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This study aimed to systematically review and explore the impact of study methods on the cost of managing adverse drug reactions (ADRs) among hospitalized patients to guide policymakers and researchers. A literature search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library, and Google Scholar. The search was restricted to studies from 2000 to 2017. Two authors independently reviewed the studies, assessed their risk of bias, and extracted information for analysis. Data abstraction was based on the study design, ADR reporting, and costing approaches. Of 677 studies identified, 12 were included for analysis. All studies defined ADR according to WHO classifications. The percentage of admission due to ADR ranged from 0.03% to 17.11%. All studies adopted a healthcare provider perspective, using either a micro-costing (n = 7), case-mix group costing (n = 3), or average-per-diem costing (n = 2) approach. The cost per ADR widely fluctuated from USD 65.00 to USD 12,129.90 based on various factors. The micro-costing approach generally had a lower cost compared to other approaches. The cost per ADR in high-income countries was also 10 times higher than in lower- or middle-income countries. This study evidenced that the methodological heterogeneity across studies has resulted in a wide range of cost estimations for ADR management. [ABSTRACT FROM AUTHOR]

Oral cancer has been recognized as a significant challenge to healthcare. In Malaysia, numerous patients frequently present with later stages of cancers to the highly subsidized public healthcare facilities. Such a trend contributes to a substantial social and economic burden. This study aims to determine the cost of treating oral potentially malignant disorders (OPMD) and oral cancer from a public healthcare provider's perspective. Medical records from two tertiary public hospitals were systematically abstracted to identify events and resources consumed retrospectively from August 2019 to January 2020. The cost accrued was used to estimate annual initial and maintenance costs via two different methods- inverse probability weighting (IPW) and unweighted average. A total of 86 OPMD and 148 oral cancer cases were included. The initial phase mean unadjusted cost was USD 2,861 (SD = 2,548) in OPMD and USD 38,762 (SD = 12,770) for the treatment of cancer. Further annual estimate of initial phase cost based on IPW method for OPMD, early and late-stage cancer was USD 3,561 (SD = 4,154), USD 32,530 (SD = 12,658) and USD 44,304 (SD = 16,240) respectively. Overall cost of late-stage cancer was significantly higher than early-stage by USD 11,740; 95% CI [6,853 to 16,695]; p< 0.001. Higher surgical care and personnel cost predominantly contributed to the larger expenditure. In contrast, no significant difference was identified between both cancer stages in the maintenance phase, USD 700; 95% CI [-1,142 to 2,541]; p = 0.457. A crude comparison of IPW estimate with unweighted average displayed a significant difference in the initial phase, with the latter being continuously higher across all groups. IPW method was shown to be able to use data more efficiently by adjusting cost according to survival and follow-up. While cost is not a primary consideration in treatment recommendations, our analysis demonstrates the potential economic benefit of investing in preventive medicine and early detection. [ABSTRACT FROM AUTHOR]

Background: Transfusion-dependent thalassaemia (TDT) is a hereditary blood disorder in which blood transfusion is the mainstay treatment to prolong survival and improve quality of life. Patients with this disease require blood transfusion at more than 100 ml/kg annually and iron-chelating therapy (ICT) to prevent iron overload (IOL) complications. There are substantial numbers of TDT patients in Malaysia, but limited data are available regarding the economic burden associated with this disease. The purpose of this study was to determine the lifetime cost of TDT from a societal perspective and identify potential factors increasing patient and family expenditures among thalassaemia populations.Methods: The total lifetime cost per TDT patient (TC1) is the sum of lifetime healthcare cost (TC2) and lifetime patient and family healthcare expenditure (TC3). TC2 was simulated using the Markov model, taking into account all costs subsidized by the government, and TC3 was estimated through a cross-sectional health survey approach. A survey was performed using a two-stage sampling method in 13 thalassaemia centres covering all regions in Malaysia.Results: A TDT patient is expected to incur TC2 of USD 561,208. ICT was the main driver of cost and accounted for 56.9% of the total cost followed by blood transfusion cost at 13.1%. TC3 was estimated to be USD 45,458. Therefore, the estimated TC1 of a TDT patient was USD 606,665. Sensitivity analyses showed that if all patients were prescribed oral ICT deferasirox for their lifetime, the total healthcare cost would increase by approximately 65%. Frequency of visits to health facilities for blood transfusion/routine monitoring and patients who were prescribed desferrioxamine were observed to be factors affecting patient and family monthly expenses.Conclusion: The lifetime cost per TDT patient was USD 606,665, and this result may be useful for national health allocation planning. An estimation of the economic burden will provide additional information to decision makers on implementing prevention interventions to reduce the number of new births and medical service reimbursement. [ABSTRACT FROM AUTHOR]

Purpose: There is a gap of information describing the health state utility values (HSUVs) of transfusion-dependent thalassemia (TDT) patients in Malaysia. These values are useful in the assessment of health-related quality of life (HRQoL), economic evaluations and provide guidance to disease management decisions. The objective of this study was to estimate and derive HSUVs associated with the treatment and complications of TDT patients in Malaysia using the EQ-5D-3L instrument.Methods: A cross-sectional survey using the EQ-5D-3L instrument was conducted between May to September 2018 across various public hospitals in Malaysia. Using a multi-stage sampling, patients diagnosed with TDT and receiving iron chelating therapy were sampled. The findings on the EQ-5D-3L survey were converted into utility values using local tariff values. A two-part model was used to examine and derive the HSUVs associated with the treatment and complications of iron overload in TDT.Results: A total of 585 patients were surveyed. The unadjusted mean (SD) EQ-5D-3L utility value for TDT patients were 0.893 (0.167) while mean (SD) EQ VAS score was 81.22 (16.92). Patients who had more than two iron overload complications had a significant decline in HRQoL. Patients who were on oral monotherapy had a higher utility value of 0.9180 compared to other regimen combinations.Conclusion: Lower EQ-5D-3L utility values were associated with patients who developed iron overload complications and were on multiple iron chelating agents. Emphasizing compliance to iron chelating therapy to prevent the development of complications is crucial in the effort to preserve the HRQoL of TDT patients. [ABSTRACT FROM AUTHOR]

Background: The treatment of children with transfusion-dependent thalassemia (TDT) in Malaysia has progressed since 2005. This study provides an updated health-related quality of life (HRQoL) assessment for children with the disorder and the factors affecting the HRQoL.Methods: A cross-sectional HRQoL survey of Malaysian children with TDT was conducted using the PedsQL™ 4.0 Generic Core Scales. Patients with non-transfusion dependent thalassemia and other haemoglobinopathies were excluded. Parent-proxy and self-reported HRQoL scores were obtained using a multi-stage convenient sampling. The relationship between HRQoL scores and demographic factors were tested using association, correlation and regression analysis.Results: A total of 368 patients were recruited. The mean (SD) Total Summary Score (TSS) was 80.12(13.87). Predictors for a lower TSS was an increasing age group and the use of dual chelating agents (R2 = 0.057, F (4, 359) = 5.40, p = < 0.001). The mean (SD) Physical Health Summary Score (PHSS) was 82.21 (16.82). Predictors of a higher PHSS score was being male, while predictors of a lower score was an increasing age group and parent-proxy reports(R2 = 0.075, F (5,358) = 5.80, p = < 0.001). The mean (SD) Psychosocial Health Summary Score (PCHS) was 79.39 (14.81). Predictors for a lower PCHS was the use of dual chelating agents(R2 = 0.041, F (1, 362) = 15.60, p = < 0.001). The school functioning score had the lowest mean (SD) score of 69.52(20.92) in the psychosocial dimension.Conclusion: The HRQoL of TDT children in Malaysia has improved over the last decade owing to the better access in treatment. However, further effort is needed to improve the school functioning dimension. [ABSTRACT FROM AUTHOR]

Objective: Rare diseases are often underdiagnosed, and their management is frequently complicated by a lack of access to treatment and information about the diseases. To allow for better policy planning, we sought to examine the current status of managing rare diseases in Malaysia. Methods: This study was conducted in two phases. In the first phase, we triangulated information from reviews of journal publications, documents from the Malaysian government and in-depth interviews among selected key healthcare stakeholders in Malaysia. The second phase was designed as a cross-sectional survey to estimate the number of cases and treatment coverage for rare diseases in Malaysia. Results: Malaysia has no official definition of rare disease yet but currently in the process of reviewing them for Malaysia. There are 13 rare disease specialists and a dozen medical doctors in genetic clinics around Malaysia, mainly in public health facilities. From the survey, 1,249 patients were diagnosed with rare diseases in public hospitals. Only 60% received their medications or supplements, and the rest continued with symptomatic treatment. Conclusion: Generally, Malaysia has made significant progress in the management of rare diseases, but there are still opportunities for development in critical areas. Ultimately, if all healthcare providers, government, society, and politicians work together to manage rare diseases, we will see an improvement in patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop an EQ-5D-5L value set reflecting the health preferences of the Malaysian adult population.Methods: Respondents were sampled with quotas for urbanicity, gender, age, and ethnicity to ensure representativeness of the Malaysian population. The study was conducted using a standardized protocol involving the EuroQol Valuation Technology (EQ-VT) computer-assisted interview system. Respondents were administered ten composite time trade-off (C-TTO) tasks and seven discrete choice experiment (DCE) tasks. Both linear main effects and constrained non-linear regression models of C-TTO-only data and hybrid models combining C-TTO and DCE data were explored to determine an efficient and informative model for value set prediction.Results: Data from 1125 respondents representative of the Malaysian population were included in the analysis. Logical consistency was present in all models tested. Using cross-validation, eight-parameter models for C-TTO only and C-TTO + DCE hybrid data displayed greater out-of-sample predictive accuracy than their 20-parameter, main-effect counterparts. The hybrid eight-parameter model was chosen to represent the Malaysian value set, as it displayed greater out-of-sample predictive accuracy over C-TTO data than the C-TTO-only model, and produced more precise estimates. The estimated value set ranged from - 0.442 to 1.Conclusions: The constrained eight-parameter hybrid model demonstrated the best potential in representing the Malaysian value set. The presence of the Malaysian EQ-5D-5L value set will facilitate its application in research and health technology assessment activities. [ABSTRACT FROM AUTHOR]

Purpose: To determine the psychometric properties and performance of Malay and English versions of the EQ-5D-5L descriptive instrument in the general Malaysian population.Methods: 1137 members of the Malaysian general public were sampled in this national study. Respondents were recruited by quota sampling of urbanicity, gender, age, and ethnicity. In face-to-face interviews, respondents first answered the EQ-5D-5L questionnaire administered using the EQ-Valuation Technology software, and then completed the EQ-5D-3L questionnaire on paper. A subgroup of the respondents were given paper form of EQ-5D-5L for completion within 2 weeks for test-retest reliability. Ceiling effects, response redistribution, informativity, and convergent validity were compared between EQ-5D-5L and ED-5D-3L separately by Malay and English language versions.Results: The proportion of 'full health' responses (11111) drastically decreased by 25.55% and 15.74% in the Malay and English language versions indicating lower ceiling effects in EQ-5D-5L. Inconsistencies from response redistribution was below 6% for all dimensions across languages. The measure of relative informativity was comparatively higher in EQ-5D-5L than in EQ-5D-3L in both language versions, with the exception of dimensions mobility and pain/discomfort in the English version. Convergent validity in terms of correlation with EQ-VAS was relatively better for EQ-5D-5L dimensions, with pain/discomfort of the Malay version having the strongest correlation (|r| = 0.37). Also, reliability testing revealed moderate to poor agreements on all 5L dimensions.Conclusions: EQ-5D-5L fared better in terms of psychometric performance compared to EQ-5D-3L for both language versions. This encourages the application of the EQ-5D-5L in health-related research in Malaysia. [ABSTRACT FROM AUTHOR]

Objectives The primary objective of this study was to estimate the health utility values for hypoglycaemia events according to their severity and frequency. The secondary objective was to compare the health utilities between those with Type 2 Diabetes Mellitus and the general population. Method The health utilities of hypoglycaemia event were measured using Visual Analogue Scale (VAS) and Time Trade-Off (TTO) methods among conveniently sampled consenting adults (>18 years and literate in either English or Malay language), which were then divided into two groups: those in the general population (GP) and those with Type 2 Diabetes Mellitus (T2DM). Each respondent was required to value 13 different health states, including frequencies of daytime hypoglycaemia and nocturnal hypoglycaemia, each depending on its severity (non-severe or severe). Results: 256 respondents from the GP and 99 respondents with T2DMcompleted the survey. The T2DMgroup gave higher VASvalues compared to the GP group. The highest mean VAS-utility value for non-severe nocturnal hypoglycaemia occurring once monthly was 0.543 (SD 0.161), and for severe daytime hypoglycaemia occurring once quarterly was 0.293 (SD 0.162) which was the lowest utility value compared to other health states. However, non-severe nocturnal hypoglycaemia occurring once quarterlywas 0.537 (SD 0.284) and has the highest TTO-utility value. Severe nocturnal hypoglycaemia occurring once quarterly has the lowest utility value which was -0.104 (SD 0.380). Daytime hypoglycaemia has lower utility value compared to nocturnal hypoglycaemia. Severe hypoglycaemia has a greater disutility compared with the non-severe hypoglycaemia in both studied groups. Conclusion: The findings show that as a health utility, hypoglycaemia has a substantial impact on utility with severe hypoglycaemia having a greater negative impact compared to non-severe events across the board. This highlights the importance of preventing development of severe hypoglycaemia in patients with Type 2 Diabetes Mellitus at any time of the day. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Hepatitis C is a chronic infectious liver disease that can lead to cirrhosis, liver cancer and liver failure. This study aimed to estimate the healthcare cost of treating chronic hepatitis C virus (HCV) from the perspective of Ministry of Health hospitals in Malaysia. Methods: The cost analysis study was conducted from the healthcare provider's perspective. Healthcare sector resource utilisations for managing patients with chronic hepatitis C were obtained from a retrospective cohort study of patients with hepatitis C at Sultanah Bahiyah Hospital, Malaysia, between December 2008 and 2014. These utilisations were organised by disease stage. When no patients were available for a specific stage, resource utilisations were estimated using expert opinions collected through iterative structured interviews with two gastroenterologists. Key findings: There were 112 patients included in the final analysis. Ninety‐one per cent of these were male, and patients had a mean age of 45.8 (SE 1.1) years. The mean (SE) annual total cost for ‘mild and moderate chronic HCV’ was GBP 338.08 (58.95), that for ‘compensated cirrhosis chronic HCV’ was GBP 493.39 (162.57), that for ‘recovered, no HCV, history of mild fibrosis’ was GBP 259.73 (30.79), that for ‘recovered, no HCV, history of moderate fibrosis’ was GBP 257.09 (31.10), that for ‘recovered, no HCV, history of severe fibrosis’ was GBP 359.92, that for ‘decompensated cirrhosis’ was GBP 512.89 (214.12), and that for ‘hepatocellular carcinoma’ was GBP 426.08. Conclusions: Chronic HCV infection is generally a progressively expensive condition. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate the effect of calendar packaging (CP) on medication adherence among hypertensive patients in Malaysia. Setting Outpatient Pharmacy Department, Kulim Hospital. Methods This was a parallel randomized controlled trial of CP (intervention group) versus normal pack (control group) for patients who were on daily dose antihypertensive drug (amlodipine).The primary outcome was medication adherence to amlodipine, assessed by medication possession ratio (MPR), percentage of on-time refills and Malay Version Morisky medication adherence scales. Key findings Eighty-three patients participated. The mean age (standard deviation) was 55.85 (10.25) and 56.55 (10.42) for intervention and control group respectively. This study found that intervention group has better medication adherence score than the control group measured by MPR, Morisky medication adherence score ( P < 0.05) and percentage of on-time refills ( P < 0.01). Intervention group showed a significantly lower systolic and diastolic blood pressure ( P < 0.05) compared to control group. Intervention group was significantly associated with higher medication adherence measured by MPR (β = 0.006, P < 0.05), Morisky scale (β = 0.365, P < 0.05) and percentage of on-time refill (β = 0.063, P < 0.01); in addition lower systolic blood pressure (β = −4.4, P < 0.05) after controlling for the study period and patient age. Conclusions This study found that CP could improve adherence to medication among hypertensive patients. The results also suggest possible improvement in blood pressure with the use of CP. [ABSTRACT FROM AUTHOR]

Objectives: To develop and test the feasibility and validity of a computer-based utility assessment tool that used standard gamble (SG) method for measuring asthma-specific health utilities.Methods: A computer-based SG (CBSG) tool was developed using Microsoft® PowerPoint 2007 to value asthma-specific health states in Malaysia. Eight hypothetical health states were considered, including two anchor states (healthy and dead), three chronic (C) states and three temporary (T) states (each numbered 1 through 3, with increasing severity) in addition to the subject's current health state. Twenty adult asthma patients completed the CBSG tool in addition to paper-based Asthma Control Test, three health status measures (EQ-5D, EQ-VAS, and Mini Asthma Quality of Life Questionnaire (MiniAQLQ)), and VAS utility assessment tool. Patients and interviewers rated the difficulty of the VAS and CBSG tools. Correlations between current health state values derived from the various measures were determined.Results: The SG and the VAS received similar difficulty ratings. 17 patients completed the CBSG tool within 30 minutes. The mean utilities determined by the CBSG tool for the T1-T3 asthma health states met the expected logical order of 1>2>3, but those for the C1-C3 states did not. Correlation between current health state values derived from the CBSG tool and other measurement tools was poor.Conclusion: The CBSG tool developed for measuring utilities of asthma health states showed acceptable feasibility and overall validity. [ABSTRACT FROM AUTHOR]

Background: Rare diseases, also referred to as orphan diseases, are characterised by their low prevalence with majority of them are chronically debilitating and life threatening. Given the low prevalence and the widely dispersed but very small patient base for each disease, there may often be a disproportion in the availability of treatments and resources to manage patients, spur research and train experts. This is especially true in Southeast Asian countries that are currently in the process of implementing or revising their universal health coverage schemes. This paper aims to examine the status of rare disease management in Southeast Asian countries. It will serve as the basis for a more active discussion on how countries in the region can address an under-recognised rare disease burden and enhance national and regional capacities.Methods: The study consists of literature reviews and key stakeholders interviews in six focus countries, including the Philippines, Singapore, Malaysia, Indonesia, Vietnam, and Thailand and five countries as best practice, comprising of France, Canada, Australia, Taiwan, and South Korea. Rare disease management initiatives across each country were examined based on the World Health Organization's framework for action in strengthening health systems.Results: The results suggest rare disease management remains challenging across Southeast Asia, as many of the focus countries face fundamental issues from basic healthcare systems to funding. Nonetheless, there are substantial improvement opportunities, including leveraging best practices from around the world and organising a multi-stakeholder and regional approach and strategy.Conclusions: Southeast Asian countries have made significant progress in the management of rare disease, but there remain key areas for substantial development opportunities. [ABSTRACT FROM AUTHOR]

In the Rare disease awareness and patient advocacy subsection of the Results, there is an error in the second sentence of the third paragraph. Reference 1 Shafie AA, Supian A, Ahmad Hassali MA, Ngu L- H, Thong M- K, Ayob H, et al. (2020) Rare disease in Malaysia: Challenges and solutions. The correct sentence is: Additionally, there are also many other societies, such as the Welfare Association for Dwarfism Malaysia and Spinal Muscular Atrophy (SMA) Malaysia, that represent patients according to the specific disorder. [Extracted from the article]

Aim This study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria. Methods The IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A 1 chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of <3.0 times GDPc. Comprehensive sensitivity analyses were performed. Results In the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of >1 year and was highly cost-effective, with ICERs of −0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective. Conclusion Starting BIAsp 30 in people with type 2 diabetes in the A 1 chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy. [ABSTRACT FROM AUTHOR]

Introduction: Many countries have established their own EQ-5D value sets proceeding on the basis that health preferences differ among countries/populations. So far, published studies focused on comparing value set using TTO data. This study aims to compare the health preferences among 11 Asian populations using the DCE data collected in their EQ-5D-5L valuation studies. Methods: In the EQ-VT protocol, 196 pairs of EQ-5D-5L health states were valued by a general population sample using DCE method for all studies. DCE data were obtained from the study PI. To understand how the health preferences are different/similar with each other, the following analyses were done: (1) the statistical difference between the coefficients; (2) the relative importance of the five EQ-5D dimensions; (3) the relative importance of the response levels. Results: The number of statistically differed coefficients between two studies ranged from 2 to 16 (mean: 9.3), out of 20 main effects coefficients. For the relative importance, there is not a universal preference pattern that fits all studies, but with some common characteristics, e.g. mobility is considered the most important; the relative importance of levels are approximately 20% for level 2, 30% for level 3, 70% for level 4 for all studies. Discussion: Following a standardized study protocol, there are still considerable differences in the modeling and relative importance results in the EQ-5D-5L DCE data among 11 Asian studies. These findings advocate the use of local value set for calculating health state utility. [ABSTRACT FROM AUTHOR]

Background: Malaysia has been experiencing an escalation in dengue cases since the past 5 years. As the dengue vaccine pipeline continues to develop steadily with strong public interests, this study had been sought to elicit the acceptance and the willingness to pay (WTP) for hypothetical dengue vaccine in Malaysia. Methods: This study adopted the cross-sectional, contingent valuation study that involved 400 respondents in Penang, Malaysia. The double-bounded dichotomous choice via bidding game approach was employed to elicit the WTP value for two hypothetical 3-doses dengue vaccines (Vaccines A and B with 5- and 10-years' protection, respectively against dengue). A univariate logistic regression model was employed to assess the key determinants of vaccine acceptance, while the mean WTP value and its associated factors were measured by using the parametric two-part model (TPM). Results: Dengue vaccine appeared to be highly acceptable (88.4%) among the population in Penang, Malaysia. Respondents who were of Chinese ethnicity (OR 0.36, p = 0.017), with higher dengue knowledge score (OR 1.43, p = 0.016), and higher vaccination attitude score (OR 1.91, p < 0.001) were more likely to accept the vaccine. The first step logit estimation from TPM displayed that pensioners (OR 2.37, p = 0.036), respondents who were self-employed or working in the private sector (OR 1.21, p = 0.002), respondents with higher education level (OR 2.09–3.29, p < 0.05), and those who accepted the vaccine (OR 3.23, p = 0.001) were more likely to pay for the vaccine. The adjusted mean WTP value for the vaccine was MYR39.21 (USD9.45) per dose. Next, the second-stage regression from TPM revealed the key factors that significantly affected the WTP value, which were composed of age, gender, occupation, household income, dengue prevention practice, and protection duration of the vaccine. The pensioners and those with better dengue prevention practice were willing to pay more for the vaccines. Additionally, all the respondents elicited a higher WTP amount toward the vaccine with longer protection duration (Vaccine B). Conclusion: Strong acceptance toward dengue vaccine reflects the high value of the vaccine in Malaysia. The WTP estimates offer quantification of the private benefit in reducing occurrences of the disease. Besides, the people's preferences-based WTP value for the vaccine tends to complement scientific decision-making and prioritization in the management of dengue in the country. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Unused medications have not only caused wastage, but improper disposal of unwanted medicines also has a negative impact on the environment and public health. The aim of this study was to study the public's knowledge, awareness and practice of disposing of unwanted or unused medicines in Malaysia. Methods: This was a descriptive, cross‐sectional survey conducted across Malaysia among the general public using a pre‐validated questionnaire. A non‐probability convenience sampling method was used for data collection. The approval of the study was obtained from ethics committee, and written consent was acquired from the participants prior to the data collection. Key findings: The study involved 483 subjects. Only 13.8% of the respondents scored >80% in their knowledge of the proper disposal methods. Majority of the respondents were very mindful of their responsibility towards the environment (95.3%), living species on earth (94.6%) and family members (96.7%) attributable to unintentional harmful exposure to unused medicines. Respondents admitted that they have unused medicines because they stop taking the medicines when they feel better (76.9%), doctor has changed their treatment (50.3%), experienced unwanted side effects (49%), did not take the medicines as instructed/prescribed (47.2%) and did not feel better after taking the medicines (46%). A substantial correlation has been established between the knowledge of improper disposal methods and their current practices. Conclusions: This finding suggested that a lack of knowledge and awareness is a major factor in the improper disposal of unused medicines. Therefore, an urgent need to increase public awareness through educational campaigns and Medication Return Program should be promoted more effectively. [ABSTRACT FROM AUTHOR]

Background Around the globe, community pharmacy has always been a health care hub made accessible to the public. Aim This study was conducted to evaluate consumers' perceptions towards the role of the pharmacist as health educator ( HE) and hence to identify the barriers toward consumers' acceptance of the role. Method This qualitative study was conducted in four states of Malaysia where participants (>18 years old) were recruited using a convenience sampling method until saturation of themes. A semi-structured interview guide was used and face-to-face interviews with consenting participants were conducted for approximately 20 min by trained interviewers. All interviews were audio-recorded, transcribed verbatim and evaluated using a thematic content analysis approach. Results In all, 21 consumers were interviewed. Analysis of interview transcripts identified four major themes: understanding of the term ' HE', facilitators and barriers for consumers accepting pharmacists as HE, and strategies to overcome the barriers. Most respondents acknowledged and recognised the roles of community pharmacists in terms of giving clear advice and explanations about healthcare issues and medications, and the ability to educate the public. The major barriers included the experience of the pharmacist, consumers' preferences for general practitioners as their HEs, the unavailability of pharmacists on the premises and personal encounters with pharmacists with bad attitudes. Conclusion Consumers generally accept pharmacists as HEs. However, some barriers do exist. The pharmacy stakeholders in the country need to address these barriers in order to improve future utilisation of community pharmacists as HEs in the existing healthcare system. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the association between knowledge and attitude with health-related quality of life (HRQoL) among patients with type 2 diabetes mellitus in Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional descriptive study was undertaken with a cohort of 75 patients attending the University Diabetic Center at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. The EuroQoL-five-dimensional (EQ-5D) scale was used to assess HRQoL. EQ-5D was scored using values derived from the UK general population survey. The brief diabetic knowledge test in questionnaire format developed by the University of Michigan Diabetes Research and Training Center and the attitude toward self-care questionnaire based on the diabetic care profile were used. Results: Fifty-eight (77.35%) respondents were male with a mean 12.6 ± 8.4 years of a history of diabetes. Thirty-four (45.3%) were in the age group of 45-55 years with a mean age of 54 ± 9.2 years. A moderate level of HRQoL (0.71 ± 0.22) was recorded in the study cohort. The mean EQ-5D score was lower in females compared to male patients (0.58 ± 0.23 vs. 0.74 ± 0.20). The mean score of Michigan Diabetic Knowledge Test was 8.96 ± 2.1 and the median score was 9.00. Of 75 diabetic patients, 14.7% had poor knowledge; 72% had moderate knowledge, and only 13.3% had good knowledge. The average attitude score of all respondents was 6.38 ± 2.11. There was a significant positive association between attitude and EQ-5D score. Conclusion: HRQoL and knowledge scores were moderate in type 2 diabetic patients in Riyadh, Saudi Arabia. Patient attitude toward the disease was positive, and this was positively associated with HRQoL; most respondents believed they are responsible for their care. It is likely that a high quality of diabetes self-management education program will provide benefits and affect significantly on type 2 diabetes patients in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors. Methods: All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.). Results: During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment. Conclusion: In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them. [ABSTRACT FROM AUTHOR]

Background: Chronic pain has a major impact on a patient's quality of life, affecting physical and psychological functioning. It has debilitating consequences on social and economic aspects too. This study aimed to explore the status of health-related quality of life (HRQoL) of Malaysian patients suffering from chronic non-malignant pain.Methods: Four hospitals offering pain clinic services were involved in this multicentre cross-sectional study conducted between June and September 2020. Adult patients who had been diagnosed with non-malignant chronic pain lasting for at least three months and able to communicate in English or Malay language were recruited in this study. Participants were informed about the study and were made aware that their participation was entirely voluntary. A battery of questionnaires consists of the EuroQol-5 dimensions-5 levels questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ VAS), the Pain Self-Efficacy questionnaire (PSEQ) and the Pain Catastrophizing Scale (PCS) were self-administered by the patients. Besides, a structured questionnaire was used to collect their socio-demographic information, pain condition, sleep quality and working status. Participants' usage of pain medications was quantified using the Quantitative Analgesic Questionnaire (QAQ).Results: A total of 255 patients participated in this study. A median EQ-5D index value of 0.669 (IQR: 0.475, 0.799) and a median EQ VAS score of 60.0 (IQR: 50.0, 80.0) were recorded. Malay ethnicity (Adj. B: 0.77; 95% CI: 0.029, 0.126; p = 0.002) and a higher level of self-efficacy (Adj. B: 0.008; 95% CI: 0.006, 0.011; p < 0.001) were predictors of a better HRQoL, while suffering from pain in the back and lower limb region (Adj. B: -0.089; 95% CI: - 0.142, - 0.036; p = 0.001), the use of a larger amount of pain medications (Adj. B: -0.013; 95% CI: - 0.019, - 0.006; p < 0.001), and a higher degree of pain magnification (Adj. B: -0.015; 95% CI: - 0.023, - 0.008; p < 0.001) were associated with a poorer HRQoL.Conclusions: These findings suggested that Malay ethnicity and a higher level of self-efficacy were predictors of a better HRQoL in patients with chronic pain, whereas pain-related factors such as higher usage of medication, specific pain site and pain magnification style were predictors of poorer HRQoL. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between patient's knowledge of Hepatitis-B and Health Related Quality of Life (HRQoL). Methods: A cross sectional, descriptive study was undertaken with 390 hepatitis-B patients attending two public hospitals in Quetta City, Pakistan. Knowledge of hepatitis-B was assessed using a pre-validated questionnaire. European Quality of Life scale was used for the assessment of HRQoL. Descriptive analysis was used to elaborate patients' demographic characteristics while inferential statistics were applied to report the association among study variables. Spearman's rho correlation was used to identify the association between variables. Results: Out of 390, (230, 59.5 %) were males and the mean age of the subjects was 36.2 ± 9.2 years. One hundred and three (26 %) had primary level of education and 109 (27.9 %) were employees in the private sector. Eighty four (21 %) had a monthly income of between 10001-15000 Pakistan rupees (1 PKR = 0.0115527 USD) with 272 (69.7 %) respondents resident in urban areas. Mean HRQoL and Hepatitis-B related knowledge (HBRK) scores were categorized as poor (0.37± 0.3) and (8.52 ± 2.7) respectively. The correlation coefficient between HRQoL and HBRK was -0.102 (p < 0.001), indicating a week negative association between the study variables. Conclusion: The findings indicate a negative association between Hepatitis-B related knowledge and HRQoL. Therefore, providing disease-related knowledge to patients does not necessarily improve HRQoL. More attention should be given to identify individual factors that affect HRQoL among patients with Hepatitis-B. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to evaluate senior year pharmacy students' perceptions of and knowledge about generic medicines and generic substitution and to explore factors influencing these students' future generic substitution practices. Materials and Methods: The study was conducted among third year pharmacy students studying at five public pharmacy schools located in Malaysia. A pre-validated self-administered questionnaire was used to collect the data. The questionnaire was distributed via collaborating lecturers at their respective universities after a normal class session and recollected on the same day. In addition to the descriptive analysis, inferential statistics were used to determine the association among study variables. SPSS v 17.0 was used for data analysis. Results: A total of 364 students from five different universities offering pharmacy course in Malaysia responded to the survey. Females subjugated the group (n=284, 78.0%) with mean age being 24.48±0.97 years. In response to the regulatory limits for the ratio of the areas under the plasma drug concentration versus time curves and the maximum plasma drug concentrations, only 11 (3.0%) of the respondents correctly identified the regulatory limits. Students reported mixed perceptions towards the efficacy, safety and comparability of generic medicines. Major limitations were seen whereby participants demanded more information towards safety issues of generic medicines hence reported lack of confidence in their ability of brand switching. Majority of the respondents insisted that they require additional information of bioequivalence testing were in favor that an audio/visual educational package will help them in understanding the concepts of bioequivalence and bioavailability in a much progressive manner. Conclusion: The findings highlight that pharmacy students needs a better understanding of the principles and concepts of bioavailability and bioequivalence if they are to contribute appropriately to generic medicine use. [ABSTRACT FROM AUTHOR]

Introduction: In understanding of the general public’s knowledge, attitude and practice (KAP) on the returning and disposal of unused medications is imperative towards the designing of better educational materials and policy development. The objectives of this study was to validate the Malay version of the Return and Disposal of Unused Medications (ReDiUM) questionnaire for use among Malaysian as well as to gain an understanding on these patterns of behaviour among Malaysians. Methods: The English version of the ReDiUM was translated into Malay language according to international guidelines. Content and face validity of the questionnaire was examined by experts. Subsequently, the questionnaire was pilot tested in 10 native speakers. Reliability was assessed using Cronbach’s alpha coefficients. The test-retest reliability was measured with Spearman’s Correlation Coefficient and Cohen’s κ coefficient. Public were recruited through convenient sampling for the study. Results: The study recruited 319 respondents. For test-retest reliability, all the correlation coefficient values were >0.5 indicating strong reliability (26 respondents). Except few items, most of the kappa coefficients were >0.61 indicating substantial to almost perfect agreement. Cronbach’s alpha of the KAP domains were 0.585, 0.770 and 0.759, respectively. The median knowledge score was only 50% with some negative attitudes and practices found. Conclusions: The translated questionnaire was valid and reliable for use in Malaysia with acceptable to strong internal consistency and most items with substantial to almost perfect agreement. The findings from the study provide supporting evidence for policy makers to develop interventions to help with reducing wastage and optimize healthcare expenditure. [ABSTRACT FROM AUTHOR]

Death among tuberculosis patients is one of the major reasons for non-attainment of 85% treatment success target set by World Health Organization. In this short paper, we evaluated whether the overall mortality rate in pulmonary tuberculosis is being affected by other comorbid conditions. All new smear positive pulmonary tuberculosis patients (N =336), who started their treatment at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were followed-up until December 2011. Tuberculosis treatment outcomes were reported according to six treatment outcome categories recommended by World Health Organization. The outcome category 'died' was defined as 'a patient who died due to tuberculosis or other cause during tuberculosis treatment'. Our findings showed that out of 336 smear positive pulmonary tuberculosis patients, 59 (17.6%) died during treatment (mortality rate = 1.003 cases per 1000 person-days of follow-up). Among the deceased patients, the mean age was 55.8 years (SD =16.17) and 49 were male. According to the mortality review forms, 29 deaths were tuberculosis-related, while the remaining 30 patients died due to reasons other than tuberculosis. Cerebrovascular accident (n =7), septicaemia shock (n =4) and acute coronary syndrome (n =4) were the most common non-tuberculosis related reasons for mortality in the patients. If the 30 patients, for whom tuberculosis was incidental to death, are excluded from the final cohort, the proportion of patients in the 'died' outcome category could be reduced to 9.5%. The treatment outcome criterion (i.e., died) set by World Health Organization has limitations. Therefore, it requires improvement for more objective evaluation of the performance of the National Tuberculosis Program. [ABSTRACT FROM AUTHOR]

Death among tuberculosis patients is one of the major reasons for non-attainment of 85% treatment success target set by World Health Organization. In this short paper, we evaluated whether the overall mortality rate in pulmonary tuberculosis is being affected by other comorbid conditions. All new smear positive pulmonary tuberculosis patients (N =336), who started their treatment at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were followed-up until December 2011. Tuberculosis treatment outcomes were reported according to six treatment outcome categories recommended by World Health Organization. The outcome category 'died' was defined as 'a patient who died due to tuberculosis or other cause during tuberculosis treatment'. Our findings showed that out of 336 smear positive pulmonary tuberculosis patients, 59 (17.6%) died during treatment (mortality rate = 1.003 cases per 1000 person-days of follow-up). Among the deceased patients, the mean age was 55.8 years (SD =16.17) and 49 were male. According to the mortality review forms, 29 deaths were tuberculosis-related, while the remaining 30 patients died due to reasons other than tuberculosis. Cerebrovascular accident (n =7), septicaemia shock (n =4) and acute coronary syndrome (n =4) were the most common non-tuberculosis related reasons for mortality in the patients. If the 30 patients, for whom tuberculosis was incidental to death, are excluded from the final cohort, the proportion of patients in the 'died' outcome category could be reduced to 9.5%. The treatment outcome criterion (i.e., died) set by World Health Organization has limitations. Therefore, it requires improvement for more objective evaluation of the performance of the National Tuberculosis Program. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a major public health concern, accelerated by antibiotic overuse. Inadequate knowledge among the public has been associated with inappropriate use of antibiotics. This study determined the impact of a self-developed educational leaflet for addressing specific knowledge gaps in antibiotic use among the public. Methods: This was an experimental study conducted at five hospitals and 20 primary health care clinics in the state of Perak. Adults over 18 years of age were recruited using sequential sampling. The first phase of data collection consisted of a pre-intervention assessment, an educational session, and an immediate post-intervention assessment. Each educational session was conducted by trained pharmacists and lasted approximately 15 min for each participant. A two-week post-intervention assessment was then conducted via a phone call to re-assess the participants using the same questionnaire. Results: Out of 300 questionnaires distributed, 234 were completed for our study. The mean age of participants was 40.7 ± 14.6 years old. Most of the respondents were female (143, 61.1%), Malay (162, 69.2%), and had tertiary education (162, 69.2%). A mean score was generated for each domain, with knowledge towards antibiotic resistance: 2.83 ± 1.28 pre-intervention, 3.76 ± 0.62 immediate post-intervention, and 3.67 ± 0.78 two-weeks post-intervention (total score: 4.00); knowledge towards antibiotic use: 2.03 ± 1.56 pre-intervention, 4.56 ± 1.46 immediate post-intervention, and 4.32 ± 1.48 two-weeks post-intervention (total score: 6.00); perception towards antibiotic use: 2.83 ± 1.38 pre-intervention, 4.25 ± 1.06 immediate post-intervention, and 4.22 ± 1.02 two-weeks post-intervention (total score: 5.00). Significant improvement in the mean scores were found before and after intervention in all domains (p < 0.001). Conclusion: The educational leaflet was able to address salient knowledge gaps in the participants and remained sustainable over a two-week follow-up. Thus, its inclusion into future antibiotic awareness campaigns should be encouraged. [ABSTRACT FROM AUTHOR]

Background: The general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care. Method: This study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response. Results: Response rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed. Conclusion: Overall, the study findings witnessed the expert panel’s support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate use of antibiotics has led to antimicrobial resistance, a major public health challenge worldwide. This study aimed to explore beliefs, knowledge, and practice on antibiotic use among general public. Methodology: Cross-sectional study was conducted at 13 hospitals and 44 primary health clinics in Perak from May to July 2017. Adults above 18 years, literate, and had experience in antibiotics consumption were selected through sequential sampling method. Data was collected using a self-administered questionnaire which included the three study domains i.e. belief, knowledge and practice. The questionnaire was pilot on 30 subjects. Results: Out of 2850 distributed questionnaires, 2773 returned and 2632 were included for analysis. Mean age of the respondents was 39.7 ± 14.5 years old. Most respondents were female (58.6%), Malay (74.7%) and underwent upper secondary school (45.6%). Mean score were generated for each domain with belief: 5.87 ± 3.00 (total score: 12), knowledge: 15.82 ± 3.85 (total score: 24), practice: 6.91 ± 2.07 (total score: 12). In the belief domain, 63.2% of respondents believed that antibiotics would help them to recover faster. In the knowledge domain, 52.7% of respondents inappropriately thought that antibiotics could work on viral infections. In the practice domain, 70% of respondents expected doctors to prescribe antibiotics if suffered from symptoms. Conclusion: Majority of the respondents expect doctors to prescribe antibiotics for their illness, and most believes that antibiotics can speed up recovery of illness. Lack of awareness on antibiotic resistance was found to be a significant factor associated with inappropriate antibiotic use. [ABSTRACT FROM AUTHOR]

Background: Dengue disease poses a great economic burden in Malaysia.Methods: This study evaluated the cost effectiveness and impact of dengue vaccination in Malaysia from both provider and societal perspectives using a dynamic transmission mathematical model. The model incorporated sensitivity analyses, Malaysia-specific data, evidence from recent phase III studies and pooled efficacy and long-term safety data to refine the estimates from previous published studies. Unit costs were valued in $US, year 2013 values.Results: Six vaccination programmes employing a three-dose schedule were identified as the most likely programmes to be implemented. In all programmes, vaccination produced positive benefits expressed as reductions in dengue cases, dengue-related deaths, life-years lost, disability-adjusted life-years and dengue treatment costs. Instead of incremental cost-effectiveness ratios (ICERs), we evaluated the cost effectiveness of the programmes by calculating the threshold prices for a highly cost-effective strategy [ICER <1 × gross domestic product (GDP) per capita] and a cost-effective strategy (ICER between 1 and 3 × GDP per capita). We found that vaccination may be cost effective up to a price of $US32.39 for programme 6 (highly cost effective up to $US14.15) and up to a price of $US100.59 for programme 1 (highly cost effective up to $US47.96) from the provider perspective. The cost-effectiveness analysis is sensitive to under-reporting, vaccine protection duration and model time horizon.Conclusion: Routine vaccination for a population aged 13 years with a catch-up cohort aged 14-30 years in targeted hotspot areas appears to be the best-value strategy among those investigated. Dengue vaccination is a potentially good investment if the purchaser can negotiate a price at or below the cost-effective threshold price. [ABSTRACT FROM AUTHOR]

Background: Insulin analogues have a pharmacokinetic advantage over human insulin and are increasingly used to treat diabetes mellitus. A summary of their cost effectiveness versus other available treatments was required.Objective: Our objective was to systematically review the published cost-effectiveness studies of insulin analogues for the treatment of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).Methods: We searched major databases and health technology assessment agency reports for economic evaluation studies published up until 30 September 2015. Two reviewers performed data extraction and assessed the quality of the data using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines.Results: Seven of the included studies assessed short-acting insulin analogues, 12 assessed biphasic insulin analogues, 30 assessed long-acting insulin analogues and one assessed a combination of short- and long-acting insulin analogues. Only 17 studies involved patients with T1DM, all were modelling studies and 12 were conducted in Canada. The incremental cost-effectiveness ratios (ICERs) for short-acting insulin analogues ranged from dominant to $US435,913 per quality-adjusted life-year (QALY) gained, the ICERs for biphasic insulin analogues ranged from dominant to $US57,636 per QALY gained and the ICERs for long-acting insulin analogues ranged from dominant to $US599,863 per QALY gained. A total of 15 studies met all the CHEERS guidelines reporting quality criteria. Only 26 % of the studies assessed heterogeneity in their analyses.Conclusion: Current evidence indicates that insulin analogues are cost effective for T1DM; however, evidence for their use in T2DM is not convincing. Additional evidence regarding compliance and efficacy is required to support the broader use of long-acting and biphasic insulin analogues in T2DM. The value of insulin analogues depends strongly on reductions in hypoglycaemia event rates and its efficacy in lowering glycated haemoglobin (HbA1c). [ABSTRACT FROM AUTHOR]

Objective: To improve pharmaceutical care delivery in Malaysia, the Ministry of Health (MOH) had introduced the concept of value added services (VAS). Despite its reported convenience and advantages, VAS utilization rate is low in the country. The study aims to explore patients’ understanding, beliefs and expectations towards VAS in Malaysia using the theory of planned behaviour (TPB) as the theoretical model. Methods: A qualitative methodology was used whereby face‐to‐face interviews were conducted with 12 patients who collected partial medicine supplies from government pharmacies. Participants were recruited using purposive and snowball sampling method in the state of Negeri Sembilan, Malaysia. Interviews were audio‐recorded. Verbatim transcription and thematic content analysis were performed on the data. Results: Thematic content analysis yielded five major themes: (i) attitudes towards using VAS, (ii) subjective norms, (iii) perceived behavioural control, (iv) lack of knowledge and understanding of VAS and (v) expectations towards VAS. Conclusion: The interviews explored and informed new information about salient beliefs towards pharmacy VAS. The findings suggest that VAS is still in its infancy and a more robust and effective advertising and marketing campaign is needed to boost the adoption rate. Behavioural attitudes, subjective norms and perceived control elements were discussed and serve as important variables of interest in future study. Expectations towards VAS serve as an important guideline to further improve patient‐oriented services. [ABSTRACT FROM AUTHOR]

Background: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control. Methods: This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c. Results: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P < 0.001). Higher self-efficacy score was shown to be correlated with lower HbA1c (r − 0.41, P < 0.001). Multiple linear regression analysis demonstrated that higher self-efficacy scores (b − 0.398; 95% CI: -0.024, − 0.014; P < 0.001), shorter duration of diabetes (b 0.177; 95% CI: 0.002, 0.007; P < 0.001) and smaller waist circumference (b 0.135; 95% CI: 0.006, 0.035; P = 0.006), were significantly associated with good glycaemic control. Conclusion: This study demonstrated that higher self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care. [ABSTRACT FROM AUTHOR]