Displaying publications 1 - 20 of 112 in total

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  1. 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.

  2. Kuan WC, Sim R, Wong WJ, Dujaili J, Kasim S, Lee KK, et al.
    Value Health, 2023 Oct;26(10):1558-1576.
    PMID: 37236395 DOI: 10.1016/j.jval.2023.05.011
    OBJECTIVES: Decision-analytic models (DAMs) with varying structures and assumptions have been applied in economic evaluations (EEs) to assist decision making for heart failure with reduced ejection fraction (HFrEF) therapeutics. This systematic review aimed to summarize and critically appraise the EEs of guideline-directed medical therapies (GDMTs) for HFrEF.

    METHODS: A systematic search of English articles and gray literature, published from January 2010, was performed on databases including MEDLINE, Embase, Scopus, NHSEED, health technology assessment, Cochrane Library, etc. The included studies were EEs with DAMs that compared the costs and outcomes of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, angiotensin-receptor neprilysin inhibitors, beta-blockers, mineralocorticoid-receptor agonists, and sodium-glucose cotransporter-2 inhibitors. The study quality was evaluated using the Bias in Economic Evaluation (ECOBIAS) 2015 checklist and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklists.

    RESULTS: A total of 59 EEs were included. Markov model, with a lifetime horizon and a monthly cycle length, was most commonly used in evaluating GDMTs for HFrEF. Most EEs conducted in the high-income countries demonstrated that novel GDMTs for HFrEF were cost-effective compared with the standard of care, with the standardized median incremental cost-effectiveness ratio (ICER) of $21 361/quality-adjusted life-year. The key factors influencing ICERs and study conclusions included model structures, input parameters, clinical heterogeneity, and country-specific willingness-to-pay threshold.

    CONCLUSIONS: Novel GDMTs were cost-effective compared with the standard of care. Given the heterogeneity of the DAMs and ICERs, alongside variations in willingness-to-pay thresholds across countries, there is a need to conduct country-specific EEs, particularly in low- and middle-income countries, using model structures that are coherent with the local decision context.

  3. Drummond MF, Augustovski F, Bhattacharyya D, Campbell J, Chaiyakanapruk N, Chen Y, et al.
    Value Health, 2022 Aug;25(8):1257-1267.
    PMID: 35931428 DOI: 10.1016/j.jval.2022.02.006
    Health technology assessment (HTA) has been growing in use over the past 40 years, especially in its impact on decisions regarding the reimbursement, adoption, and use of new drugs, devices, and procedures. In countries or jurisdictions with "pluralistic" healthcare systems, there are multiple payers or sectors, each of which could potentially benefit from HTA. Nevertheless, a single HTA, conducted centrally, may not meet the needs of these different actors, who may have different budgets, current standards of care, populations to serve, or decision-making processes. This article reports on the research conducted by an ISPOR Health Technology Assessment Council Working Group established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The Group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them. We recommend that countries with pluralistic healthcare systems establish a national focus for HTA, develop a uniform set of HTA methods guidelines, ensure that HTAs are produced in a timely fashion, facilitate the use of HTA in the local setting, and develop a framework to encourage transparency in HTA. These efforts can be enhanced by the development of good practice guidance from ISPOR or similar groups and increased training to facilitate local use of HTA.
  4. Henry EB, Barry LE, Hobbins AP, McClure NS, O'Neill C
    Value Health, 2020 07;23(7):936-944.
    PMID: 32762996 DOI: 10.1016/j.jval.2020.03.003
    OBJECTIVES: To estimate and compare the minimally important difference (MID) in index score of country-specific EQ-5D-5L scoring algorithms developed using EuroQol Valuation Technology protocol version 2, including algorithms from Germany, Indonesia, Ireland, Malaysia, Poland, Portugal, Taiwan, and the United States.

    METHODS: A simulation-based approach contingent on all single-level transitions defined by the EQ-5D-5L descriptive system was used to estimate the MID for each algorithm.

    RESULTS: The resulting mean (and standard deviation) instrument-defined MID estimates were Germany, 0.083 (0.022); Indonesia, 0.093 (0.012); Ireland, 0.098 (0.023); Malaysia, 0.072 (0.010); Poland, 0.080 (0.030); Portugal, 0.080 (0.018); Taiwan, 0.101 (0.010); and the United States, 0.078 (0.014).

    CONCLUSIONS: These population preference-based MID estimates and accompanying evidence of how such values vary as a function of baseline index score can be used to aid interpretation of index score change. The marked consistency in the relationship between the calculated MID estimate and the range of the EQ-5D-5L index score, represented by a ratio of 1:20, might substantiate a rule of thumb allowing for MID approximation in EQ-5D-5L index score warranting further investigation.

  5. Kongpakwattana K, Chaiyakunapruk N
    Value Health, 2020 Jun;23(6):710-718.
    PMID: 32540228 DOI: 10.1016/j.jval.2020.01.010
    OBJECTIVES: Decision-analytic models for Alzheimer's disease (AD) have been advanced to a discrete-event simulation (DES), in which individual-level modeling of disease progression across continuous severity spectra become feasible. This study aimed to apply DES to perform cost-effectiveness analysis of AD treatment in Thailand.

    METHODS: A data set of Thai AD patients, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of 50 000 patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine, or no treatment. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence; mortality; and predictive equations for functional status, costs (Thai baht in 2017), and quality-adjusted life-year (QALY) were derived from country-specific real-world data.

    RESULTS: From a societal perspective, only the prescription of donepezil to AD patients with all disease-severity levels was found to be cost-effective (incremental cost-effectiveness ratio): 138 524 Thai baht/QALY ($4062/QALY)]. Regardless of whether the treatment-stopping rule when the mini-mental state examination score <10 was introduced, providing early treatment with donepezil to mild AD patients further reduced the incremental cost-effectiveness ratio. Extensive sensitivity analyses indicated robust simulation findings.

    CONCLUSIONS: Discrete-event simulation greatly enhances the real-world representativeness of decision-analytic models for AD. Donepezil is the most cost-effective treatment option for AD in Thailand and is worth being considered for universal financial coverage. Application of DES in heath technology assessment should be encouraged, especially when the validity of the model is questionable with classical modeling methods.

  6. Kongpakwattana K, Dejthevaporn C, Krairit O, Dilokthornsakul P, Mohan D, Chaiyakunapruk N
    Value Health, 2019 10;22(10):1137-1145.
    PMID: 31563256 DOI: 10.1016/j.jval.2019.04.1937
    BACKGROUND: Although an increase in the burden of Alzheimer's disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HRQOL) associated with AD in low- and middle-income countries is still lacking.

    OBJECTIVES: This study aimed to collect real-world cost and HRQOL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand.

    METHODS: We recruited AD patients aged ≥60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HRQOL, and caregiving information using standardized tools. The hospital's database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HRQOL.

    RESULTS: Among 148 community-dwelling patients, average annual total societal costs of AD care were $8014 (95% confidence interval [CI]: $7295-$8844) per patient. Total costs of patients with severe stage ($9860; 95% CI: $8785-$11 328) were almost twice as high as those of mild stage ($5524; 95% CI: $4649-$6593). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient's HRQOL (P value

  7. Santos J, Palumbo F, Molsen-David E, Willke RJ, Binder L, Drummond M, et al.
    Value Health, 2017 12;20(10):1227-1242.
    PMID: 29241881 DOI: 10.1016/j.jval.2017.10.018
    As the leading health economics and outcomes research (HEOR) professional society, ISPOR has a responsibility to establish a uniform, harmonized international code for ethical conduct. ISPOR has updated its 2008 Code of Ethics to reflect the current research environment. This code addresses what is acceptable and unacceptable in research, from inception to the dissemination of its results. There are nine chapters: 1 - Introduction; 2 - Ethical Principles respect, beneficence and justice with reference to a non-exhaustive compilation of international, regional, and country-specific guidelines and standards; 3 - Scope HEOR definitions and how HEOR and the Code relate to other research fields; 4 - Research Design Considerations primary and secondary data related issues, e.g., participant recruitment, population and research setting, sample size/site selection, incentive/honorarium, administration databases, registration of retrospective observational studies and modeling studies; 5 - Data Considerations privacy and data protection, combining, verification and transparency of research data, scientific misconduct, etc.; 6 - Sponsorship and Relationships with Others (roles of researchers, sponsors, key opinion leaders and advisory board members, research participants and institutional review boards (IRBs) / independent ethics committees (IECs) approval and responsibilities); 7 - Patient Centricity and Patient Engagement new addition, with explanation and guidance; 8 - Publication and Dissemination; and 9 - Conclusion and Limitations.
  8. Lim YW, Shafie AA, Chua GN, Ahmad Hassali MA
    Value Health, 2017 09;20(8):1131-1138.
    PMID: 28964445 DOI: 10.1016/j.jval.2017.04.002
    BACKGROUND: One major challenge in prioritizing health care using cost-effectiveness (CE) information is when alternatives are more expensive but more effective than existing technology. In such a situation, an external criterion in the form of a CE threshold that reflects the willingness to pay (WTP) per quality-adjusted life-year is necessary.

    OBJECTIVES: To determine a CE threshold for health care interventions in Malaysia.

    METHODS: A cross-sectional, contingent valuation study was conducted using a stratified multistage cluster random sampling technique in four states in Malaysia. One thousand thirteen respondents were interviewed in person for their socioeconomic background, quality of life, and WTP for a hypothetical scenario.

    RESULTS: The CE thresholds established using the nonparametric Turnbull method ranged from MYR12,810 to MYR22,840 (~US $4,000-US $7,000), whereas those estimated with the parametric interval regression model were between MYR19,929 and MYR28,470 (~US $6,200-US $8,900). Key factors that affected the CE thresholds were education level, estimated monthly household income, and the description of health state scenarios.

    CONCLUSIONS: These findings suggest that there is no single WTP value for a quality-adjusted life-year. The CE threshold estimated for Malaysia was found to be lower than the threshold value recommended by the World Health Organization.

  9. Iqbal MS, Iqbal MZ, Iqbal MW, Bahari MB
    Value Health, 2015 Nov;18(7):A620.
    PMID: 26533480 DOI: 10.1016/j.jval.2015.09.2170
    Objectives: To evaluate the prevalence and patterns of CAM use among diabetes patients in Pakistan. In addition, the study also focused on the perceived effectiveness of CAM over conventional therapies, information seeking behavior and CAM disclosure to healthcare providers.
    Methods: A prospective, cross-sectional and self-administered questionnaire based study was conducted in tertiary care public hospitals in Pakistan. A prevalence based sample of 350 diabetes patients attending the tertiary hospital in Punjab, Pakistan were selected for the study. All obtained data were analyzed using descriptive and inferential statistics.
    Results: Overall, 327 questionnaires were completed and included in the analysis, showing that 52.8% of diabetics had used CAM, with most (62.4%) believing that CAM therapies assist body’s natural forces to heal. CAM usage was significantly associated with gender (P=0.001), level of education (P=0.001), employment status (P=0.03) and monthly income (P<0.001).
    Conclusions: Diabetes treatment and management requires compliance to effective therapies at early stages. Healthcare providers should engage diabetics in an open non-judgmental dialogue to ascertain better understanding of diabetes and its management options.
  10. Albaroodi KA, Syed Sulaiman SA, Awaisu A, Shafie AA, Lajis R, Abo-Maali MF
    Value Health, 2015 Nov;18(7):A714.
    PMID: 26533997 DOI: 10.1016/j.jval.2015.09.2692
    Objectives
    Endocrinologists and other clinicians who provide care to diabetic patients have ideal teaching opportunities to connect and deliver tobacco cessation interventions in diabetes care. This study aimed to develop, validate and measure the reliability of a new tool that would be used to evaluate physicians’ attitudes and practices regarding tobacco cessation counselling in patients with diabetes, as well as barriers to deliver tobacco cessation counselling in their clinics.

    Methods
    This study was conducted from March till December 2012 in the endocrine clinic at Hospital Pulau Pinang, Malaysia. A standardised, 22-item, self-administered questionnaire was developed to determine (i) physicians’ attitudes and practices regarding tobacco cessation counselling in patients with diabetes, and (ii) barriers in delivering tobacco cessation counselling in their clinics. Face and content validity were assessed. Six pharmacists, whom were faculty members with experience and expertise in research and in the development of surveys, reviewed the questionnaire to assess its content validity.Reliability test was run along to check whether the new tool questions are correlated with one another adequatly or no.

    Results
    Reliability test for the tool was pretested on a sample of 25 physicians physicians who ran the endocrine clinic at Hospital Pulau Pinang, Malaysia. Reliability analyses for the attitude domain and practice domain were 0.710 and 0.720, respectively.

    Conclusions
    The questionnaire was valid and reliable to be use for the evaluation of physician’s barriers, attitude and practice regarding tobacco cessation counselling in the diabetics clinics.
  11. Md Rezal RS, Hassali MA, Saleem F, Kumar R
    Value Health, 2015 Nov;18(7):A848-9.
    PMID: 26534536 DOI: 10.1016/j.jval.2015.09.420
    Conference abstrract
    Objectives: Antimicrobial resistance is associated with irrational use of antibiotics in general practice. We aimed to assess the frequency with which patients with Upper Respiratory Tract Infections were prescribed with antibiotics and the patterns of antibiotic prescription at primary healthcare centres in Malaysia.
    Methods: The study targeted all primary public healthcare centres in the district of Kota Setar, Kedah, Malaysia. A retrospective prescription analysis was conducted whereby prescriptions from 1st January 2014 to 31st March 2014 were screened and retrieved for antibiotics prescribed for upper respiratory infections. The data was entered into Microsoft Excel spread sheet, and exported to Statistical Package for Social Sciences, version 20 for further analysis. Frequencies and percentages were used to summarize the data. The Jonckheere–Terpstra test was used to evaluate the trend of antibiotic prescription. Where significant associations were reported, effect size was calculated by using Kendall tau correlation coefficient. P value of <0.05 was considered to be of statistical significance.
    Results: For the period of three months, 123,524 prescriptions were screened and analysed. 2270 (31.8%) prescriptions contained antibiotics prescribed for all URTIs visits. Among all antibiotics, macrolides were the most commonly prescribed antibiotic, constituting of 61% (n=1404) of total antibiotics prescribed for all cases. The Jonckheere–Terpstra test revealed a statistical relationship between prescribers and the diagnosis of the disease (p=0·001). Furthermore, a weak positive trend of association was reported with FMS being more accurate in diagnosis followed by MOs and AMOs (τ=0·122).
    Conclusions: Practicing physicians should adhere to the standard treatment practices, as antibiotic use in viral aetiology is ineffective, and encourages the persistence development of resistance. A comprehensive development of national antibiotic stewardship program is recommended to ensure organised and regulated control of antibiotic use in Malaysia.
  12. Mallhi TH, Khan AH, Adnan AS, Sarriff A, Jummaat F, Khan YH
    Value Health, 2015 Nov;18(7):A843.
    PMID: 26534509 DOI: 10.1016/j.jval.2015.09.390
  13. Khan AH, Aftab RA, Sulaiman SA, Ali I
    Value Health, 2015 Nov;18(7):A840.
    PMID: 26534490 DOI: 10.1016/j.jval.2015.09.373
    Objectives: To review patient’s prescriptions and calculate direct cost for the treatment and management of asthma
    Methods: A prospective cross-sectional detailed review of 180 prescriptions written by 6 doctors was conducted at respiratory department of Hospital Pulau Pinang, Malaysia. Medication price was confirmed from the hospital formulary. Interview with the key personals were conducted to identify activities of each service provided to asthma patients. This was followed by determination of time taken to complete each activity using stopwatch. The duration was captured 15 times for each for three alternate days and summarized as the mean time (minutes) for each activity. The cost of each employee per single activity was obtained by multiplying the mean time (minute) spent by that employee doing a specific activity by his/her salary per minute
    Results: A total of 6 different classes of medications were prescribed to 180 asthma patients. β agonist was the most prescribed class of asthma medication that included Salbutamol 72 (39.8) and albuterol 20 (11) followed by Corticosteroids that included budisonide 59 (32.8%), prednisolone 16 (8.8%) and fluticasone 11 (6.1%). Fifty one (28.3%) units of budisonide/formoterol combination medication were prescribed followed by fluticasone/salmeterol 40 (22.2%). A total of RM 10610.79(USD) medication were prescribed to 180 asthma patients with average cost of RM 59.08 per patient. The combination medication of budisonide/formoterol RM.5253 (USD) made the majority of total cost of asthma medication. Spirometry was performed for all 180 patients at every hospital visit that costed RM 5400.00. The cost of services provided by doctors and nursing staff for 180 asthma patients for single visit was RM 1198.8 and RM 331.2 respectively
    Conclusions: Combination medication adds a substantial cost to over all asthma cost. Careful selection of asthma pharmacotherapy can greatly reduce medication cost without compromising on treatment outcomes
  14. 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.
  15. Tan BY, Shafie AA, Hassali MA, Saleem F, Kumar R
    Value Health, 2015 Nov;18(7):A831.
    PMID: 26534439 DOI: 10.1016/j.jval.2015.09.317
    Objectives: Medication adherence to treatment recommendations has major impact on health outcomes. Numerous interventions to improve medication adherence among the patients have been studied in clinical trials, including calendar packaging and patient reminder letters. Therefore, this study is aimed to explore hypertensive patient’s perceptions towards calendar packaging and its impact on medication adherence.
    Methods: A qualitative method was adopted, whereby two focus group sessions were conducted among 16 conveniently sampled hypertensive patients from a community based non-governmental organisation in the state of Penang, Malaysia. A pre validated focus group guide was constructed and used for data collection. Collected data was transcribed verbatim and analysed by thematic content analysis to identify the emerging themes.
    Results: Each focus group consisted of 8 hypertensive patients. Thematic content analysis resulted into 3 major themes (knowledge and familiarity with the medicines names and their packaging; perception about the packaging and labelling of medicines; knowledge and views of calendar packaging) and each theme was further divided into 2 sub themes. Majority of the hypertensive patients were not familiar with their medication names, however they were able to identify their medications based on the appearance and packaging. Participants agreed that calendar packaging is a great intervention to increase awareness among patients about regular medicine use and increase medication adherence.
    Conclusions: The study concluded that hypertensive patients relied on the packaging and labelling on the medications to identify their medications. Thus, packaging and labelling of the medications play an important role in improving medication adherence and reduce medication errors. This finding can help to enhance the drug manufacturers to pay attention on the drug packaging in order to increase medication adherence among the patients.
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