Displaying publications 1 - 20 of 151 in total

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  1. Regional and national differences in stroke thrombolysis use and disparities in pricing, treatment availability, and coverage
    de Souza AC, Sebastian IA, Zaidi WAW, Nasreldein A, Bazadona D, Amaya P, et al.
    Int J Stroke, 2022 10;17(9):990-996.
    PMID: 35137645 DOI: 10.1177/17474930221082446
    BACKGROUND: Major disparities have been reported in recombinant tissue plasminogen activator (rtPA) availability among countries of different socioeconomic status.

    AIMS: To characterize variability of rtPA price, its availability, and its association with and impact on each country's health expenditure (HE) resources.

    METHODS: We conducted a global survey to obtain information on rtPA price (50 mg vial, 2020 US Dollars) and availability. Country-specific data, including low, lower middle (LMIC), upper middle (UMIC), and high-income country (HIC) classifications, and gross domestic product (GDP) and HE, both nominally and adjusted for purchasing power parity (PPP), were obtained from World Bank Open Data. To assess the impact of rtPA cost, we computed the rtPA price as percentage of per capita GDP and HE and examined its association with the country income classification.

    RESULTS: rtPA is approved and available in 109 countries. We received surveys from 59 countries: 27 (46%) HIC, 20 (34%) UMIC, and 12 (20%) LMIC. Although HIC have significantly higher per capita GDP and HE compared to UMIC and LMIC (p < 0.0001), the median price of rtPA is non-significantly higher in LMICs (USD 755, interquartile range, IQR (575-1300)) compared to UMICs (USD 544, IQR (400-815)) and HICs (USD 600, IQR (526-1000)). In LMIC, rtPA cost accounts for 217.4% (IQR, 27.1-340.6%) of PPP-adjusted per capita HE, compared to 17.6% (IQR (11.2-28.7%), p < 0.0001) for HICs.

    CONCLUSION: We documented significant variability in rtPA availability and price among countries. Relative costs are higher in lower income countries, exceeding the available HE. Concerted efforts to improve rtPA affordability in low-income settings are necessary.

    Matched MeSH terms: Costs and Cost Analysis
  2. An analysis of the length of hospital stay after acetaminophen overdose
    Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW
    Hum Exp Toxicol, 2011 Jul;30(7):550-9.
    PMID: 20630911 DOI: 10.1177/0960327110377647
    Acetaminophen is one of the most commonly encountered medications in self-poisoning, with a high rate of morbidity. The prevalence and characteristics of acetaminophen intoxication associated with long hospital stay in patients are not well defined.
    Matched MeSH terms: Costs and Cost Analysis
  3. Fulltext Will pay-per-view in the advanced charging model recover the business losses for online video companies in China?
    Zhang C, Phoong SW
    PLoS One, 2024;19(1):e0297977.
    PMID: 38295093 DOI: 10.1371/journal.pone.0297977
    The evolution of Internet technology is closely mirrored by the innovative business and profit models emerging within the platform economy. Integrating this economic framework, online video platforms are dynamically refining their pricing strategies to optimize profit margins. This paper, anchored in the theoretical construct of second-degree price discrimination, selects the Chinese online video platforms iQiyi and Tencent Video for in-depth case studies. It charts the progression of its pricing strategies and juxtaposes these with those of prominent international online video sites to highlight both congruities and divergences. The synthesis of theoretical models with real-world case studies culminates in strategic recommendations to foster the growth of Chinese online video platforms in the global Internet arena.
    Matched MeSH terms: Costs and Cost Analysis
  4. 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.
    Matched MeSH terms: Costs and Cost Analysis
  5. Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries
    Zack R, Okunade O, Olson E, Salt M, Amodeo C, Anchala R, et al.
    Hypertension, 2019 05;73(5):990-997.
    PMID: 30929516 DOI: 10.1161/HYPERTENSIONAHA.118.11916
    High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. Hypertension control remains a challenge, especially in low-resource settings. One approach to improvement is the prioritization of patient-centered care. However, consensus on the outcomes that matter most to patients is lacking. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. The International Consortium for Health Outcomes Measurement convened a Working Group of 18 experts and patients representing 15 countries. We used a modified Delphi process to reach consensus on a set of outcomes, case-mix variables, and a timeline to guide data collection. Literature reviews, patient interviews, a patient validation survey, and an open review by hypertension experts informed the set. The set contains 18 clinical and patient-reported outcomes that reflect patient priorities and evidence-based hypertension management and case-mix variables to allow comparisons between providers. The domains included are hypertension control, cardiovascular complications, health-related quality of life, financial burden of care, medication burden, satisfaction with care, health literacy, and health behaviors. We present a core list of outcomes for evaluating hypertension care. They account for the unique challenges healthcare providers and patients face in low- and middle-income countries, yet are relevant to all settings. We believe that it is a vital step toward international benchmarking in hypertension care and, ultimately, value-based hypertension management.
    Matched MeSH terms: Costs and Cost Analysis
  6. The estimated cost of surgically managed isolated traumatic head injury secondary to road traffic accidents
    You X, Liew BS, Rosman AK, Dcsn, Musa KI, Idris Z
    Neurosurg Focus, 2018 05;44(5):E7.
    PMID: 29712526 DOI: 10.3171/2018.1.FOCUS17796
    OBJECTIVE Traumatic brain injury due to road traffic accidents occurs mainly in the younger age group in which injury-related disability leads to long-term impact on employment and economic and social consequences across the lifespan. This study was designed to assign a monetary cost (in Malaysian ringgits [RM]) to the treatment of patients with surgically treated isolated traumatic head injury as determined up to 1 year after injury. METHODS Relevant resource items used were identified and valued using the direct measurement of costs method, cost accounting methods, standard unit costs method, fees, charges and/or market prices method. These values were then tabulated to generate the total costs for each patient, via a combination of macro-costing and micro-costing methods. Malaysian currency values were converted to US dollars according to the average conversion rate for the period from January to May 2016: RM1 = US$0.2452. RESULTS This costing study analyzed data from 49 patients. The estimated cost for the 1st year of care for all patients was RM1,471,919.80 (US$360,914.735), with a mean (± SD) cost per case of RM30,039.18 ± 22,986.25 or $7365.61 ± $5636.23. The mean cost of care per case was RM11,041.35 ± 10,936.88 or $2707.34 ± $2681.72 for mild head injury, RM32,550.00 ± 20,998.76 or $7981.26 ± $5148.90 for moderate head injury, and RM36,917.86 ± 23,697.34 or $9052.26 ± $5810.59 for severe head injury. Severe head injury (p = 0.001), sustaining 2 or more intracranial pathologies (p = 0.01), having a poor Glasgow Outcome Scale (GOS) score (GOS score 1-3) (p = 0.02), requiring a tracheostomy (p < 0.001), and contracting pneumonia (p < 0.001) were significantly associated with higher cost. Logistic regression analysis revealed that cost of care increased by RM591.60 or $145.06 per year increment of age (β = RM591.60, p = 0.05). CONCLUSIONS The mean cost of treatment for traumatic head injury is high compared to the per capita income of RM37,900 in 2016. The cost values generated in this study provide baseline cost estimates that the authors hope will be used as a guide to determine where adequate funding should be allocated to provide timely and appropriate delivery of care.
    Matched MeSH terms: Costs and Cost Analysis/economics*; Costs and Cost Analysis/trends
  7. Winner's curse, size effect and bandwagon effect in explaining the under-pricing phenomenon of Malaysian IPOs
    Yong, Othman
    CREAM : Current Research in Malaysia (Penyelidikan Terkini di Malaysia), 2013;2(1):101-120.
    MyJurnal
    This study examines the issues of winner's curse, size effect and bandwagon effect in explaining the under-pricing phenomenon of Malaysian IPOs, for the period from January 2001 to December 2008. The average initial return for the Malaysian private placement IPOs (a proxy for informed investors) is significantly lower than that of the non-private placement IPOs (a proxy for uninformed investors), which gives support to the winner's curse hypothesis, where uninformed investors demand a higher initial return in the absence of informed investors. Using listing board as proxy for size of companies, we find that the smaller the company, the higher the average initial return, thus giving support to size effect, where investors usually demand higher initial return for smaller companies due to their higher perceived risk. The study also finds that the presence of a large number of informed investors as compared to uninformed investors in an IPO exercise will result in an increase in demand for that particular stock in the secondary market, which gives support to the bandwagon effect.
    Matched MeSH terms: Costs and Cost Analysis
  8. Development and Practical Application of a Multiple-Criteria Decision Analysis Framework on Respiratory Inhalers: Is It Always Useful in the MOH Malaysia Medicines Formulary Listing Context?
    Yong YV, Mahamad Dom SH, Ahmad Sa'ad N, Lajis R, Md Yusof FA, Abdul Rahaman JA
    MDM Policy Pract, 2021 03 30;6(1):2381468321994063.
    PMID: 33855190 DOI: 10.1177/2381468321994063
    Objectives. The current health technology assessment used to evaluate respiratory inhalers is associated with limitations that have necessitated the development of an explicit formulary decision-making framework to ensure balance between the accessibility, value, and affordability of medicines. This study aimed to develop a multiple-criteria decision analysis (MCDA) framework, apply the framework to potential and currently listed respiratory inhalers in the Ministry of Health Medicines Formulary (MOHMF), and analyze the impacts of applying the outputs, from the perspective of listing and delisting medicines in the formulary. Methods. The overall methodology of the framework development adhered to the recommendations of the ISPOR MCDA Emerging Good Practices Task Force. The MCDA framework was developed using Microsoft Excel 2010 and involved all relevant stakeholders. The framework was then applied to 27 medicines, based on data gathered from the highest levels of available published evidence, pharmaceutical companies, and professional opinions. The performance scores were analyzed using the additive model. The end values were then deliberated by an expert committee. Results. A total of eight main criteria and seven subcriteria were determined by the stakeholders. The economic criterion was weighted at 30%. Among the noneconomic criteria, "patient suitability" was weighted the highest. Based on the MCDA outputs, the expert committee recommended one potential medicine (out of three; 33%) be added to the MOHMF and one existing medicine (out of 24; 4%) be removed/delisted from the MOHMF. The other existing medicines remained unchanged. Conclusions. Although this framework was useful for deciding to add new medicines to the formulary, it appears to be less functional and impactful for the removal/delisting existing medicines from the MOHMF. The generalizability of this conclusion to other formulations remains to be confirmed.
    Matched MeSH terms: Costs and Cost Analysis
  9. Fulltext Using a dynamic adherence Markov model to assess the efficiency of Respiratory Medication Therapy Adherence Clinic (RMTAC) on asthma patients in Malaysia
    Yong YV, Shafie AA
    Cost Eff Resour Alloc, 2018;16:36.
    PMID: 30377414 DOI: 10.1186/s12962-018-0156-1
    Background: Respiratory Medication Therapy Adherence Clinic (RMTAC) is an initiative by the Ministry of Health (MOH) Malaysia to improve patients' medication adherence, as an adjunct to the usual physician care (UC). This study aimed to evaluate the cost-effectiveness of combined strategy of RMTAC and UC (RMTAC + UC) vs. UC alone in asthma patients, from the MOH Malaysia perspective.
    Methods: A lifetime horizon dynamic adherence Markov model with monthly cycle was developed, for quality-adjusted life year (QALY) gained and hospitalization averted outcomes. Transition probabilities of composite asthma control and medication adherence, utilities, costs, and mortality rates due to all causes were measured from local data sources. Effectiveness, exacerbation rates, and asthma mortality rates were taken from non-local data sources. One-way sensitivity analysis (SA) was conducted for assessing parameter uncertainties, whereas probabilistic SA (PSA) was conducted on a different set of utilities and effectiveness data. Costs were adjusted to 2014 US dollars ($). Both costs and benefits were discounted at a 3% rate annually.
    Results: RMTAC + UC was found to be a dominant alternative compared to UC alone; $- 13,639.40 ($- 109,556.90 to $104,445.54) per QALY gained and $- 428.93 ($- 521.27 to ($- 328.69)) per hospitalization averted. These results were found to be robust against changes in all parameters except utilities in the one-way SA, and for both scenarios in PSA.
    Conclusions: RMTAC + UC is more effective and yet cheaper than UC alone, from the MOH perspective. For the benefit of both MOH and patients, RMTAC is thus recommended to be remained, and expanded to more healthcare settings where possible.
    Matched MeSH terms: Costs and Cost Analysis
  10. 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.
    Matched MeSH terms: Costs and Cost Analysis*
  11. Hepatitis C virus core antigen as alternative diagnostic algorithm for active hepatitis C virus infection among haemodialysis population: Cost implications
    Wong XZ, Amirah A, Gan CC, Fatiha S, Maznah D, Yahya R, et al.
    Nephrology (Carlton), 2021 May;26(5):463-470.
    PMID: 33580732 DOI: 10.1111/nep.13862
    AIMS: In Malaysia, majority anti-HCV positive haemodialysis patients do not undergo hepatitis C confirmation due to the high cost of HCV RNA. HCV Core Antigen might be a cost-effective diagnostic test to identify HD patients who have active HCV infection eligible for Direct Acting Anti-viral therapy.

    METHODS: A cross-sectional study was conducted to assess the correlation between HCV Ag and HCV RNA and the cost implications of different diagnostic algorithms to diagnose active HCV infection using Anti-HCV, HCV Ag, and HCV RNA. Pre-dialysis blood was tested for both HCV Ag and HCV RNA. HCV Ag was tested with Abbott ARCHITECT HCV Ag test.

    RESULTS: Two-hundred twenty-seven haemodialysis patients were recruited from 20 centres with mean age of 57.68 ± 12.48 years, and male constitutes 56.8% (129) of the study population. HCV Ag correlated well with HCV RNA (Spearman test coefficient 0.943, p Cost analysis indicated that a sequential test involving Anti-HCV antibody as initial screening, followed by HCV Ag on Anti-HCV positive and HCV RNA on HCV Ag negative cases translated to a modest cost-saving algorithm compared to standard diagnostic algorithm.

    CONCLUSION: HCV Ag correlated well with HCV RNA and can potentially be fused in an alternative diagnostic algorithm to generate cost savings methods to diagnose active HCV infection among haemodialysis patients. This alternative algorithm is especially relevant in low to middle-income countries such as Malaysia to optimize the use of the healthcare resource and gains in clinical outcomes.

    Matched MeSH terms: Costs and Cost Analysis
  12. Physicians' experiences with HPV vaccine delivery: evidence from developing country with multiethnic populations
    Wong LP
    Vaccine, 2009 Mar 4;27(10):1622-7.
    PMID: 19100803 DOI: 10.1016/j.vaccine.2008.11.107
    Physicians' experiences in providing human papillomavirus (HPV) immunization were assessed by mailed questionnaire. Response rate of 41.4% was achieved. Malay Muslim physicians were more likely to agree that cultural sensitivity is an issue when recommending HPV vaccines. Pediatricians and family physicians were more likely to agree that acceptance is better if vaccines were recommended to prevent cervical cancer than to prevent a sexually transmitted disease. Near 70% rated success of HPV vaccines recommendation in their practice as very poor with the majority patients preferred to postpone immunization. Physicians reported cultural disparities in vaccine uptake and perceived high vaccination cost limits its use.
    Matched MeSH terms: Costs and Cost Analysis
  13. Fulltext Nationwide study of factors associated with public's willingness to use home self-test kit for dengue fever in Malaysia
    Wong LP, Atefi N, AbuBakar S
    BMC Public Health, 2016 08 12;16:780.
    PMID: 27520825 DOI: 10.1186/s12889-016-3409-y
    BACKGROUND: As there is no specific treatment for dengue, early detection and access to proper treatment may lower dengue fatality. Therefore, having new techniques for the early detection of dengue fever, such as the use of dengue test kit, is vitally important. The aims of the study were: 1) identify factors associated with acceptance of a home self-test kit for dengue fever if the dengue test is available to the public and 2) find out the characteristics of the test kits that influence the use of the dengue test kit.

    METHODS: A national telephone survey was carried out with 2,512 individuals of the Malaysian public aged 18-60 years old. Individuals were contacted by random digit dialling covering the whole of Malaysia from February 2012 to June 2013.

    RESULTS: From 2,512 participants, 6.1 % reported to have heard of the availability of the dengue home test kit and of these, 44.8 % expressed their intention to use the test kit if it was available. Multivariate logistic regressions indicated that participants with primary (OR: 0.65; 95 % CI: 0.43-0.89; p = 0.02, vs. tertiary educational level) and secondary educational levels (OR: 0.73; 95 % CI: 0.57-0.90; p = 0.01, vs. tertiary educational level) were less likely than participants with a tertiary educational level to use a home self-testing dengue kit for dengue if the kit was available. Participants with lower perceived barriers to dengue prevention (level of barriers 0-5) were less likely (OR: 0.67, 95 % CI: 0.53-0.85, p 

    Matched MeSH terms: Costs and Cost Analysis
  14. Sensitivity and specificity of five screening tests for diabetes in ten countries
    West KM, Kalbfleisch JM
    Diabetes, 1971 May;20(5):289-96.
    PMID: 5581317 DOI: 10.2337/diab.20.5.289
    The sensitivity and specificity of each of five screening tests were estimated in each of three to ten countries by testing subjects drawn from the general populations of adults over thirty-four years of age. This permitted comparisons among countries and among the different tests (fasting, postprandial, and postglucose urine tests, and fasting and postprandial blood glucose values). Sensitivity and specificity of each test varied widely among populations. For example, the sensitivity of the two-hour urine glucose ranged from 17 per cent in Nicaragua to 100 per cent in East Pakistan. Apparently specificity and sensitivity of such tests are influenced by many factors including both the circumstances under which the tests are performed and the characteristics of the population tested. It is, therefore, not possible to predict prevalence rates reliably by extrapolating from the results of screening tests. However, we believe the data for specific populations on the sensitivity and specificity of various tests will provide a rough guide in predicting the cost-effectiveness of alternative approaches to case detection in those particular countries. For instance, these results suggest that roughly 56 per cent of the occult diabetics in Costa Rica in this age group would be detected by a two-hour urine glucose, but only about 41 per cent of those in whom this test was positive would prove to have diabetes. Even modest changes of criteria in defining either "diabetes" or "abnormality" of the screening results produced marked changes in rates of sensitivity and specificity. With few exceptions, tests which were more sensitive were, comparably, less specific, and the reverse was also true. Rates of "diabetes" were markedly influenced by modest changes in diagnostic criteria.
    Matched MeSH terms: Costs and Cost Analysis
  15. Fulltext Entropy-based financial asset pricing: Evidence from Pakistan
    Wang S, Khan SA, Munir M, Alhajj R, Khan YA
    PLoS One, 2022;17(12):e0278236.
    PMID: 36548250 DOI: 10.1371/journal.pone.0278236
    Entropy is an alternative measure to calculate the risk, simplify the portfolios and equity risk premium. It has higher explanatory power than capital asset price model (CAPM) beta. The comparison of Entropy and CAPM beta provide in depth analysis about the explanatory power of the model that in turn help investor to make right investment decisions that minimizes risk. In this context, this study aims to compare Shannon and Rennyi Entropies with the CAPM beta for measuring the risk. Ordinary Least square approach has been utilized using a dataset of 67 enterprises registered in Pakistan Stock exchange. The comparative analysis of CAPM beta and entropy has been carried out with the R2 parameters. The result indicates that entropy has more explanatory power as compare to CAPM beta's explanatory power, and this turns out to be the best option to evaluate the risk performances. The result implies that an investor should make the best investment decision by choosing an enterprise that provide with good returns at minimum risk based on entropy technique.
    Matched MeSH terms: Costs and Cost Analysis
  16. Applicability of fluidized bed reactor in recalcitrant compound degradation through advanced oxidation processes: a review
    Tisa F, Abdul Raman AA, Wan Daud WMA
    J Environ Manage, 2014 Dec 15;146:260-275.
    PMID: 25190594 DOI: 10.1016/j.jenvman.2014.07.032
    Treatment of industrial waste water (e.g. textile waste water, phenol waste water, pharmaceutical etc) faces limitation in conventional treatment procedures. Advanced oxidation processes (AOPs) do not suffer from the limits of conventional treatment processes and consequently degrade toxic pollutants more efficiently. Complexity is faced in eradicating the restrictions of AOPs such as sludge formation, toxic intermediates formation and high requirement for oxidants. Increased mass-transfer in AOPs is an alternate solution to this problem. AOPs combined with Fluidized bed reactor (FBR) can be a potential choice compared to fixed bed or moving bed reactor, as AOP catalysts life-span last for only maximum of 5-10 cycles. Hence, FBR-AOPs require lesser operational and maintenance cost by reducing material resources. The time required for AOP can be minimized using FBR and also treatable working volume can be increased. FBR-AOP can process from 1 to 10 L of volume which is 10 times more than simple batch reaction. The mass transfer is higher thus the reaction time is lesser. For having increased mass transfer sludge production can be successfully avoided. The review study suggests that, optimum particle size, catalyst to reactor volume ratio, catalyst diameter and liquid or gas velocity is required for efficient FBR-AOP systems. However, FBR-AOPs are still under lab-scale investigation and for industrial application cost study is needed. Cost of FBR-AOPs highly depends on energy density needed and the mechanism of degradation of the pollutant. The cost of waste water treatment containing azo dyes was found to be US$ 50 to US$ 500 per 1000 gallons where, the cost for treating phenol water was US$ 50 to US$ 800 per 1000 gallons. The analysis for FBR-AOP costs has been found to depend on the targeted pollutant, degradation mechanism (zero order, 1st order and 2nd order) and energy consumptions by the AOPs.
    Matched MeSH terms: Costs and Cost Analysis
  17. Cost analysis of pathology services comparing conventional 6-core transrectal biopsy versus transperineal saturation biopsy in diagnosing prostate cancer
    Tham JH, Looi LM, Ghazali R
    Malays J Pathol, 2022 Dec;44(3):469-475.
    PMID: 36591714
    INTRODUCTION: Patients who are suspected of having prostate cancer from screening tests require a tissue biopsy to confirm the presence of cancer. This study aims to compare the cost and cancer detection rate of two different biopsy protocols: 6-core transrectal (TR) approach, and transperineal (TP) saturation biopsy.

    METHODS: In this descriptive, retrospective study, we selected all prostate biopsies received by the diagnostic pathology department of a tertiary hospital in Malaysia in the year 2020, from adult patients for analysis. Data on demographics, specimen preparation processes, and final histopathological diagnosis was extracted from the Laboratory Information System (LIS). The cost incurred for each biopsy diagnosed as cancer was calculated with the cost prices referenced from laboratory documentation. Statistical analysis was performed using SPSS, version 28.

    RESULTS: The total cost for detection of cancer using TR biopsy ranged from RM11.22 - RM271.02 with mean of RM47.53. The standard deviation, s is RM43.45. For TP biopsies, the total cost ranged from RM112.20 - RM349.56 with mean of RM160.85, standard deviation of RM80.37. TR biopsies had a detection rate of 43.2%, while TP biopsies had a 24.2% cancer detection rate. There is a 3.38-fold increase in costs between TR and TP biopsy.

    CONCLUSION: The results show a 3.38-fold increase in costs and a reduction in cancer detection rate when comparing TR and TP biopsy. The reason for the reduced detection rate is unascertained in this study.

    Matched MeSH terms: Costs and Cost Analysis
  18. The economic burden of schizophrenia in Malaysia
    Teoh SL, Chong HY, Abdul Aziz S, Chemi N, Othman AR, Md Zaki N, et al.
    Neuropsychiatr Dis Treat, 2017;13:1979-1987.
    PMID: 28814869 DOI: 10.2147/NDT.S137140
    INTRODUCTION: Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia.

    METHODS: A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted.

    RESULTS: The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M.

    CONCLUSION: This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden.

    Matched MeSH terms: Costs and Cost Analysis
  19. Fulltext Budget impact analysis of wider adoption of biphasic insulin Aspart (Biasp) in the treatment of type 2 diabetes mellitus (T2DM): a perspective of patients treated by public providers in Singapore. [Abstract]
    Tan SC, Matzen P, Khoo SP
    Value Health, 2014 Nov;17(7):A743.
    PMID: 27202681 DOI: 10.1016/j.jval.2014.08.153
    Objectives
    Economic evaluations of BIAsp have been published in the context of different countries. This study aimed to evaluate the financial impact from a perspective of patients treated by public providers of different adoption rates of Biphasic Insulin Aspart (BIAsp; NovoMix 30 FlexPen®) versus Biphasic Human Insulin (BHI; Mixtard Penfill®) in treating T2DM.
    Methods
    An Excel based 5-year budget impact model was built to estimate insulin treated patients by public providers using the local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and medical costs for major hypoglycaemia and other complications were applied with a 3% discount rate to the estimated corresponding incidence rates derived from the UKPDS equations. The projected adoption rates were based on the 2013 utilisation volume data. Other local specific considerations e.g. subsidized selling prices and co-payments were included in the analyses for an assumed size of eligible patients. Sensitivity analyses were conducted.
    Results
    The adoption rates of BIAsp were assumed to increase from 23.6% in 2013 to 30% or 36.5% in 2018 for base case and upside scenario, respectively. In comparison to base case scenario, increases in adoption rate of BIAsp were associated with a cumulative increase up to slightly greater than S$ 2.02M in insulin acquisition cost but a potential cumulative net saving up to approximately S$0.92M in overall total costs over 5 years, attributing to subsidized selling price of BIAsp assuming it is included standard drug list and its significantly lower major hypoglycaemia risk, respectively. Cost savings were predicted for other complications.
    Conclusions
    The wider adoption of BIAsp was predicted to result in net cost savings from patient perspective in Singapore. More cost saving would be estimated in analyses with reduced productivity loss from a societal perspective.
    Matched MeSH terms: Costs and Cost Analysis
  20. Fulltext Budget impact analysis of biphasic insulin Aspart in the treatment of type 2 diabetes mellitus In Malaysia: a public payer perspective. [Abstract]
    Tan SC, Matzen P, Yeo LN
    Value Health, 2014 Nov;17(7):A743.
    PMID: 27202679 DOI: 10.1016/j.jval.2014.08.151
    Objectives
    Budget impact analysis (BIA) is a useful tool for reimbursement decision-makers in health technology assessments by authorities across different countries. This study aimed to evaluate the financial impact from the Ministry of Health (MOH) perspective of different adoption rates of Biphasic Insulin Aspart (BIAsp) versus Biphasic Human Insulin (BHI) in treating type 2 diabetes mellitus.
    Methods
    An Excel basfed 5-year budget impact model was built to estimate insulin treated patients by public providers using local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and other medical costs for complications e.g. major hypoglycaemia, myocardial infarction, stroke, end-stage renal disease, blindness and amputation were included at a discount rate of 3%. The incidence rates of these complications were derived from the established UKPDS equations. The adoption rates were assumed and projected from the 2013 utilisation volume data of BIAsp and BHI by public providers. Sensitivity analyses were conducted.
    Results
    The adoption rates of BIAsp were assumed to increase from 1.8% in 2013 to 4.5% or 6.9% in 2018 for base case and upside scenario, respectively. Compared to the base case, upside scenario of wider BIAsp adoption was associated with an increased insulin cost up to RM 8.2M which was offset by avoided complication costs resulting in an overall net budget saving of approximately RM 5.5M over 5 years, primarily driven by estimated reduction in major hypoglycaemia events for patients treated with BIAsp.
    Conclusions
    The higher and wider adoption of BIAsp would likely be associated with cost savings in Malaysia from the MOH perspective attributed to its superiority in H1Ac reduction and lower major hypoglycemia risk in comparison to BHI. More cost saving would be concluded if productivity loss is included from a societal perspective.
    Matched MeSH terms: Costs and Cost Analysis*
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