Displaying publications 1 - 20 of 44 in total

  1. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al.
    Lancet, 2016 Sep 10;388(10049):1081-1088.
    PMID: 27394647 DOI: 10.1016/S0140-6736(16)30579-7
    BACKGROUND: With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.

    METHODS: We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs).

    FINDINGS: Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990.

    INTERPRETATION: Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.

    FUNDING: Bill & Melinda Gates Foundation.

    Matched MeSH terms: Quality-Adjusted Life Years*
  2. Nor Zuraida, Z.
    The vital importance of the mental health of a nation for the overall well being of the population and socioeconomic development is increasingly recognized. In Malaysia, psychiatric disorders were responsible for 8.6% of the total Disability Adjusted Life Years and were ranked fourth as the leading cause of burden of disease by disease categories. More and more evidence shows that physical illnesses are strongly associated with psychiatric disorders. Those with physical illnesses have much higher risk of developing psychiatric disorders compared to that without. The mechanisms of co-morbidity of psychiatric and physical illness are complex. It is a two-way interaction and there are five different possible ways to describe this.
    Matched MeSH terms: Quality-Adjusted Life Years
  3. Dahlui, M., Hishamshah, M.I., Rahman, A.J. A, Shamsuddin, K., Aljunid, S.M.
    A cost-utility analysis was performed desferrioxamine treatment in thalctssaemia patients at two tertiary hospitals in Malaysia in 2004. A hundred and twelve transfusion dependent thalassaemia patients were grouped according to the status of desferrioxamine; optimum and sulwptimum. Cost analysis was from a patient and hospital perspectives while Quality Adjusted Life Years (QALYs) was the health outcome of choice. Incremental Cost·Effectiveness Ratio (ICER) was also stipulated to show the difference in cost for an additional QALY if patient currently on suboptimum desferrioxamine to switch using optimum desferrioxamine. Results on cost analysis showed the mean cost of treatment for thalassaemia patients on optimum desferrioxamirie was higher than those on sub·optimum desferrioxamine; (RM14, 775.00+SDRM4,737.00 and RM10,780+RM3,655, respectively). QALYs were 19.186+6.591 and 9.859+5275 in the optimum and suboptirnum group, respectively. Costutility analysis showed the cost per QALYs in optimum desferrioxamine group was RM59,045.00 compared to RM44,665.00 in suboptimum desferrioxamine group. ICER of patients on sub-optimum desferrioxamine switching to optimum desferrioxarnine was only RM420.39. Sensitivity analysis showed that the results were robust in the best and worst scenarios. In conclusion, although it is expensive for thalassaemia patients to use optimum desferrioxamine compared to sub-optimum desferrioxamine, the cost per QALYs gained was undoubtedly low.
    Matched MeSH terms: Quality-Adjusted Life Years
  4. Alibrahim OA, Al-Sadat N, Elawad NA
    J Public Health Afr, 2010 Sep 01;1(1):e7.
    PMID: 28299041 DOI: 10.4081/jphia.2010.e7
    Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks.
    Matched MeSH terms: Quality-Adjusted Life Years
  5. Foo, Lee Peng, Hanny Zurina Hamzah, Norashidah Mohamed Nor, Rusmawati Said
    The overweight and obese population may affect the population health which can lead to economic stability and development of the countries to be compromised. Thus, this study estimates the burden of disease attributable to overweight and obesity in Malaysia for adults aged 20-59 years old. Population attribution fraction (PAF) and disability-adjusted life year (DALY) have been used to quantify years of life lost from premature death and number of years lost due to disability resulting from obesity and overweight. The burden of disease attributable to overweight was 1582 and 1146 PYs per 1000 persons for male and female, respectively. Meanwhile, the burden of disease attributable to obesity was 2951 PYs per 1000 persons with women in the lead at 1657 PYs per 1000 persons. The burden of overweight and obesity among Malaysian adults is substantial. The outcome of this study is crucial as it gives a comprehensive information on the burden of overweight and obesity in Malaysia. The information from this study also enables the authorities to develop activities and programs to combat obesity and tomaintain healthy lifestyle among Malaysian.
    Matched MeSH terms: Quality-Adjusted Life Years
  6. Fransen HP, Beulens JW, May AM, Struijk EA, Boer JM, de Wit GA, et al.
    Prev Med, 2015 Aug;77:119-24.
    PMID: 26007298 DOI: 10.1016/j.ypmed.2015.05.014
    Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention.
    Matched MeSH terms: Quality-Adjusted Life Years*
  7. Nimdet K, Chaiyakunapruk N, Vichansavakul K, Ngorsuraches S
    PLoS ONE, 2015;10(4):e0122760.
    PMID: 25855971 DOI: 10.1371/journal.pone.0122760
    A number of studies have been conducted to estimate willingness to pay (WTP) per quality-adjusted life years (QALY) in patients or general population for various diseases. However, there has not been any systematic review summarizing the relationship between WTP per QALY and cost-effectiveness (CE) threshold based on World Health Organization (WHO) recommendation.
    Matched MeSH terms: Quality-Adjusted Life Years*
  8. Fransen HP, May AM, Beulens JW, Struijk EA, de Wit GA, Boer JM, et al.
    PLoS ONE, 2014;9(11):e111480.
    PMID: 25369457 DOI: 10.1371/journal.pone.0111480
    The aim of our study was to relate four modifiable lifestyle factors (smoking status, body mass index, physical activity and diet) to health expectancy, using quality-adjusted life years (QALYs) in a prospective cohort study. Data of the prospective EPIC-NL study were used, including 33,066 healthy men and women aged 20-70 years at baseline (1993-7), followed until 31-12-2007 for occurrence of disease and death. Smoking status, body mass index, physical activity and adherence to a Mediterranean-style diet (excluding alcohol) were investigated separately and combined into a healthy lifestyle score, ranging from 0 to 4. QALYs were used as summary measure of healthy life expectancy, combining a person's life expectancy with a weight for quality of life when having a chronic disease. For lifestyle factors analyzed separately the number of years living longer in good health varied from 0.12 year to 0.84 year, after adjusting for covariates. A combination of the four lifestyle factors was positively associated with higher QALYs (P-trend <0.0001). A healthy lifestyle score of 4 compared to a score of 0 was associated with almost a 2 years longer life in good health (1.75 QALYs [95% CI 1.37, 2.14]).
    Matched MeSH terms: Quality-Adjusted Life Years*
  9. Jacklin PB, Maresh MJ, Patterson CC, Stanley KP, Dornhorst A, Burman-Roy S, et al.
    BMJ Open, 2017 Aug 11;7(8):e016621.
    PMID: 28801424 DOI: 10.1136/bmjopen-2017-016621
    OBJECTIVES: To compare the cost-effectiveness (CE) of the National Institute for Health and Care Excellence (NICE) 2015 and the WHO 2013 diagnostic thresholds for gestational diabetes mellitus (GDM).

    SETTING: The analysis was from the perspective of the National Health Service in England and Wales.

    PARTICIPANTS: 6221 patients from four of the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study centres (two UK, two Australian), 6308 patients from the Atlantic Diabetes in Pregnancy study and 12 755 patients from UK clinical practice.

    PRIMARY AND SECONDARY OUTCOME MEASURES PLANNED: The incremental cost per quality-adjusted life year (QALY), net monetary benefit (NMB) and the probability of being cost-effective at CE thresholds of £20 000 and £30 000 per QALY.

    RESULTS: In a population of pregnant women from the four HAPO study centres and using NICE-defined risk factors for GDM, diagnosing GDM using NICE 2015 criteria had an NMB of £239 902 (relative to no treatment) at a CE threshold of £30 000 per QALY compared with WHO 2013 criteria, which had an NMB of £186 675. NICE 2015 criteria had a 51.5% probability of being cost-effective compared with the WHO 2013 diagnostic criteria, which had a 27.6% probability of being cost-effective (no treatment had a 21.0% probability of being cost-effective). For women without NICE risk factors in this population, the NMBs for NICE 2015 and WHO 2013 criteria were both negative relative to no treatment and no treatment had a 78.1% probability of being cost-effective.

    CONCLUSION: The NICE 2015 diagnostic criteria for GDM can be considered cost-effective relative to the WHO 2013 alternative at a CE threshold of £30 000 per QALY. Universal screening for GDM was not found to be cost-effective relative to screening based on NICE risk factors.

    Matched MeSH terms: Quality-Adjusted Life Years*
  10. Loo KW, Gan SH
    Int J Stroke, 2012 Feb;7(2):165-7.
    PMID: 22264370 DOI: 10.1111/j.1747-4949.2011.00767.x
    Stroke is one of the top five leading causes of death and one of the top 10 causes for hospitalization in Malaysia. Stroke is also in the top five diseases with the greatest burden of disease, based on disability-adjusted life years. However, prospective studies on stroke in Malaysia are limited. To date, neither the prevalence of stroke nor its incidence nationally has been recorded. Hypertension is the major risk factor for stroke. The mean age of stroke patients in Malaysia is between 54.5 and 62.6 years. Traditional medicine is commonly practiced. With the increasing number of stroke cases annually, more government and nongovernment organizations should be involved in primary and secondary prevention strategies.
    Matched MeSH terms: Quality-Adjusted Life Years
  11. Natrah, S., Sharifa Ezat, W.P.
    Impact of health care on the population health has been measured in terms of morbidity and mortality but this measurement doesn’t distinguish between children, adults and the elderly. It does not also take into account the losses that occur because of handicap, pain, or other disability. Therefore, measures of population health which combine information on mortality and non-fatal healthboutcomes to represent the health of a particular population as a single number was introduced. QALYs and DALYs are both common outcome measures in economic evaluations of health interventions. QALYs is the comprehensive measure of health outcome because it can simultaneously capture gains from reduced morbidity (quality gains) and reduced mortality (quantity gains) and combine these into a single measure. DALYs is primarily a measure of disease burden where it combines losses from premature death and loss of healthy life resulting from disability. Although QALYs and DALYs are almost similar in their basic concept but there are few distinct differences which must be paid attention to in order to correctly utilize these measures.
    Matched MeSH terms: Quality-Adjusted Life Years
  12. Bavanandan S, Yap YC, Ahmad G, Wong HS, Azmi S, Goh A
    Transplant Direct, 2015 Nov;1(10):e45.
    PMID: 27500211 DOI: 10.1097/TXD.0000000000000553
    Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia.

    AIM AND METHODS: This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death.

    RESULTS: Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively.

    CONCLUSIONS: Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life.

    Matched MeSH terms: Quality-Adjusted Life Years
  13. Lee JY, Lee SWH
    Diabetes Technol. Ther., 2018 Jul;20(7):492-500.
    PMID: 29812965 DOI: 10.1089/dia.2018.0098
    BACKGROUND: Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness.

    MATERIALS AND METHODS: A literature search was performed in 10 databases from inception until February 2018. All economic evaluations assessing the economic evaluation of telemedicine in diabetes were eligible for inclusion. We subsequently evaluated the study quality in terms of effectiveness measures, cost measure, economic model, as well as time horizon.

    RESULTS: Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers' fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost-effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management.

    CONCLUSIONS: Among all telemedicine strategies examined, teleophthalmology was the most cost-effective intervention. Future research is needed to provide evidence on the long-term experience of telemedicine and facilitate resource allocation.

    Matched MeSH terms: Quality-Adjusted Life Years
  14. McDonald SA, Azzeri A, Shabaruddin FH, Dahlui M, Tan SS, Kamarulzaman A, et al.
    Appl Health Econ Health Policy, 2018 Dec;16(6):847-857.
    PMID: 30145775 DOI: 10.1007/s40258-018-0425-3
    INTRODUCTION: The World Health Organisation (WHO) has set ambitious goals to reduce the global disease burden associated with, and eventually eliminate, viral hepatitis.

    OBJECTIVE: To assist with achieving these goals and to inform the development of a national strategic plan for Malaysia, we estimated the long-term burden incurred by the care and management of patients with chronic hepatitis C virus (HCV) infection. We compared cumulative healthcare costs and disease burden under different treatment cascade scenarios.

    METHODS: We attached direct costs for the management/care of chronically HCV-infected patients to a previously developed clinical disease progression model. Under assumptions regarding disease stage-specific proportions of model-predicted HCV patients within care, annual numbers of patients initiated on antiviral treatment and distribution of treatments over stage, we projected the healthcare costs and disease burden [in disability-adjusted life-years (DALY)] in 2018-2040 under four treatment scenarios: (A) no treatment/baseline; (B) pre-2018 standard of care (pegylated interferon/ribavirin); (C) gradual scale-up in direct-acting antiviral (DAA) treatment uptake that does not meet the WHO 2030 treatment uptake target; (D) scale-up in DAA treatment uptake that meets the WHO 2030 target.

    RESULTS: Scenario D, while achieving the WHO 2030 target and averting 253,500 DALYs compared with the pre-2018 standard of care B, incurred the highest direct patient costs over the period 2018-2030: US$890 million (95% uncertainty interval 653-1271). When including screening programme costs, the total cost was estimated at US$952 million, which was 12% higher than the estimated total cost of scenario C.

    CONCLUSIONS: The scale-up to meet the WHO 2030 target may be achievable with appropriately high governmental commitment to the expansion of HCV screening to bring sufficient undiagnosed chronically infected patients into the treatment pathway.

    Matched MeSH terms: Quality-Adjusted Life Years
  15. Lee KKC, Chia Wu DB, Topachevskyi O, Delgleize E, DeAntonio R
    Value Health Reg Issues, 2013 May;2(1):64-74.
    PMID: 29702855 DOI: 10.1016/j.vhri.2013.01.012
    BACKGROUND: Pneumococcal universal vaccination in Hong Kong was introduced in 2009.

    OBJECTIVES: We assessed the health and economic impact of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PCV-10) compared with the current 13-valent pneumococcal conjugate vaccine (PCV-13) recommended for Hong Kong in 2011, providing new elements to be considered by public health authorities in the future decision-making process for pneumococcal vaccines in this country.

    METHODS: An analytical model was used to estimate the annual economic and health outcomes of invasive pneumococcal disease (IPD), community-acquired pneumonia, and acute otitis media (AOM), including nontypeable H. influenzae-related AOM, for a birth cohort in Hong Kong from the payer perspective with a 10-year horizon. Clinical impact including morbidity-mortality, quality-adjusted life-years (QALYs), incremental costs, and cost-effectiveness comparing PCV-10 and PCV-13 were estimated. Probabilistic sensitivity analyses by using alternate scenarios were performed.

    RESULTS: Model projections indicate that PCV-13 and PCV-10 have approximately equivalent impact on the prevention of deaths caused by IPD and pneumonia. PCV-13 is projected to prevent 6 additional cases of IPD, whereas PCV-10 is projected to prevent 13,229 additional AOM cases and 101 additional QALYs. For the base case, PCV-10 vaccination is estimated to save 44.6 million Hong Kong dollars (34.1 million Hong Kong dollars discounted). Sensitivity analysis indicated that PCV-10 would generate more QALYs and save costs as compared with PCV-13.

    CONCLUSIONS: Universal infant vaccination with new available pneumococcal vaccines is expected to generate a significant additional impact on reducing the burden of pneumococcal diseases in Hong Kong. PCV-10 vaccination would be potentially a cost-saving strategy compared with PCV-13 vaccination, generating better cost offsets and higher QALY gains.

    Matched MeSH terms: Quality-Adjusted Life Years
  16. Wee HL, Loke WC, Li SC, Fong KY, Cheung YB, Machin D, et al.
    Ann. Acad. Med. Singap., 2007 Jun;36(6):403-8.
    PMID: 17597964
    INTRODUCTION: The aims of this study were to cross-culturally adapt and evaluate the validity of the Singaporean Malay and Tamil versions of the EQ-5D.
    MATERIALS AND METHODS: The EQ- 5D was cross-culturally adapted and translated using an iterative process following standard guidelines. Consenting adult Malay- and Tamil-speaking subjects at a primary care facility in Singapore were interviewed using a questionnaire (including the EQ-5D, a single item assessing global health, the SF-8 and sociodemographic questions) in their respective language versions. Known-groups and convergent construct validity of the EQ-5D was investigated by testing 30 a priori hypotheses per language at attribute and overall levels.
    RESULTS: Complete data were obtained for 94 Malay and 78 Indian patients (median age, 54 years and 51 years, respectively). At the attribute level, all 16 hypotheses were fulfilled with several reaching statistical significance (Malay: 4; Tamil: 5). At the overall level, 42 of 44 hypotheses related to the EQ-5D/ EQ-VAS were fulfilled (Malay: 22; Tamil: 20), with 21 reaching statistical significance (Malay: 9; Tamil: 12).
    CONCLUSION: In this study among primary care patients, the Singapore Malay and Tamil EQ-5D demonstrated satisfactory known-groups and convergent validity.
    Matched MeSH terms: Quality-Adjusted Life Years*
  17. Saokaew S, Rayanakorn A, Wu DB, Chaiyakunapruk N
    Pharmacoeconomics, 2016 12;34(12):1211-1225.
    PMID: 27510721
    BACKGROUND: Although pneumococcal conjugate vaccines (PCVs) have been available for prevention of invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae (S. pneumoniae) for over a decade, their adoption into national immunization programmes in low- and middle-income countries (LMICs) is still limited. Economic evaluations (EEs) play a crucial role in support of evidence-informed decisions.

    OBJECTIVE: This systematic review aims to provide a critical summary of EEs of PCVs and identify key drivers of EE findings in LMICs.

    METHODS: We searched Scopus, ISI Web of Science, PubMed, Embase and Cochrane Central from their inception to 30 September 2015 and limited the search to LMICs. The search was undertaken using the search strings 'pneumococc* AND conjugat* AND (vaccin* OR immun*)' AND 'economic OR cost-effectiveness OR cost-benefit OR cost-utility OR cost-effectiveness OR cost-benefit OR cost-utility' in the abstract, title or keyword fields. To be included, each study had to be a full EE of a PCV and conducted for an LMIC. Studies were extracted and reviewed by two authors. The review involved standard extraction of the study overview or the characteristics of the study, key drivers or parameters of the EE, assumptions behind the analyses and major areas of uncertainty.

    RESULTS: Out of 134 records identified, 22 articles were included. Seven studies used a Markov model for analysis, while 15 studies used a decision-tree analytic model. Eighteen studies performed a cost-utility analysis (CUA), with disability-adjusted life-years, quality-adjusted life-years or life-years gained as a measure of health outcome, while four studies focused only on cost-effectiveness analysis (CEA). Both CEA and CUA findings were provided by eight studies. Herd effects and serotype replacement were considered in 10 and 13 studies, respectively. The current evidence shows that both the 10-valent and 13-valent PCVs are probably cost effective in comparison with the 7-valent PCV or no vaccination. The most influential parameters were vaccine efficacy and coverage (in 16 of 22 studies), vaccine price (in 13 of 22 studies), disease incidence (in 11 of 22 studies), mortality from IPD and pneumonia (in 8 of 22 studies) and herd effects (in 4 of 22 studies). The findings were found to be supportive of the products owned by the manufacturers.

    CONCLUSION: Our review demonstrated that an infant PCV programme was a cost-effective intervention in most LMICs (in 20 of 22 studies included). The results were sensitive to vaccine efficacy, price, burden of disease and sponsorship. Decision makers should consider EE findings and affordability before adoption of PCVs.

    Matched MeSH terms: Quality-Adjusted Life Years*
  18. 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.

    Matched MeSH terms: Quality-Adjusted Life Years*
  19. Endarti D, Riewpaiboon A, Thavorncharoensap M, Praditsitthikorn N, Hutubessy R, Kristina SA
    Value Health Reg Issues, 2018 May;15:50-55.
    PMID: 29474178 DOI: 10.1016/j.vhri.2017.07.008
    OBJECTIVES: To gain insight into the most suitable foreign value set among Malaysian, Singaporean, Thai, and UK value sets for calculating the EuroQol five-dimensional questionnaire index score (utility) among patients with cervical cancer in Indonesia.

    METHODS: Data from 87 patients with cervical cancer recruited from a referral hospital in Yogyakarta province, Indonesia, from an earlier study of health-related quality of life were used in this study. The differences among the utility scores derived from the four value sets were determined using the Friedman test. Performance of the psychometric properties of the four value sets versus visual analogue scale (VAS) was assessed. Intraclass correlation coefficients and Bland-Altman plots were used to test the agreement among the utility scores. Spearman ρ correlation coefficients were used to assess convergent validity between utility scores and patients' sociodemographic and clinical characteristics. With respect to known-group validity, the Kruskal-Wallis test was used to examine the differences in utility according to the stages of cancer.

    RESULTS: There was significant difference among utility scores derived from the four value sets, among which the Malaysian value set yielded higher utility than the other three value sets. Utility obtained from the Malaysian value set had more agreements with VAS than the other value sets versus VAS (intraclass correlation coefficients and Bland-Altman plot tests results). As for the validity, the four value sets showed equivalent psychometric properties as those that resulted from convergent and known-group validity tests.

    CONCLUSIONS: In the absence of an Indonesian value set, the Malaysian value set was more preferable to be used compared with the other value sets. Further studies on the development of an Indonesian value set need to be conducted.

    Matched MeSH terms: Quality-Adjusted Life Years*
  20. Bhanegaonkar AJ, Horodniceanu EG, Abdul Latiff AH, Woodhull S, Khoo PC, Detzel P, et al.
    Asia Pac Allergy, 2015 Apr;5(2):84-97.
    PMID: 25938073 DOI: 10.5415/apallergy.2015.5.2.84
    BACKGROUND: Breastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD).

    OBJECTIVE: To estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy.

    METHODS: A cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50).

    RESULTS: Feeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W.

    CONCLUSION: Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.

    Matched MeSH terms: Quality-Adjusted Life Years
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