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.
Conference abstract:
OBJECTIVES.. To evaluate doctors’ adherence to Malaysian Clinical Practice Guideline (CPG) 2009 in the management of diabetes mellitus with co-morbidities in Malaysia.
METHODS. Cross-sectional study was done at a tertiary-care hospital in Malaysia. Total 51 physicians and 1020 patients’ prescriptions written by same physicians (20 prescriptions per physician) were analyzed. All patients had diabetes mellitus with co-morbidities. Depending on the recommendations of CPG 2009, the prescriptions were clustered as adherent and non-adherent prescriptions. All obtained data were analyzed using descriptive and inferential statistics.
RESULTS. A statistically significant negative association (Ф= 0.094, p-value=0.003) was observed between diabetes mellitus control and co-morbidities. CPG adherent had statistically weak negative association (Ф= - 0.081, p-value=0.010) with patients having co-morbidities (41.6%). No statistically significant association was observed between CPG adherence and any other co-morbidity. Majority of the patients received guidelines-compliant pharmacotherapy. The overall good level of physician adherence with CPG 2009 was observed in the management of diabetes mellitus with co-morbidities.
CONCLUSIONS. The study explored several features of prescription pattern of the physicians involved in the management of diabetes mellitus with co-morbidities and recognized the need for improvement in their prescription pattern for treating the diabetes mellitus.
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.
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.
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.
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