The Effectiveness of the Eracs Method for Cesarean Section on Patient Care Costs at Level IV Hospital 03.07.04 Guntur Garut Regency

Abstract

Cesarean section (CS) remains an essential procedure for specific delivery indications; however, delayed postoperative mobilization can prolong length of stay (LOS) and increase hospital costs. Under Indonesia’s JKN/INA-CBG reimbursement system, hospitals bear any difference between actual costs and fixed reimbursement tariffs, making cost-efficient clinical pathways a managerial priority. This study analyzed the effectiveness of the Enhanced Recovery After Cesarean Surgery (ERACS) method compared with the conventional method in relation to patient care cost components at Level IV Hospital 03.07.04 Guntur, Garut Regency. A quantitative descriptive-comparative design with a cost-effectiveness analysis approach was employed. Secondary data were obtained from medical records and the hospital billing system of 45 CS patients (ERACS = 19; non-ERACS = 26) treated from May to June 2025. Data were analyzed using the Mann–Whitney U test, multiple linear regression, Cost-Consequence Analysis (CCA), Average Cost-Effectiveness Ratio (ACER), and Incremental Cost-Effectiveness Ratio (ICER). ERACS resulted in a significantly shorter LOS (2.42 vs. 3.35 days), lower postoperative pain intensity (78.9% vs. 19.2% classified as mild pain), higher clinical pathway effectiveness (78.9% vs. 69.2%), and lower actual cost per patient (Rp9,470,982.47 vs. Rp12,300,211.62; p = 0.001). The negative ICER (?Rp29,117,483.25) indicated that ERACS was the dominant intervention. Regression analysis showed that room and medication costs were the main cost drivers. ERACS was more effective and cost-efficient than the conventional method, reducing hospital financial deficits without compromising clinical outcomes. Its adoption as a standard elective CS protocol is recommended.