutic regimens has progressed, starting with the introduction of cimetidine in the mid-1970s, followed by the launch of the proton pump inhibitor (PPI) omeprazole in 1989, and later dexlansoprazole with a dual delayed release system in 2009⁷. Among PPIs, omeprazole and lansoprazole are often used because of their high effectiveness, although the clinical effectiveness of both in eradicating H. pylori is considered equivalent⁸. Therefore, economic considerations are important in the selection of therapy. Pharmacoeconomics facilitates the comparison of costs and outcomes of therapy to support efficient clinical decision-making⁹. One method used is Cost Minimization Analysis (CMA), which compares the costs of two interventions with equivalent clinical effectiveness to determine the most economical alternative¹⁰. Cost minimization analysis demonstrates that drug molecules with identical strengths can vary in price across different brands, despite providing equivalent clinical outcomes¹¹.

Pharmacoeconomics is a branch of science that studies the comparison between costs (inputs) and outcomes of a pharmaceutical intervention with the aim of supporting efficient and rational clinical decision-making¹². This study is important in optimizing the use of limited health resources, especially in an era of increasing medical costs. In pharmacoeconomics, costs are divided into several types, namely fixed costs, variable costs, direct costs (medical and non-medical costs), indirect costs, and intangible costs that include patient and family suffering¹³. There are several methods used in pharmacoeconomic analysis, including Cost Minimization Analysis (CMA), Cost Effectiveness Analysis (CEA), Cost Utility Analysis (CUA), and Cost Benefit Analysis (CBA). CMA is used when two or more therapies have equivalent clinical effectiveness and only compares the cost side, while CEA assesses the effectiveness of therapy based on clinical indicators such as lowering blood pressure or disease incidence rates¹⁴. CUA assesses the effectiveness of therapy based on quality of life such as QALYs and DALYs¹⁵, while CBA compares costs and benefits in monetary units¹⁶. Among the four methods, CMA is the relevant method used in this study because it compares two drugs with equivalent effectiveness, namely omeprazole and lansoprazole, to determine the most economically effective therapeutic alternative¹⁷.

The issue of cost efficiency in therapy is very relevant in the management of gastritis, which is an inflammation of the gastric mucosa due to various factors such as consumption of irritating foods, stress, nonsteroidal anti-inflammatory drugs (NSAIDs), and Helicobacter pylori infection¹⁸. Gastritis can be acute or chronic, with symptoms including epigastric pain, nausea, vomiting, bloating, and in severe cases can cause anemia to bleeding¹⁹. Risk factors for gastritis include smoking, excessive coffee or tea consumption, alcohol, and psychological stress²⁰. Examination of gastritis can be done through blood tests, stool, endoscopy, and upper gastrointestinal x-rays²¹. Management of gastritis involves reducing gastric acid production, treating H. pylori infection, and protecting the gastric mucosa from further damage. Proton Pump Inhibitor (PPI) drugs such as lansoprazole and omeprazole are the main therapies that are often prescribed. Lansoprazole works by inhibiting the proton pump in gastric parietal cells, reducing gastric acid production, and is usually given at a dose of 30 mg per day²². Lansoprazole, as one of the main therapies for gastritis, works by inhibiting the proton pump in the gastric parietal cells, thereby reducing gastric acid production²³. Oral administration is considered the simplest and most convenient method compared to other routes of drug delivery²⁴. Meanwhile, omeprazole is also an effective PPI, with a common dose of 20–40mg per day, and has been shown to cure gastric disorders in most patients²².Controlled-release lansoprazole, which may provide therapeutic benefits in clinical practice²⁵. Omeprazole at both standard (20mg) and higher (40mg) dosages has been shown to be effective and well-tolerated in the treatment of gastroduodenal ulcers among chronic NSAID users, with comparable outcomes in terms of ulcer healing and symptom improvement²⁶. Since the effectiveness of both drugs is relatively equivalent, an evaluation based on a pharmacoeconomic approach, especially CMA, is needed to determine the most cost-efficient therapeutic option.

MATERIALS AND METHODS:

Material:

Medical records of inpatient gastritis patients with lansoprazole or omeprazole at Dirgahayu Hospital Samarinda January-December 2024.

Method:

Preparation Stages:

This stage includes an application for a permit, where the researcher submits an application for a research permit to the Dirgahayu Hospital, Samarinda, East Kalimantan by submitting a research permit that has been prepared by the Samarinda Health Sciences College.

Sampling:

Sampling was carried out by taking data on the cost of treating gastritis patients at Dirgahayu Hospital Samarinda for the period January-December 2024 retrospectively by looking at the inclusion and exclusion criteria.

Data collection:

Data taken from the medical records of gastritis patients at Dirgahayu Hospital Samarinda for the period January-December 2024, includes patient clinical information and direct costs associated with the patient. Direct costs include drug costs, medical device costs, laboratory costs and inpatient costs.

Data processing:

Data obtained from the medical records of Dirgahayu Hospital, Samarinda, East Kalimantan were edited to ensure that the data obtained was in accordance with what was needed. The analysis method in this study is as follows:

a) Determining Goals:

This stage aims to determine the objectives of the study. The purpose of the problem to be solved is to assess the costs incurred for the treatment of gastritis patients in the inpatient unit of Dirgahayu Hospital, Samarinda, East Kalimantan, and to compare the costs of lansoprazole and lower omeprazole for the treatment of gastritis in the inpatient unit of Dirgahayu Hospital, Samarinda, East Kalimantan.

b) Identifying the Magnitude of Effectiveness of Treatment Options:

The magnitude of the effectiveness of treatment options is obtained from the results of the literature studies conducted.

c) Cost Identification:

The costs identified and measured are direct costs, including drug costs, medical device costs, laboratory costs and inpatient costs.

Data analysis:

Data analysis was performed univariately and bivariately. Univariate test was used to describe the characteristics of respondents based on gender, age, and length of hospitalization with descriptive statistics such as mean, median, and standard deviation. Furthermore, cost minimization analysis was performed to compare the total cost of treatment of inpatient gastritis patients using lansoprazole and omeprazole. Costs were calculated from the perspective of Dirgahayu Hospital Samarinda, including fixed costs and variable costs with the formula:

Total cost = Fixed Cost + Variable Cost

The formula for determining the minimum cost per patient uses the formula:

Total Medical Costs

CMA Per Patient = ––––––––––––––––––

Number of Patients

To compare the average costs between the two groups thenThe calculation results are analyzed by minimizing costs and analyzing the data using SPSS 25. The selection of statistical tests is based on the results of the data normality test. If the data is normally distributed, the Independent T-test is used, while if it is not normal, the Mann-Whitney test is used. The goal is to determine whether there is a significant difference between the cost of treatment with lansoprazole and omeprazole.

RESULTS:

Patient Characteristics Based on Gender:

Based on Figure 1, of the total 61 inpatients using omeprazole or lansoprazole at Dirgahayu Hospital Samarinda, the majority of patients were female. In both the omeprazole and lansoprazole groups, the number of female patients was greater than male patients.

Figure 1. Patient Characteristics Based on Gender

Patient Characteristics Based on Age:

The majority of hospitalized gastritis patients who received omeprazole therapy were in the productive age range, especially the age range of 30-49 years. This age is classified as physically and psychologically active, so it is susceptible to stress and irregular eating patterns that can trigger gastritis.

Figure 2. Subject Characteristics Based on Age

Characteristics of Length of Patient Hospitalization:

Most patients in both groups were hospitalized for three days or less. This suggests that treatment of gastritis with omeprazole or lansoprazole is quite effective in a short time. The lansoprazole group showed a trend of slightly shorter treatment, in line with its pharmacokinetic profile which has a higher bioavailability compared to omeprazole.

Figure 3. Characteristics of Research Subjects Based on Length of Hospitalization in the Omeprazole and Lansoprazole Groups

Length of hospitalization in this study was calculated from the first day the patient underwent treatment in the hospital until the day the patient was declared fit to go home by the treating physician, based on stable and improving clinical conditions. This information is one of the indirect indicators in assessing the efficacy of treatment, because more effective therapy tends to accelerate patient recovery and shorten the treatment period²⁷. To facilitate analysis, data on length of hospitalization are presented in the form of frequency distributions in each treatment group.

Average Direct Medical Cost Analysis:

The average total direct medical costs of hospitalized gastritis patients receiving lansoprazole therapy were higher than those receiving omeprazole, which was IDR 80,389,978 for lansoprazole and IDR 72,353,649 for omeprazole. This difference was mainly due to higher inpatient and laboratory costs in the lansoprazole group. The inpatient costs of the lansoprazole group reached IDR 35,760,000, higher than the omeprazole group at IDR 31,080,000. Laboratory costs also showed a significant difference, which was IDR 13,418,500 for lansoprazole and IDR 9,886,500 for omeprazole, while the cost of lansoprazole was also IDR 1,434,915 higher than omeprazole at IDR 1,168,219. The cost of medical procedures in the lansoprazole group was slightly lower at IDR 23,948,000 compared to the omeprazole group at IDR 24,456,000, although the difference was not too large. The components of administration costs and medical devices in both groups did not show too much difference. The administration cost of lansoprazole was IDR 960,000, slightly higher than omeprazole at IDR 870,000, while the cost of medical devices was almost the same, which was around IDR 4,800,000.

Cost Minimization Analysis (CMA) :

The results of the cost minimization analysis showed that the cost of therapy per patient with omeprazole was IDR 2,495,987, while with lansoprazole it was IDR 2,512,812. This difference shows that omeprazole provides better cost efficiency.

Table 2 Average Direct Medical Costs of Gastritis Patients Based on Therapy Group

Therapy Costs	Average Cost (IDR)
Therapy Costs	Omeprazole Group (n = 29)	Lansoprazole group (n = 32)
Inpatient Costs	IDR 31,080,000	IDR 35,760,000
Laboratory Fees	IDR 9,886,500	IDR 13,418,500
Drug Costs	IDR 1,168,219	IDR 1,434,915
Action Costs	IDR 24,456,000	IDR 23,948,000
Administrative costs	IDR 870,000	IDR 960,000
Medical Device Costs	IDR 4,892,930	IDR 4,868,563
Total Cost of Therapy	IDR 72,353,649	IDR 80,389,978

Table 3. Cost Minimization Analysis

Cost Components	Omeprazole Group	Lansoprazole Group
Total Cost of Therapy	IDR 72,353,649	IDR 80,389,978
CMA Per Patient	IDR 2,495,987	IDR 2,512,812

Bivariate Cost Analysis:

The normality test showed that most of the data were not normally distributed, so the Mann-Whitney test was used, except for medical device costs (t-test).

Table 4. Data Normality Test

Variables	Shapiro-Wilk (Sig.)	Distribution	Statistical Test
Medical Device Costs	0.083	Normal	Independent T-test
Inpatient Costs	0,000	Abnormal	Mann Whitney
Laboratory Fees	0,000	Abnormal	Mann Whitney
Drug Costs	0.008	Abnormal	Mann Whitney
Action Costs	0.030	Abnormal	Mann Whitney
Total cost	0.026	Abnormal	Mann Whitney

Statistical tests were conducted to determine whether there was a significant difference in the total cost of treatment between the two groups of patients, namely lansoprazole users and omeprazole users. This test was conducted to support the cost minimization analysis by comparing the average or median costs of each group.

Table 5. Results of the Independent T-Test on Medical Device Costs

Type of Fee

Omeprazole

Lansoprazole

Test Statistic Value

Medical Device Costs

Mean= 168,272

Mean= 152,143

t(59) = 1.187,

p = 0.240 (equal variances assumed)

Mean Difference

= 16,579

95% CI : -11.374 to 44.532

SD= 51,406

SD = 57,126

Table 6. Mann – Whitney Test Results

Cost Components	Probability (p)
Laboratory Fees	0.097
Inpatient Costs	0.572
Action Costs	0.201
Drug Costs	0.340
Total Cost	0.988

The t-test results in table 5 for medical device costs show no significant difference between the two groups (p = 0.240) while table 6 which presents the results of the Mann-Whitney test also shows that there is no statistically significant difference in each cost component and total cost (p > 0.05 for all variables). This strengthens the finding that although there is a difference in nominal costs, it is not statistically significant.

DISCUSSION:

There are gender characteristics showing that during the period from January to December 2024, gastritis patients at Dirgahayu Hospital Samarinda were dominated by women. Women generally pay more attention to their physical appearance, so many of them adopt unhealthy diets that have the potential to harm stomach health. Women also more often consume foods or drinks that can irritate the stomach, have irregular eating habits, and are more susceptible to stress²⁸. Women tend to be more easily stressed because of the monthly hormonal cycle that affects the nervous system and emotions. Women only have a short period (often around 2 days) in a month where hormones are relatively balanced and emotions are stable, the rest of the time, the body is in a state of hormonal fluctuation that makes them more easily tired, depressed, or stressed than men whose main hormone (testosterone) is more stable²⁹. These factors are influenced by various aspects, such as busy daily activities, low awareness of the importance of a healthy diet, and lack of knowledge regarding proper nutrition²⁸.

The results of the study on patient characteristics based on age showed that the majority of patients with gastritis who were hospitalized and received therapy with either omeprazole or lansoprazole were in their productive age, especially in the age group of 30 to 49 years. In addition, it was seen that there were also quite a lot of patients aged ≥50 years, indicating that the elderly group remains an important population in gastritis therapy. The percentage of patients aged <30 years was lower than the other two groups, but still showed that gastritis can also occur at a young age, although with less frequency. The productive age group (30–49 years) is the age group that most often experiences gastritis, especially due to modern lifestyle, irregular eating patterns, and stress related to work activities. The study also emphasized that although gastritis can occur at any age, its prevalence tends to increase in the early adulthood to elderly age group, in accordance with the trend found in this study³⁰. As age increases, there are significant changes in the defense mechanisms of the gastric mucosa, although gastritis can be experienced by all ages, the risk increases after the age of 40, especially in the elderly who are susceptible to thinning and weakening of the gastric mucosal layer in the elderly causing them to be more susceptible to irritation due to increased stomach acid, which if left untreated can worsen stomach damage and trigger gastritis³¹.

Based on the data obtained, the average cost per length of stay (LOS). It can be seen that the shorter the LOS, the lower the costs incurred. In the group of patients receiving lansoprazole therapy, the average cost with a 2-day LOS was IDR 1,982,523, a 3-day LOS was IDR 2,819,002, and a 4-day LOS was IDR 3,347,067, while in the group of patients receiving omeprazole, the average cost with a 2-day LOS was IDR 2,078,494, a 3-day LOS was IDR 2,598,280, and a 4-day LOS was IDR 3,340,750. Although this difference is not too large, it can be a consideration in the evaluation of cost minimization, because each additional day of hospitalization will have a direct impact on increasing hospital service costs21. Therapy for gastritis patients mostly uses lansoprazole, tends to have a fast length of stay, which is 2 days with a total of 13 patients. Omeprazole has lower bioavailability (35%-60%) than lansoprazole (80%), with higher bioavailability lansoprazole is absorbed more efficiently than omeprazole, thus providing a more optimal therapeutic response³². Omeprazole and lansoprazole are widely known as effective proton pump inhibitors (PPIs) and are often used in the treatment of gastroesophageal reflux disease (GERD), gastric ulcers and gastritis. Both drugs have the advantages of a rapid onset of action, the ability to optimally suppress gastric acid production, and flexibility in dosage. These characteristics make them the right choice for both short-term and long-term treatment, both can significantly relieve ulcer symptoms and accelerate the healing process of gastric ulcers. Lansoprazole is able to provide faster symptom relief compared to omeprazole³³.

The average total direct medical costs of hospitalized gastritis patients receiving therapy lansoprazole higher compared to patients who received omeprazole, which is as much as IDR 80,389,978 for lansoprazole and IDR 72,353,649 for omeprazole. This difference was mainly due to higher inpatient and laboratory costs in the lansoprazole group. Inpatient costs in the lansoprazole group reached IDR 35,760,000, greater than the omeprazole group by IDR 31,080,000. Laboratory costs also show a significant difference, namely IDR 13,418,500 on lansoprazole and IDR 9,886,500 on omeprazole meanwhile, the cost of lansoprazole medication IDR 1,434,915 also higher than omeprazole IDR 1,168,219. The cost of medical procedures in the lansoprazole group was slightly lower at IDR 23,948,000 compared to the omeprazole group at IDR 24,456,000, although the difference was not too large. The components of administration and medical device costs in both groups did not show too much difference. The administration cost of lansoprazole was IDR 960,000, slightly higher than omeprazole at IDR 870,000, while the cost of medical devices was almost the same, at around IDR 4,800,000. This small difference may be due to variations in hospital administration policies, service procedures, and the use of relatively uniform medical devices in both therapy groups. Variability in the costs of procedures and administration is often influenced by clinical protocols, duration of hospitalization, and individual preferences of medical personnel, not only by the type of drug used, therefore, although lansoprazole has a higher total cost of therapy, not all components of its costs show a uniform trend³⁴. Overall, although lansoprazole may provide certain pharmacological benefits such as a faster onset of action and stronger inhibition of gastric acid secretion, in terms of direct medical costs, omeprazole remains a more economical therapeutic option for hospitalized gastritis patients. Omeprazole has significantly lower direct medical costs compared to esomeprazole, pantoprazole, rabeprazole, and lansoprazole, both in generic and branded formulations³⁵.

This analysis uses the Cost Minimization Analysis (CMA) approach. Based on the research results obtained, it shows that omeprazole therapy has a lower cost per patient, which is IDR 2,495,987, compared to lansoprazole of IDR 2,512,812. This difference shows that omeprazole is the most minimal cost compared to lansoprazole which has a relatively higher cost. Lansoprazole is slightly more effective in some conditions, however, omeprazole remains a more economical choice because of its lower cost. In the context of hospital costs, omeprazole is often a better choice³⁶. Omeprazole has higher cost efficiency compared to other proton pump inhibitors (PPIs), including lansoprazole. The cost minimization analysis approach shows that omeprazole has the lowest cost, so it is worthy of being recommended as a cost-effective alternative therapy in the management of gastric acid disorders³⁷.

The results of the statistical test showed that there was no statistically significant difference in costs between the group of patients using lansoprazole and the group using omeprazole, both in single cost components and total treatment costs. This indicates that from an economic perspective, both types of therapy have similar cost efficiency, so these results support the cost minimization analysis approach, where the choice of therapy is determined not based on effectiveness, but on expenditure efficiency. In the context of Dirgahayu Hospital Samarinda, both omeprazole and lansoprazole can be used interchangeably according to availability and clinical considerations, without causing significant cost differences to the burden on the hospital or patients.

CONCLUSION:

The use of omeprazole and lansoprazole as gastritis therapy needs to be evaluated not only from a clinical perspective, but also from a cost-efficiency perspective. Through a cost-minimization analysis approach, this study emphasizes the importance of choosing a therapy that provides clinical benefits equivalent to more economical expenditure in hospital health care practices.

CONFLICT OF INTEREST:

The authors have no conflict of interest regarding this research.

ACKNOWLEDGMENTS:

The authors would like to sincerely thank Apt. Heri Wijaya, for the guidance, suggestions, and direction provided in shaping the research topic, developing the methodology, interpreting results, and preparing the manuscript. Special thanks also go to apt. Rusdiati Helmidanora, the valuable input and support during data analysis, and academic refinement of the manuscript. Their contributions and support have been essential to the successful completion of this work.

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Received on 19.06.2025 Revised on 20.10.2025

Accepted on 29.01.2026 Published on 15.04.2026

Available online from April 18, 2026

Asian J. Pharm. Res. 2026; 16(2):128-134.

DOI: 10.52711/2231-5691.2026.00019

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Length of Stay(LOS)	Number of Lansoprazole Patients		Percentage (%)	Average Cost of Lansoprazole	Number of Omeprazole Patients	Percentage (%)	Average Cost of Omeprazole
2 days	13	40.6		IDR1,982,523	9	31.0	IDR 2,078,494
3 days	17	53.1		IDR 2,819,002	17	58.6	IDR 2,598,280
4 days	2	6.3		IDR 3,347,067	3	10.3	IDR 3,340,750