MyMedR

Cost efficiency and cost effectiveness of cataract surgery at the Malaysian Ministry of Health ophthalmic services

Loo CY, Kandiah M, Arumugam G, Goh PP, John E, Gurusami B, et al.

Int Ophthalmol, 2004 Mar;25(2):81-7.

PURPOSE: To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery (ECCE) and phacoemulsification at three hospitals of the Malaysian Ministry of Health (MOH).

METHODS: Patient demography, pre-operative visual acuity, intra-operative complications, post-operative complications and post-operative visual acuity were recorded for two hundred and forty seven of the 400 patients who underwent cataract surgery during a 2-week period. The cost of surgery, which included capital, staff and overhead, and patient care consumable costs were assessed prospectively in 8 randomly sampled patients over a 3-month period. Cost efficiency refers to cost per cataract surgery. Cost effectiveness refers to cost per successful cataract surgery. This is estimated by the ratio of cost efficiency to the proportion of successful cataract surgery. Successful surgery was defined as best-corrected visual acuity (BCVA) of better than 6/12 at 3 months post-operatively.

RESULTS: Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group (94%) than in the ECCE group (81%). Conventional extracapsular cataract surgery with intraocular lens implant costs RM3442 (USD 905.79) and phacoemulsification with intraocular lens implant costs RM4288 (USD 1128.42).

DISCUSSION: There was no significant difference in cost effectiveness between ECCE and phacoemulsification. The cost of cataract surgery in the MOH hospital was found to be high due to the high overhead costs.

Treatment by practitioners of traditional healing in Malaysia

Moissinac K, Merican H, Sukumar M, Azmi S, Raja Lope A, Tajuddin AJ, et al.

Trop Doct, 2004 Jul;34(3):191.

PMID: 15267066

Fulltext Hospital-acquired vancomycin-resistant enterococci: now appearing in Kuala Lumpur Hospital

Zubaidah AW, Ariza A, Azmi S

Med J Malaysia, 2006 Oct;61(4):487-9.

PMID: 17243529 MyJurnal

Hospital-acquired vancomycin-resistant enterococci (VRE) were first reported in the late 1980s and have since been an increasing problem worldwide. Kuala Lumpur Hospital thus far, to the best of our knowledge has been spared from this pathogen. We describe the first confirmed case of Enterococcus faecium exhibiting the van A phenotype in our hospital, in a patient with chronic renal failure who was successfully treated with linezolid. The microbiology laboratory plays an important role in the identification and detection of VRE.

Fulltext Clinicians' knowledge, beliefs and acceptance of intravenous-to-oral antibiotic switching, Hospital Pulau Pinang

Lee SL, Azmi S, Wong PS

Med J Malaysia, 2012 Apr;67(2):190-8.

PMID: 22822642 MyJurnal

A cross-sectional study was conducted to explore clincians' baseline knowledge, practice beliefs and acceptance of intravenous (IV)-to-oral antibiotic switching practice in Hospital Pulau Pinang. The factors most highly rated for antibiotic conversion were the ability to maintain oral intake (85.6%) and microbiology etiology (85.0%). Majority of the clinicians (76%) agreed with the traditional clinical rule that "patient should be afebrile for 24 hours before IV-to-oral switch". Specialists and consultants had the highest knowledge score among the clinicians. However, they were generally less positive about a guideline being integrated into practice.

Fulltext Extending the roles of community pharmacists: views from general medical practitioners

Azmi S, Nazri N, Azmi AH

Med J Malaysia, 2012 Dec;67(6):577-81.

PMID: 23770948 MyJurnal

This study investigates the views of general medical practitioners (GP) to the extended role of the community pharmacists (CP). A self-administered questionnaire was distributed to all private clinics (n=438) run by GPs in the state of Penang. The questionnaire asked GP's views on ideas for new services provided by community pharmacists. Three hundred and twenty-seven questionnaires were collected, giving a response rate of 74.5%. More than 50% of respondents were in favour of the community pharmacist involvement in activities of providing public health education (58.7%), contacting GPs on matters related to prescribing and prescription errors (56.0%), and referring patients who exhibit drug-related problems (53.0%). However, the respondents had a mixed opinion regarding the roles of CPs in smoking cessation programme (34.8%) and providing drug information to physicians (43.0%). Additional research is needed to explain GPs attitudes towards the acceptability of the new role of the pharmacist.

Fulltext Estimating an EQ-5D value set for Malaysia using time trade-off and visual analogue scale methods

Yusof FA, Goh A, Azmi S

Value Health, 2012 Jan-Feb;15(1 Suppl):S85-90.

PMID: 22265073 DOI: 10.1016/j.jval.2011.11.024

OBJECTIVES: To estimate a EQ-5D value set for Malaysia by using time trade-off (TTO) and visual analogue scale (VAS) valuation methods.
METHODS: TTO and VAS valuations were obtained from face-to-face surveys of a convenience sample of patients, caregivers, and health professionals conducted at nine government hospitals in 2004 and 2005. Forty-five EQ-5D questionnaire health states were valued, divided into five sets of 15 health states. Analysis was conducted by using linear additive regression models applying N3 and D1 specifications. Model selection was based on criteria of coefficient properties, statistical significance, and goodness of fit.
RESULTS: One hundred fifty-two respondents were interviewed, yielding 2174 TTO and 2265 VAS valuations. Respondents found TTO valuations to be more difficult than VAS valuations, and there were more inconsistencies in TTO valuations. All the independent variables in the models were statistically significant and consistent with expected signs and magnitude, except for the D1 specification modeled on TTO valuations. The N3 model provided the best fit for the VAS valuation data, with a mean absolute error of 0.032.
CONCLUSION: This study provides a Malaysian EQ-5D questionnaire value set that can be used for cost-utility studies despite survey limitations.
Study site: convenience sampling from three categories of respondents (patients undergoing dialysis, patients’ carers, and dialysis center staff) from public hospitals

Fulltext Xanthine oxidase inhibitory activity from potential Malaysian medicinal plant as remedies for gout

Azmi SMN, Jamal P, Amid A

International Food Research Journal, 2012;19(1):159-165.

MyJurnal

Malaysia has a rich diversity of medicinal plants and some of them inhibit xanthine oxidase (XO), which can be introduced as new natural sources of gout medication and a substitute for synthetic xanthine oxidase inhibitors (XOI). The degree of XO inhibitory activity was determined by measuring the absorbance spectrophotometrically at 295 nm, which is associated with uric acid formation. Our preliminary screening study had employed the use of distilled water, 70% methanol and absolute ethanol to extract XOI from twenty parts of five plant species, namely, Averrhoa carambola, Carica papaya, Dimocarpus longan malesianus, Manilkara zapota and Salacca zalacca. These plants were selected based on their frequent medicinal usages by local folks. The results have shown that an aqueous extract of Carica papaya mature leaves has promising activity to inhibit XO up to 75.68 ± 0.1%. Statistical experimental design were employed to optimize the selected sample (dried Carica papaya leaves: distilled water) on extraction of XOI and the maximum XOI percentage of 86.93 ± 1.9% was obtained, which exhibited only 6.76% less than the activity exhibited by allopurinol (93.69 ± 0.2%), a commercial XOI. The comparison was made between allopurinol and optimized extract on the basis of IC50concentrations. Allopurinol showed IC50 value of 3.74 μg/ml that is considerably lower as compared to the optimized sample (4.33 μg/ml).

Fulltext Drug utilization review of potassium chloride injection formulations available in a private hospital in kuching, sarawak, malaysia

Melissa MH, Azmi S

Malays J Med Sci, 2013 Jul;20(4):47-55.

PMID: 24043996 MyJurnal

The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia.

Economic Impact of Pneumococcal Protein-D Conjugate Vaccine (PHiD-CV) on the Malaysian National Immunization Programme

Aljunid S, Maimaiti N, Ahmed Z, Muhammad Nur A, Md Isa Z, Azmi S, et al.

Value Health Reg Issues, 2014 May;3:146-155.

PMID: 29702920 DOI: 10.1016/j.vhri.2014.04.008

OBJECTIVE: To assess the cost-effectiveness of introducing pneumococcal polysaccharide and nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in the National Immunization Programme of Malaysia. This study compared introducing PHiD-CV (10 valent vaccine) with current no vaccination, as well as against the alternative 13-valent pneumococcal conjugate vaccine (PCV13).

METHODS: A lifetime Markov cohort model was adapted using national estimates of disease burden, outcomes of pneumococcal disease, and treatment costs of disease manifestations including pneumonia, acute otitis media, septicemia, and meningitis for a hypothetical birth cohort of 550,000 infants. Clinical information was obtained by review of medical records from four public hospitals in Malaysia from the year 2008 to 2009. Inpatient cost from the four study hospitals was obtained from a diagnostic-related group-based costing system. Outpatient cost was estimated using clinical pathways developed by an expert panel. The perspective assessed was that of the Ministry of Health, Malaysia.

RESULTS: The estimated disease incidence was 1.2, 3.7, 70, and 6.9 per 100,000 population for meningitis, bacteremia, pneumonia, and acute otitis media, respectively. The Markov model predicted medical costs of Malaysian ringgit (RM) 4.86 billion (US $1.51 billion) in the absence of vaccination. Vaccination with PHiD-CV would be highly cost-effective against no vaccination at RM30,290 (US $7,407) per quality-adjusted life-year gained. On comparing PHiD-CV with PCV13, it was found that PHiD-CV dominates PCV13, with 179 quality-adjusted life-years gained while saving RM35 million (US $10.87 million).

CONCLUSIONS: It is cost-effective to incorporate pneumococcal vaccination in the National Immunization Programme of Malaysia. Our model suggests that PHiD-CV would be more cost saving than PCV13 from the perspective of the Ministry of Health of Malaysia.

Study site: UKM Medical Centre, Hospital Kuala Lumpur, Hospital
Alor Setar, and Hospital Queen Elizabeth, Kota Kinabalu

Fulltext Health Utility Of Acute Coronary Syndrome Patients From An Asian Population

Azmi S, Anchah L, Goh A, Fong A

Value Health, 2014 Nov;17(7):A496.

PMID: 27201492 DOI: 10.1016/j.jval.2014.08.1478

Fulltext Comparative Pharmacoeconomics Studies of Treatment for Major Depressive Disorder in China

Low W, Azmi S, Yee SL, Abdat A, Brignone M, Hansen K, et al.

Value Health, 2014 Nov;17(7):A769.

PMID: 27202828 DOI: 10.1016/j.jval.2014.08.303

Fulltext Health Care Databases Applied to Antidepressants Use in Asia-Pacific

Milea D, Reginald P, Saragoussi D, Kalita P, Verpillat P, Azmi S

Value Health, 2014 Nov;17(7):A728-9.

PMID: 27202597 DOI: 10.1016/j.jval.2014.08.069

Fulltext Health Economics Methodologies Involving Parkinson's Disease Treatment in China

Low W, Azmi S, Yee SL, Milea D

Value Health, 2014 Nov;17(7):A727-8.

PMID: 27202587 DOI: 10.1016/j.jval.2014.08.063

Fulltext Cost and Resource Use of Managing Major Depressive Disorder (MDD) in China

Low W, Azmi S, Yee SL, Abdat A, Yang Y, Milea D

Value Health, 2014 Nov;17(7):A768-9.

PMID: 27202825 DOI: 10.1016/j.jval.2014.08.302

Fulltext Prevalence of Major Depressive Disorder in China

Low W, Azmi S, Li Y, Yee SL, Abdat A, Kalita P, et al.

Value Health, 2014 Nov;17(7):A767.

PMID: 27202816 DOI: 10.1016/j.jval.2014.08.292

Fulltext Assessing The Medication Use Among Diabetic Patients With Comorbid Diseases

Azmi S, Mustapha FI, Abdul AS

Value Health, 2014 Nov;17(7):A359.

PMID: 27200726 DOI: 10.1016/j.jval.2014.08.776

Fulltext Prevalence of faecal incontinence and its related factors among patients in a Malaysian academic setting

Roslani AC, Ramakrishnan R, Azmi S, Arapoc DJ, Goh A

BMC Gastroenterol, 2014;14:95.

PMID: 24885285 DOI: 10.1186/1471-230X-14-95

Prevalence data is essential for planning of healthcare services. The prevalence of faecal incontinence (FI) varies worldwide, and in Malaysia is not known. We sought to estimate its prevalence among patients with various conditions in a Malaysian academic setting.

Quality of life among Patients with Acute Coronary Syndrome in Malaysia

Azmi S, Goh A, Fong A, Anchah L

Value Health Reg Issues, 2015 May;6:80-83.

PMID: 29698198 DOI: 10.1016/j.vhri.2015.03.015

OBJECTIVES: This study's objectives were to estimate the quality of life (QOL) of Malaysian patients with acute coronary syndrome (ACS) during admission and at 12 months, to explore the factors associated with the QOL, and to compare utility scores derived from tariffs from local and foreign populations.

METHODS: Data collected from patients with ACS between 2008 and 2009 for a study on cardiac rehabilitation at the Sarawak General Hospital were used for this study. QOL data were obtained using a validated version of the EuroQol five-dimensional questionnaire at baseline and at 12 months. Health utility scores were calculated using visual analogue scale scores and utility tariffs from Malaysia and the United Kingdom.

RESULTS: Data from 104 subjects from the earlier study was used. The mean age was 56.1 years, with 88.5% being men. The mean hospitalization duration was 6.3 days. The mean utility score was 0.75 at baseline and 0.82 at 12 months. There was a statistically significant improvement in utility from baseline to 12 months based on the Malaysian tariff (P = 0.014) but not with the UK tariff (P = 0.086). The QOL of patients was associated with sex and diagnosis of ST-segment elevation myocardial infarction.

CONCLUSIONS: Our results showed that there was a significant improvement in the QOL from baseline to 12 months. Only sex and diagnosis affected the QOL score at baseline because of limited variables available for testing. It also reconfirms the importance of applying the appropriate, country-specific utility tariffs in QOL studies. Despite limitations, the study is useful toward describing QOL among a group of Malaysian patients with ACS.

Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review

Ng CJ, Lai PS, Lee YK, Azmi SA, Teo CH

Int J Clin Pract, 2015 Oct;69(10):1050-70.

PMID: 26147376 DOI: 10.1111/ijcp.12691

AIM: To identify the barriers and facilitators to start insulin in patients with type 2 diabetes.
METHOD: This was a systematic review. We conducted a systematic search using PubMed, EMBASE, CINAHL and Web of Science (up to 5 June 2014) for original English articles using the terms 'type 2 diabetes', 'insulin', and free texts: 'barrier' or 'facilitate' and 'initiate'. Two pairs of reviewers independently assessed and extracted the data. Study quality was assessed with Qualsyst.
RESULTS: A total of 9740 references were identified: 41 full-text articles were assessed for eligibility. Twenty-five articles (15 qualitative, 10 quantitative) were included in the review. Good inter-rater reliability was observed for the Qualsyst score (weighted kappa 0.7). Three main themes identified were as follows: patient-related, healthcare professional and system factors. The main patient-related barriers were fear of pain and injection (n = 18), concerns about side effects of insulin (n = 12), perception that insulin indicated end stage of diabetes (n = 11), inconvenience (n = 10), difficulty in insulin administration (n = 7), punishment (n = 7) and stigma and discrimination (n = 7). Healthcare professionals' barriers were as follows: poor knowledge and skills (n = 9), physician inertia (n = 5) and language barriers (n = 4). System barriers included lack of time (n = 5). The most common facilitators were understanding the benefits of insulin (n = 7), not being afraid of injections (n = 5), and patient education and information (n = 5).
CONCLUSION: Major barriers to insulin initiation persist despite availability of newer and safer insulin. Healthcare professionals should explore and address these barriers. Targeted interventions should be developed to overcome these barriers.

The association of waist circumference with glycaemic control in diabetic patients in an Asian population. [Abstract]

Azmi S, Feisul MI, Abdat A, Goh A, Abdul Aziz SH

Value Health, 2015 Nov;18(7):A600.

PMID: 26533372 DOI: 10.1016/j.jval.2015.09.2060

Conference abstract:
Objectives: The aim of the study was to explore the association of waist circumference with glycaemic control in Malaysian patients with type 2 diabetes.
Methods: We utilised data of type 2 diabetes patients followed up in Malaysian public sector primary care clinics contained in the National Diabetes Registry in the year 2012. The variable of interest was poor glycaemic control, defined as HbA1c≥ 6.5%. Multiple logistic regression was used to explore the association between glycaemic control and waist circumference, which was adjusted for age, sex, duration of diabetes, systolic blood pressure, total cholesterol, use of insulin and other medications.
Results: A total of 98,825 patients with type 2 diabetes were included in the study. The mean age of patients was 59.9 years (SD: 10.9) and 38.9% were males. The mean duration of diabetes was 6.8 years (SD: 5.0) and 76.2% of patients had HbA1c ≥ 6.5%. The mean waist circumference was 94.0 cm (SD: 11.8) for male and 90.7 cm (SD: 11.8) for female; while 78.3% of the patients had waist circumference above the cut-off (≥ 90 cm for men and ≥ 80 cm for women). Larger waist circumference was found to be significantly associated with HbA1c≥ 6.5% (adj. OR 1.009; p< 0.001; 95% CI: 1.007–1.011) after adjusting for confounding factors.
Conclusions: Analysis showed that glycaemic control was poorer in patients with higher waist circumference than in patients with lower waist circumference.

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