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"Vaksinasi tetanus toksoid merupakan intervensi pencegahan tetanus yang terbukti efektif secara klinis. Program vaksinasi tetanus toksoid di negara berkembang sering kali terhambat karena keterbatasan budget yang dialokasikan untuk program vaksinasi, berkompetisi dengan intervensi kesehatan lainnya pada kondisi belanja kesehatan semakin meningkat. Efektivitas klinis perlu bersinergi dengan efektivitas biaya agar dapat mencapai keberhasilan program. Efektivitas biaya program dapat dinilai dengan evaluasi ekonomi. Penelitian ini bertujuan untuk mengidentifikasi teknik evaluasi ekonomi pada vaksinasi tetanus toksoid pada ibu hamil. Kajian literatur dilakukan pada Mei 2020 sampai Juli 2020 dengan pencarian pada database CINAHL, Cochrane Library, dan PubMed. Kajian literatur mengikuti panduan Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Review. Diperoleh 4 studi yang memenuhi kriteria. Diidentifikasi 3 studi menggunakan teknik CUA, 2 studi menggunakan teknik CEA (dengan 1 studi menggunakan kedua teknik) dengan membandingkan intervensi vaksinasi TT dengan do nothing/current practice. Luaran akhir keempat studi berupa incremental cost-effectiveness ratio (ICER). ICER pada 3 studi menghasilkan kesimpulan bahwa intervensi vaksinasi TT pada ibu hamil memiliki value for money. Diperoleh suatu bukti bahwa vaksinasi dengan tetanus toksoid efektif secara biaya bahkan pada negara-negara yang belum berhasil mengeliminasi tetanus neonatal atau baru mengeliminasi tetanus neonatal secara parsial. Dari berbagai kemungkinan, vaksinasi tetanus toksoid pada ibu hamil selalu dominan dibanding komparator, berlaku pada one way sensitivity analysis dan analisis sensitivitas probabilistik simulasi Monte Carlo.

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Tetanus toxoid vaccination is an intervention aiming preventing tetanus which clinically proven to be effective. Tetanus vaccination program in developing countries is frequently hampered due to limited budget allocated for vaccination program, competing with other health interventions as health expenditure increases. Clinical effectiveness should be synergized with cost-effectiveness in order to achieve program success. Economic evaluation is an approach to assess cost effectiveness. This study aims to identify economic evaluation techniques of tetanus toxoid vaccination for pregnant women. Literature review was conducted from May 2020 to July 2020 by performing literature search in databases of CINAHL, Cochrane Library, and PubMed. This literature review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Review. Obtained 4 studies fulfilled the criteria. Identified 3 studies used CUA, 2 studies used CEA (with 1 study used both techniques) comparing TT vaccination intervention with the absence of program scenario (do nothing) or current practice. Outcomes of 4 studies are incremental cost-effectiveness ratio (ICER). ICERs obtained from 3 studies present the evidence that TT vaccination intervention for pregnant women has value for money. This study obtained an evidence that tetanus toxoid vaccination is cost-effective even among countries which have yet to eliminate or have partially eliminated neonatal tetanus. Across various probabilities, tetanus toxoid vaccination in pregnant women remains dominant compared to the comparator, holds in one way sensitivity analysis and probabilistic sensitivity analysis via Monte Carlo simulation."

"Latar belakang: Saat ini, kematian neonatal masih menjadi masalah kesehatan masyarakat nasional dan global sehingga diperlukan upaya untuk menurunkannya. Salah satunya melalui pemanfaatan antenatal care (ANC). Dalam ANC terdapat 10 komponen pelayanan kesehatan yang harus diberikan kepada ibu hamil, termasuk imunisasi tetanus toksoid (TT) yang penting untuk mencegah tetanus neonatorum (TN) yang memiliki fatality rate yang tinggi. Di Indonesia, persentase TT2+ pada ibu hamil menurun, sedangkan kasus TN mulai meningkat kembali.Tujuan: Untuk mengetahui hubungan imunisasi TT pada ibu hamil dengan kematian neonatal di Indonesia.Metode: Penelitian ini menggunakan data Survei Demografi dan Kesehatan Indonesia (SDKI) 2017 dengan desain studi cross sectional. Sampel dari penelitian ini terdiri dari 10.028 wanita usia subur yang melahirkan bayi dalam rentang tahun 2012 – 2017 dengan kondisi bayi lahir hidup dan tunggal. Analisis data dilakukan dengan analisis survei kompleks menggunakan uji chi square dan regresi logistik.Hasil: Prevalensi kematian neonatal di Indonesia mencapai 0,8%. Ada sebanyak 28,6% ibu yang belum pernah mendapatkan, 17,7% ibu yang hanya menerima satu kali, dan 53,7% ibu yang telah mendapatkan ≥2 dosis imunisasi TT selama kehamilannya. Berdasarkan uji statistik, baik sebelum maupun setelah dikontrol dengan variabel confounding, diperoleh bahwa bayi yang dilahirkan dari ibu yang tidak pernah mendapatkan imunisasi TT berpeluang tinggi untuk mengalami kematian neonatal daripada bayi yang ibunya telah mendapatkan imunisasi TT 2 kali atau lebih (AOR 1,89; 95% CI 1,11 – 3,23). Di sisi lain, pada ibu yang hanya satu kali menerima imunisasi TT tidak ditemukan adanya asosiasi dengan kematian neonatal (AOR 0,67; 95% CI 0,29 – 1,54).Kesimpulan: Menambah bukti tentang pentingnya imunisasi TT pada ibu hamil dalam upaya mencegah kematian neonatal.

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Background: Currently, neonatal mortality remains a significant public health issue both nationally and globally. Therefore, efforts are needed to reduce it. One effective strategy is the utilization of antenatal care. ANC encompasses 10 essential health services that should be provided to pregnant women, including the administration of tetanus toxoid (TT) immunization, which is crucial for preventing neonatal tetanus (NT) with a high fatality rate. In Indonesia, the percentage of TT2+ immunization among pregnant women has decreased, while NT cases have risen again.

Objective: To determine the association between TT immunization in pregnant women and neonatal mortality in Indonesia.

Method: This study utilized data from the 2017 Indonesia Demographic and Health Survey (IDHS) with a cross-sectional study design. The sample consisted of 10.028 women of childbearing age who gave birth to live and single babies between 2012 and 2017. Data analysis was performed using complex survey analysis with chi-square tests and logistic regression.

Result: The prevalence of neonatal mortality in Indonesia is 0.8%. Among the mothers, 28.6% had never received TT immunization, 17.7% had received it only once, and 53.7% had received two or more doses of it during their pregnancy. Based on statistical tests, both before and after controlling for confounding variables, it was found that babies born to mothers who had never received TT immunization had a higher likelihood of experiencing neonatal mortality compared to babies whose mothers had received TT immunization twice or more (AOR 1.89; 95% CI 1.11 – 3.23). On the other hand, no association was found between mothers who received only one dose of TT immunization and neonatal mortality (AOR 0.67; 95% CI 0.29 – 1.54).

Conclusion: Add more evidence about the importance of TT immunization in pregnant women to prevent neonatal mortality."