METHODOLOGY: Data were obtained from a cross-sectional survey in ten different nursing homes in the state of Penang, Malaysia. Participants were selected through convenience sampling were interviewed face-to-face using a questionnaire. Information concerning demographic characteristics, fall risk and depression status were collected.
RESULTS: Of the 357-elderly aged 60 years and above interviewed in the nursing homes, 32.8% (n=354) reported having one or more falls in the past 12 months whereas 13.3% were at moderate/high risk of fall. Depression (Adjusted Odds Ratio (aOR)=1.71, 95%CI: 1.00 to 2.91) and respiratory illnesses (aOR=3.38, 95%CI: 1.11 to 10.30) were shown to be associated with prevalence of falls. Depression (aOR=2.12, 95%CI: 1.06 to 4.23) and history of fall more than once in the past 12 months (aOR=3.90, 95%CI: 1.72 to 8.8) were found to be associated with moderate/high risk of falls.
CONCLUSION: This study showed that the prevalence of fall was higher among depressed elderly and those with respiratory illness. Elderly with higher history of falls were also at higher risk of falls. These findings suggest the importance of screening the elderly for the risk factors of falls as a preventive measure.
Methods: Primary data were collected through a standardized survey, and secondary data analysis was used to derive estimates of the ESRD expenditure.
Results: Total annual expenditure of ESRD by the public sector has grown 94% within a span of 7 years, from Malaysian Ringgit [MYR] 572 million (US dollars [USD] 405 million, purchasing power parity [PPP] 2010) in 2010 to MYR 1.12 billion (USD 785 million, PPP 2016) in 2016. The total ESRD expenditure in 2010 constituted 2.95% of the public sector's total health expenditure, whereas in 2016, the proportion has increased to 4.2%. Only 6% of ESRD expenditure was spent on renal transplantation, and the remaining 94% was spent on dialysis.
Conclusion: The share of ESRD expenditure in total health expenditure for the public sector is considered substantial given only a small proportion of the population is affected by the disease. The rapid increase in expenditure relative to the national total health expenditure should warrant the relevant authorities about sustainability of the existing financing mechanism of ESRD and the importance to institutionalize more drastic preventive measures.
METHODS: A mixed survey questionnaire with open- and closed-ended questions relating to HTA governance, HTA infrastructure, supply and demand of HTA and global HTA networking opportunities in each country was administered electronically to representatives of HTA nodal agencies of all ASEAN members. In-person meetings or email correspondence were used to clarify or validate any unclear responses. Results were collated and presented quantitatively.
RESULTS: Responses from eight out of ten member countries were analysed. The results illustrate that countries in the ASEAN region are at different stages of HTA institutionalization. While Malaysia, Singapore and Thailand have well-established processes and methods for priority setting through HTA, other countries, such as Cambodia, Indonesia, Lao PDR, Myanmar, the Philippines and Vietnam, have begun to develop HTA systems in their countries by establishing nodal agencies or conducting ad-hoc activities.
DISCUSSION AND CONCLUSION: The study provides a general overview of the HTA landscape in ASEAN countries. Systematic efforts to mitigate the gaps between the demand and supply of HTA in each country are required while ensuring adequate participation from stakeholders so that decisions for resource allocation are made in a fair, legitimate and transparent manner and are relevant to each local context.