MyMedR

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.

Fulltext An Asian regional analysis of cost-effectiveness of early irbesartan treatment versus conventional antihypertensive, late amlodipine, and late irbesartan treatments in patients with type 2 diabetes, hypertension, and nephropathy

Annemans L, Demarteau N, Hu S, Lee TJ, Morad Z, Supaporn T, et al.

Value Health, 2008 May-Jun;11(3):354-64.

PMID: 17888064 DOI: 10.1111/j.1524-4733.2007.00250.x

OBJECTIVE: The prevalence of type 2 diabetes, often leading to diabetic nephropathy, has increased globally, especially in Asia. Irbesartan treatment delays the progression of kidney disease at the early (microalbuminuria) and late (proteinuria) stages of nephropathy in hypertensive type 2 diabetics. This treatment has proven to be cost-effective in Western countries. This study assessed the cost-effectiveness of early irbesartan treatment in Asian settings.
METHODS: An existing lifetime model was reprogrammed in Microsoft Excel to compare irbesartan started at an early stage to irbesartan or amlodipine started at a late stage, and standard treatments from a health-care perspective in China, Malaysia, Thailand, South Korea, and Taiwan. The main effectiveness parameters were incidences of end-stage renal disease, time in dialysis, and life expectancy. All costs were converted to 2004 US$ using official purchasing power parity. Local data were obtained for costs, transplantation,dialysis, and mortality rates. Probabilities regarding disease progression after treatment with the investigated drugs were extracted from two published clinical trials. A probabilistic sensitivity analysis was performed.
RESULTS: Early use of irbesartan yielded the largest clinical and economic benefits reducing need for dialysis by 61% to 63% versus the standard treatment, total costs by 9% (Thailand) to 42% (Taiwan), and increasing life expectancy by 0.31 to 0.48 years. Early irbesartan had a 66% (Thailand) to 95% (Taiwan) probability of being dominant over late irbesartan.
CONCLUSION: Although the absolute results varied in different settings, reflecting differences in epidemiology, management, and costs, early irbesartan treatment was a cost-effective alternative in the Asian settings.

Fulltext Understanding the Rationale for Responses to a Time-Trade-Off Assessment and Willingness-To-Pay in Lung Cancer in Thailand

Crawford B, Permsuwan U, Thongprasert S, Sakulbumrungsil R, Chaiyakunapruk N, Leartsakulpanitch J, et al.

Value Health, 2014 Nov;17(7):A738.

PMID: 27202652 DOI: 10.1016/j.jval.2014.08.121

Haemodialysis Versus Non-Dialysis Therapy Among Older Adults With Stage 5 Chronic Kidney Disease: A Comparison of Health-Related Quality of Life

Ch'ng AS, Chen LL, Lim SK, Poi PJ

Value Health, 2015 Nov;18(7):A745.

PMID: 26534174 DOI: 10.1016/j.jval.2015.09.2874

Health Professional Students' Willingness To Pay For Human Papillomavirus Vaccination And Factors Influencing Their Decision In Malaysia

Mari Kannan M, Kingston R, Kelly Num S, Sue Chin N, Jin Yong N, Yun Lui L, et al.

Value Health, 2015 Nov;18(7):A475-6.

PMID: 26532670 DOI: 10.1016/j.jval.2015.09.1274

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 Assessment of KAP Among Hospital Pharmacists

Sadeeqa S

Value Health, 2014 Nov;17(7):A754.

PMID: 27202745 DOI: 10.1016/j.jval.2014.08.219

Fulltext A qualitative exploration of Malaysian doctors' perceptions towards complementary and alternative medicines (CAM) [Abstract]

Farooqui M, Othman CN, Hassali AA, Saleem F, Ul Haq N, Sadeeqa S

Value Health, 2014 Nov;17(7):A789.

PMID: 27202944 DOI: 10.1016/j.jval.2014.08.425

Objectives: The study aims to assess doctors’ perceptions towards Complementary and Alternative Medicines (CAM) in their medical practice, factors that affect the referral of CAM and suggestions to improve CAM in medical practice.
Methods: A qualitative research approach was adopted to gain a better understanding of the current perceptions and practice held by doctors’ within their medical professions. In order to gain a wide perspective of the issue, eleven doctors were purposively selected who were working in academics, hospitals and in the community health clinics. Participants were interviewed using a semi-structured interview guide. A saturation point was reached after the 10th interview, and no new information emerged with the subsequent interviews. All interviews were transcribed verbatim and analyzed by means of a standard content analysis framework.
Results: The doctors expressed a range of views on CAM that can be divided into two major themes: doctors’ knowledge and understanding towards CAM and doctors’ viewpoint on CAM in their professional practice. A key factor which affected doctor’s perspectives on CAM was the lack of scientific evidences. The attitudes on CAM were basically shaped based on their personal CAM use rather than knowledge gained during an academic course. Lack of knowledge on CAM was also attributing to the doctors’ reluctance in CAM discussion with their patients. Though addition of CAM courses into the medical curriculum was proposed by some of the doctors; the practical implication was criticized as some found medical curriculum heavily packed with the biomedical courses.
Conclusions: Majority of the doctors in this study were skeptical and uncertain about CAM due to lack of scientific evidence. Doctor-patient communication on CAM can only be improved when doctors’ knowledge on CAM can be improved by providing necessary training on CAM.

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

Patterns Of Medication Use In Chronic Kidney Disease Stage 5d: Emphasis On Medications For The Management Of Ckd-Mbd

Salman M, Khan AH, Adnan AS, Syed Sulaiman SA, Hussain K, Mansoor S, et al.

Value Health, 2015 Nov;18(7):A508-9.

PMID: 26532849 DOI: 10.1016/j.jval.2015.09.1460

Fulltext Assessing the cost effectiveness of an anticoagulation clinic in comparison with the usual medical clinic In Kuala Lumpur Hospital [Abstract]

Thanimalai S, Shafie AA, Ahmad HM, Sinnadurai J

Value Health, 2014 Nov;17(7):A487.

PMID: 27201439 DOI: 10.1016/j.jval.2014.08.1428

Objectives: Systematic anticoagulation management clinic is now recommended to manage warfarinized atrial fibrillation (AF) patient. In Malaysia, the service is recently introduced as pharmacist managed Warfarin Medication Therapy Adherence Clinic (WMTAC). The objective of the present study was to assess the cost effectiveness of anticoagulation clinic in comparison with usual medical in Kuala Lumpur Hospital.
Methods: A Markov model built using the provider perspective and 20 year time horizon was used to assess the cost effectiveness. The base case analysis assumed a cohort of patients with AF 57 years of age with comorbid illnesses. Data sources include a 6 month retrospective cohort analysis of the effectiveness of the clinics, the cost of drugs, cost of personnel and space of the clinics, cost of monitoring and cost of adverse events were obtained from the local source and publications. The transition probabilities of these clinics outcomes were obtained from a literature search. Future costs were discounted by 3% to convert to present values. All costs were in Ringgit Malaysia (RM) based on year 2012.
Results: The results of a 20-year period model showed that UMC was dominated by the WMTAC in the same time period. The mean cost of the WMTAC was RM 5864 whereas the UMC cost was RM 6550. The sensitivity analysis showed that clinic treatment costs and effectiveness influenced the cost-effectiveness. If the cost of WMTAC was increased by 50% of the current cost, the WMTAC would not be a dominant intervention. WMTAC was also cost effective for a willingness to pay of RM32000.
Conclusions: The anticoagulation management service appears to cost less and provide greater effectiveness than usual care. In conclusion, the Markov model suggests that from the provider perspective the anticoagulation clinic is a more cost effective option than the usual medical clinic in Kuala Lumpur Hospital.
Study site: Medication Therapy Adherence Clinic, Hospital Kuala Lumpur, Malaysia

Fulltext Adverse Drug Reactions of Haart Therapy Among Hiv/Aids Patients Treated at Infectious Disease Clinic

Khan AH, Syed Sulaiman SA, Khan K, Aftab RA, Soo CT

Value Health, 2014 Nov;17(7):A803.

PMID: 27203025 DOI: 10.1016/j.jval.2014.08.504

Treatment Outcomes Among Hiv/Aids Patients Treated During Haart Therapy At Infectious Disease Clinic

Khan AH, Khan K, Sulaiman SA, Soo CT

Value Health, 2015 Nov;18(7):A869.

PMID: 26534651 DOI: 10.1016/j.jval.2015.09.535

Fulltext Cost-Effectiveness Analysis of Fondaparinux Versus Enoxaparin in Non-St Elevation Acute Coronary Syndrome in Thailand

Permsuwan U, Chaiyakunapruk N, Nathisuwan S, Sukonthasarn A

Value Health, 2014 Nov;17(7):A760-1.

PMID: 27202776 DOI: 10.1016/j.jval.2014.08.257

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