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Fulltext Be Cautious Of Triple Whammy!!!

Zulkifly H, Abdul WM, Shaharuddin S, Chiau ML, Mat ZH

Value Health, 2014 Nov;17(7):A467.
PMID: 27201328 DOI: 10.1016/j.jval.2014.08.1312
Fulltext Common Pregnancy Symptoms Increase the Risk Of Cardiovascular Disease

Zulkifly H, Dingle K, Clavarino A

Value Health, 2014 Nov;17(7):A554-5.
PMID: 27201816 DOI: 10.1016/j.jval.2014.08.1819
Assessing Retrospective Data on the Management of Ischemic Stroke

Zulkifly H, Othman PN, Shaharuddin S, Long CM

Value Health, 2015 Nov;18(7):A381.
PMID: 26532154 DOI: 10.1016/j.jval.2015.09.810
Fulltext Estimating the costs of specialist out-patient services in a public hospital. [Abstract]

Zainal R, Mahat M

Value Health, 2014 Nov;17(7):A790.
PMID: 27202949 DOI: 10.1016/j.jval.2014.08.431

Objectives: Health care services in Malaysia are widely available and accessible at a minimal cost. However, in pursuing with the health care reform, policy-makers and hospital managers need to know the unit cost for the purpose of planning and efficiency of providing the services. This study estimated the cost of out-patient services in a public hospital
Methods:The study was conducted in a 341 bedded hospital that provide secondary level care to 24,486 in-patients and 127,389 specialist out-patients in 2010. The costs were estimated using a step-down approach where the costs were allocated to the different cost-centres. Capital costs were annualised cost of capital item with life expectancy of more than 1 year and recurrent cost were all inputs consumed within a year. Total costs were then allocated to the in-patient and out-patient services based on historical financial data with a ratio of 1: 4. This was then followed by a stepwise approach of allocating the ancillary department cost centres to the clinical department cost centres. The unit cost per patient visit was calculated based on the number of visits for each department. Base year of 2010 was used to calculate the cost and patients visits. Costs were calculated from the perspective of the hospital.
Conclusions: The findings provide an estimate of the costs for out-patient visit. At the current minimal fee of MYR 5.00 (USD 1.5), the Ministry of Health is subsidising more than 95.0% of the health care cost for each patient. These estimates provide the policy-makers with an understanding of the cost data should they need to establish a cost basis for payment rates.
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 The measurement of utilities in asthma patients: a preliminary study. [Abstract]

Yong YV, Shafie AA

Value Health, 2014 Nov;17(7):A568.
PMID: 27201892 DOI: 10.1016/j.jval.2014.08.1892

Objectives: To assess the feasibility of a computer-based Standard Gamble (SG) visual prop whilst measuring utilities of different asthma health states at the same time.
Methods: Twenty adult asthma patients literate in either Malay or English language were conveniently sampled from a public hospital in Penang, Malaysia. They were interviewed by two trained interviewers using a bilingual script. Each patient was requested to value the given health states using Visual Analogue Scale (VAS) prior to SG exercise. There were three chronic health states (C1-C3) for 10 years, three temporary states (T1-T3) for 3 months, and two anchor states (healthy and dead). During the SG exercise, the visual prop was fully operated by the interviewers. The probability of being in a worse state was changed in a ‘ping-pong’ fashion until the indifference point was reached.
Results: All patients understood the SG exercise and rated SG easier than VAS. Around 85% (n=17) completed SG within 30 minutes. There was 90% (n=18) who ranked T3 as the worst temporary health state during VAS. Two patients provided logical inconsistency data in SG. The preferences by SG were higher than VAS. Preferences were also higher in temporary states measured by chained SG than other states by conventional SG. The mean utilities for C1=0.56 (SD 0.38), C2=0.47 (SD 0.33), C3=0.53 (SD 0.38), T1=0.65 (SD 0.31), T2=0.53 (SD 0.35), and T3=0.38 (SD 0.38).
Conclusions: The SG methods including the props are feasible for utilities measurement in asthma, based on the agreements achieved with other studies on the pattern of utilities measured in this preliminary study.
Economic evaluation of respiratory medication therapy adherence clinic (RMTAC) on asthma patients in Malaysia. [Abstract]

Yong YV, Shafie AA

Value Health, 2015 Nov;18(7):A501.
PMID: 26532812 DOI: 10.1016/j.jval.2015.09.1419

Objectives: To evaluate the long-term cost-effectiveness of RMTAC (an adjunct
pharmaceutical asthma management) vs. usual physician care clinic by using decision analytic modelling method. Methods: A dynamic adherence asthma Markov
cohort model was developed. The economic evaluation was based on a lifetime
horizon and cycle length of one month, from the healthcare provider‘s (Ministry
of Health) perspective, with the outcomes assessed in cost per QALY gained and
cost per hospitalization averted. Probabilities of asthma control-adherence states
from RMTAC database, costs from national sources, utilities using standard gamble method on Malaysia’s asthma patients, and other inputs from secondary data
sources were used to inform the probabilistic model, according to gender and age
subgroups. A scenario analysis was conducted to test the structural assumption on
follow-up visits after the final treatment visit. Results: In female subgroup, RMTAC
management dominates the usual care by having 0.91 (95% CI 0.24 – 1.69) QALY
gained and 0.58 (95% CI -2.30 – 6.23) hospitalization averted, at a lower cost. For male
subgroup, the ICERs were RM10 (95% CI -RM14431 – RM8323) per QALY gained and
RM18 (95% CI -RM35790 – RM30266) per hospitalization averted. At the willingnessto-pay threshold of RM29000 per an additional QALY gained, the RMTAC intervention
is likely to be cost-effective 99% and 57% of the time (for QALY and hospitalization
outcome, respectively). The analysis was robust to assumptions of follow-up visits
frequency and patients’ gender. Conclusions: Implementing RMTAC in Malaysia
has high probability of being more cost-effective than the usual care management
for both male and female subgroups across all age groups. Further investigation is
necessary to ensure that implementing this decision does not exceed the overall
national healthcare expenditure

Study site : Universiti Sains Malaysia, Penang, Malaysia
Fulltext A Longitudinal Evaluation of the Preferences of Patients With Advanced Cancer for Quality of Life and Survival in Malaysia: A Discrete Choice Experiment

Yong ASJ, Lim KK, Fox-Rushby J, Ismail F, Hamzah E, Cheong MWL, et al.

Value Health, 2023 Dec;26(12):1772-1781.
PMID: 37741445 DOI: 10.1016/j.jval.2023.08.009

OBJECTIVES: This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time.
METHODS: A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay.
RESULTS: One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost.
CONCLUSIONS: As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.
Potential Health And Economic Impact Of Introducing A Dengue Vaccine In Malaysia: Assessment Using Dynamic Transmission Modelling

Yeo HY, Shafie AA, Coudeville L, Steinberg LD, Gill BS, Jahis R

Value Health, 2015 Nov;18(7):A582.
PMID: 26533272 DOI: 10.1016/j.jval.2015.09.1949
Fulltext Cost-Effectiveness Analysis Of Ticagrelor In Treating Patients With Acute Coronary Syndrome In Hong Kong

Wu DB, Lee BS, Lee KK

Value Health, 2014 Nov;17(7):A487.
PMID: 27201437 DOI: 10.1016/j.jval.2014.08.1430
Fulltext Health and economic impact of combination therapy vs. Monotherapy for treatment of benign prostatic hyperplasia in hong kong

Wu DB, Yee CH, Ng AC, Chaiyakunapruk N, Lee KK

Value Health, 2014 Nov;17(7):A812.
PMID: 27203071 DOI: 10.1016/j.jval.2014.08.558
Fulltext Cost-Utility Analysis of Optimal Dosing of Oseltamivir Under Pandemic Influenza Using a Novel Approach: Linking Health Economics and Transmission Dynamic Models

Wu DB, Chaiyakunapruk N, Pratoomsoot C, Lee KK, Chong HY, Nelson RE, et al.

Value Health, 2014 Nov;17(7):A807.
PMID: 27203045 DOI: 10.1016/j.jval.2014.08.527
Fulltext Cost-effectiveness analysis of strontium ranelate verse alendronate for management of osteoporosis among post-menopausal women in Malaysia using a Markov modelling approach. [Abstract]

Wu DB, Hussain S, Mak V, Lee KK

Value Health, 2014 Nov;17(7):A382.
PMID: 27200852 DOI: 10.1016/j.jval.2014.08.2625

OBJECTIVES. Osteoporotic fractures are common in older adults and are often associated with high morbidity and mortality. As the incidence increases with age, it is natural that osteoporotic fractures have become a major health problem worldwide. Increasing number of patients with osteoporotic fracture will have a serious economic impact on the patient themselves and the society. The objective of this study is to study the cost-effectiveness of strontium ranelate compared to alendronate for patients with post-menopausal osteoporotic fractures in Malaysia.
METHODS. A Markov model was developed to project clinical and economic benefits of strontium in a hypothetical cohort of patients (N=1,000) over a 5-year time horizon. This study was conducted from a payer perspective. Model parameters including transition probabilities and costs of treating fracture at various sites were Malaysia-specific. Drug costs were obtained from a public teaching hospital in Kuala Lumpur. Utilities were derived from previous literatures and efficacy data were derived from two pivotal trials, i. e. SOTI and TROPOS trials. Outcomes were presented as cost per quality-adjusted life year (QALY) gained. A discount rate of 3% was applied. Both 1-way and multivariate probabilistic sensitivity analyses were undertaken to evaluate robustness of results.
RESULTS. Compared to alendronate, strontium could prevent 328 wrist, 192 hip, 7 vertebra and 115 multiple fractures respectively over 5 years, which was translated into 27.9 QALYs gained. Using strontium can lead to cost reduction of MYR1,416,595 (USD442,685), MYR478,257 (USD149,455), MYR22,784 (USD7,120) and MYR61,883 (USD113,088) due to reduced episodes of fractures at wrist/hip/vertebra/multiple sites respectively. The total reduction of direct medical costs of MYR2,279,519 (USD712,349) was larger than the extra drug cost, hence making strontium a cost-saving therapy.
CONCLUSIONS. It was shown that strontium appeared to be more cost-effective compared to alendronate and hence should be recommended in the public sector in Malaysia.
Fulltext Validity, feasibility and acceptability of time trade-off and standard gamble assessments in health valuation studies: a study in a multiethnic Asian population in Singapore

Wee HL, Li SC, Xie F, Zhang XH, Luo N, Feeny D, et al.

Value Health, 2008 Mar;11 Suppl 1:S3-10.
PMID: 18387064 DOI: 10.1111/j.1524-4733.2008.00361.x

OBJECTIVES: To assess the validity, feasibility and acceptability of standard gamble (SG) and time trade-off (TTO) assessments in a multiethnic Asian population.
METHODS: Through in-depth interviews performed among Chinese, Malay, and Indian Singaporeans (education >or= 6 years), we assessed validity of SG/TTO methods for eliciting health preferences by hypothesizing that 1) SG/TTO scores for three hypothetical health states (HS) would exhibit ranked order (decreasing scores with worse HS); and 2) more subjects would rate the most severe HS as worse than dead. Subjects also evaluated feasibility and acceptability of SG/TTO using a 10-point visual analog scale (VAS) and open-ended questions. Ratings were compared using Kruskal-Wallis, Wilcoxon signed-rank tests or tests of proportions.
RESULTS: VALIDITY: In 62 subjects (90% response rate), as hypothesized, SG and TTO scores exhibited ranked order with increasing HS severity (SG: 0.85, 0.08, -19.00; TTO: 0.85, 0.00, -0.18). More subjects rated the most severe HS as worse than dead (SG: 8%, 39%, 59%; TTO: 8%, 45% and 62%).
FEASIBILITY: Subjects felt SG and TTO were easy to understand (median VAS scores: 8.0 vs. 8.0, P = 0.87) and to complete (8.0 vs. 8.0, P = 0.84). Acceptability: SG and TTO were well accepted, with TTO less so than SG (median [interquartile range] offensiveness: 2.0 [0, 4.0] vs. 2.0 [0, 3.0], P = 0.045). Overall, subjects did not have a clear preference for SG/TTO (50% vs. 45%, P = 0.70).
CONCLUSIONS: This study suggests the validity, feasibility and acceptability of SG and TTO for population-based HS valuation studies in a multiethnic Asian population.
Fulltext The association of body mass index with health-related quality of life: an exploratory study in a multiethnic Asian population

Wee HL, Cheung YB, Loke WC, Tan CB, Chow MH, Li SC, et al.

Value Health, 2008 Mar;11 Suppl 1:S105-14.
PMID: 18387053 DOI: 10.1111/j.1524-4733.2008.00374.x

To evaluate the association between body mass index (BMI) and health-related quality of life (HRQoL) in a multiethnic Asian population in Singapore, and to explore if the World Health Organization (WHO) recommendation of alternative BMI cutoffs for Asians could be further strengthened by evidence of higher risk of impaired HRQoL using these criteria.
Fulltext Cough as a key symptom in asthma, allergic rhinitis, COPD and rhinosinusitis and its impact in Asia. [Abstract]

Wang DY, Ghoshal AG, Razak Bin Abdul MA, Lin HC, Thanaviratananich S, Bagga S, et al.

Value Health, 2014 Nov;17(7):A776-7.
PMID: 27202870 DOI: 10.1016/j.jval.2014.08.351

Objectives: Respiratory diseases represent significant impact on health care resources. A cross-sectional, observational study, Asia-Pacific Burden of Respiratory Diseases (APBORD), was conducted to examine burden of disease in adults with respiratory diseases across 6 countries - India, Korea, Malaysia, Singapore, Taiwan, and Thailand. We examined the extent to which cough is a presenting symptom and reason for medical visits for participants with Asthma, Allergic Rhinitis (AR), COPD or Rhinosinusitis.
Methods: Participants aged ≥18 years, presenting to a physician with primary diagnosis of Asthma, AR, COPD or Rhinosinusitis were enrolled. Participants completed a survey which contained questions related to demographics, respiratory symptoms, health care resource use and quality of life.
Results: A total of 13,902 participants were screened, of which 7,030 were eligible and 5,250 enrolled. The highest percentage of participants receiving care for a respiratory disorder had primary diagnosis of AR 14.0%, (95%CI: 13.4%, 14.6%), followed by Asthma 13.5% (12.9%, 14.1%), Rhinosinusitis 5.4% (4.6%, 5.3%) and COPD 4.9%, (5.0%, 5.7%). Cough or coughing up phlegm was reported as symptom by more than half the participants. Cough or coughing up phlegm was reported as the main reason for medical visit by more than 20% of participants. Among all symptoms reported, cough was most frequently reported by participants with a primarydiagnosis of COPD (73%), followed by Asthma (61%), Rhinosinusitis (59%), and AR (47%). In addition, cough was the most frequently reported main reason for seeking medical care among participants with a primary diagnosis of COPD (43%), for Asthma (33%), for Rhinosinusitis (13%), and for AR (11%).
Conclusions: Cough is a prominent symptom and major driver of medical care for patients with Asthma, Allergic Rhinitis, COPD or Rhinosinusitis. These data suggest that patients presenting with cough should be investigated comprehensively for any underlying more serious respiratory disorders to help with appropriate disease management.
Students' Knowledge and Perceptions Towards Quality Use of Medicines: A Descriptive Analysis From Universiti Sains Malaysia

Verma AK, Hassali MA, Saleem F, Aljadhey H

Value Health, 2015 Nov;18(7):A744.
PMID: 26534167 DOI: 10.1016/j.jval.2015.09.2866
Purpose, Belief And Rate of Disclosure of Cam Use Among Diabetic Patients In Quetta, Pakistan

Ul Haq N, Saeed S, Iqbal Q, Naseem A, Razaq G, Farooqui M

Value Health, 2015 Nov;18(7):A865-6.
PMID: 26534632 DOI: 10.1016/j.jval.2015.09.517
Use of complementary and alternative medicines (CAM) in diabetics patients In Quetta [Abstract]

Ul Haq N, Saeed S, Iqbal Q, Naseem A, Razaq G, Farooqui M

Value Health, 2015 Nov;18(7):A865.
PMID: 26534631 DOI: 10.1016/j.jval.2015.09.516

Objectives: The current study aimed to determine the prevalence of Complementary and Alternative Medicines (CAM) and its types used in diabetes patients in Quetta, Pakistan.
Methods: A cross-sectional study was undertaken with diabetes patients, attending different government and private hospitals and clinic of Quetta city, Pakistan. A self-administered questionnaire containing 16 questions (5 questions related with disease and remaining questions were for information regarding CAM use). Descriptive statistics were applied to evaluate the patient’s demographics. Inferential statistics were used to fine the association between demographics characteristics and CAM (p<0.05).
Results: A total of 500 questionnaires were distributed and 451 were returned (with response rate of 90.2%). Out of 451 patients 148 (32.8%) used CAM for the diabetes treatment, out of which 87 (58.8%) were females and 61 (41.2%) were males. Most of the participants were uneducated 51 (34.5%) and belongs to large families 89 (60.1%). Fifty (33.8%) participants were using mind body intervention, followed by alternative medical system (33.1%) and herbal products (31.8%) respectively for treatment of diabetes. Type of family, monthly income and per month medicine cost were significant associated (p<0.05) with CAM use.
Conclusions: The current study indicated that diabetes patients used mind body intervention, alternative medical system and herbal products are the most common CAM type used for diabetes control. Further research is recommended to evaluate the diabetes control in patients with CAM used.
Fulltext Evidence-based decision on medical technologies in Asia Pacific: experiences from India, Malaysia, Philippines, and Pakistan

Thatte U, Hussain S, de Rosas-Valera M, Malik MA

Value Health, 2009 Nov-Dec;12 Suppl 3:S18-25.
PMID: 20586975 DOI: 10.1111/j.1524-4733.2009.00622.x

This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices.

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