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Almost all preference-based measures (PBMs) have been developed in Western countries, with none having been formulated in Asian countries. In this study, we construct a new generic PBM based on concept elicitation using interview surveys in East and Southeast Asian countries and qualitative analysis. This cross-sectional study included 225 adults recruited from 9 East and Southeast Asian countries or regions (Indonesia, Japan, Korea, mainland China, Malaysia, the Philippines, Singapore, Taiwan, and Thailand). Trained interviewers conducted semistructured interviews with 25 participants from the general population of each country/region. Qualitative data were analyzed using a content analysis approach. The selection of items was determined based on interview surveys and team member discussions. The description of items was considered based on a detailed qualitative analysis of the interview survey. A new region-specific PBM—the Asia PBM 7 dimensions instrument—was designed. It reflects East and Southeast Asian values and comprises 7 items: pain, mental health, energy, mobility, work/school, interpersonal interactions, and burden to others. The new region-specific instrument is one of the first PBMs developed in the context of non-Western countries. The Asia PBM 7 dimensions contains 7 items that address the core concepts of health-related quality of life that are deemed important based on East and Southeast Asian health concepts. • Almost all preference-based measures (PBMs) were developed in Western countries. No major PBM has been developed in non-Western countries, including East and Southeast Asian countries. A new PBM, "Asia PBM 7 dimensions" (AP-7D), was designed by concept elicitation and item selection using interview surveys. The survey included a sample of 225 East and Southeast Asian people and qualitative analysis. • The AP-7D includes the following 7 items: pain, mental health, energy, mobility, work or school, interpersonal interactions, and burden to others, which are the most bothersome symptoms and the most important health-related impacts revealed by our interview surveys. • The scores measured using the AP-7D based on Asian people's concepts may reflect the truer preference of East and Southeast Asians. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the cross-sectional convergent and known-group validity of the Malay-language EQ-5D-3L instrument in children and adults with transfusion-dependent thalassemia (TDT). A cross-sectional health-related quality of life survey involving TDT patients from 12 different treatment centers across Malaysia was conducted using the Malay PedsQL 4.0 Generic Core Scales and the Malay EQ-5D-3L questionnaire. Patients with non–TDT and other hemoglobinopathies were excluded. Convergent, discriminant, and known-group validity of the EQ-5D-3L was assessed against the PedsQL 4.0 Generic Core Scales in children. In the adult population, known-group validity of the EQ-5D-3L was assessed using an a priori hypothesis between patients' demographic characteristics and health outcomes obtained from literature. A total of 370 children and 225 adults were sampled. The mean (standard deviation) EQ-5D-3L scores of the children were 0.892 (0.082) and the adults were 0.887 (0.085). Convergent and discriminant validity was identified when correlated with the PedsQL domain in children. In both groups, known-group validity was evident when comparing groups of patients with reported problems to the group of patients with no reported problems on the EQ-5D-3L domains based on the a priori hypothesis derived from literature. This study found convergent, discriminant, and known-group validity of the Malay EQ-5D-3L in a population-based sample of patients with TDT. Hence, the instrument is valid for the assessment of health-related quality of life in children and adults with TDT in Malaysia. [ABSTRACT FROM AUTHOR]

The combination of pegylated-interferon and ribavirin (PegIFN+RBV) is currently the gold standard in treating chronic hepatitis C virus (HCV) patients in Malaysia and is reimbursed by the Malaysian authorities. This analysis evaluated the cost-effectiveness (CE) of the ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavirin (OBT/PTV/r+DSB±RBV) regimen as compared with the PegIFN+RBV or no treatment in chronic HCV Genotype 1 (GT1) treatment-naïve and treatment-experienced cirrhotic and noncirrhotic patients in Malaysia. A Markov model based on previously published CE models of HCV was adapted for the Malaysian public healthcare payer perspective, based on good modeling practices. Treatment attributes included efficacy, regimen duration, and EQ-5D treatment-related health utility. Transitional probabilities and health state health utilities were derived from previous studies. Costs were derived from Malaysian data sources. Costs and outcomes were discounted at 3.0% per year. Deterministic and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainties around key variables. Based on the analysis, patients treated with the OBT/PTV/r+DSB±RBV showed less frequent progression to compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths when compared with standard care (ie, PegIFN+RBV or no treatment). At a price of MYR 1846/day, the OBT/PTV/r+DSB±RBV regimen is cost-effective over PegIFN+RBV and yields better outcomes in terms of life-years (LYs) gained and quality-adjusted life-years (QALYs) at a higher cost, which is still well below the implied willingness to pay threshold of MYR 384 503/QALY. The OBT/PTV/r+DSB±RBV regimen is cost-effective for treatment naïve, treatment experienced, cirrhotic, and noncirrhotic GT1 chronic HCV patients in Malaysia. • In Malaysia, only the combination of Pegylated-interferon and ribavirin (PegIFN+RBV) is reimbursed by the Malaysian authorities as the gold standard in treating chronic hepatitis C virus (HCV) patients. Although the favorable cost-effectiveness (CE) profile of the ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavarin (OBT/PTV/r+DSB±RBV) regimen compared with multiple standards of care has been documented worldwide, evidence from Malaysia is limited. • This analysis evaluated the CE of the OBT/PTV/r+DSB±RBV regimen compared with PegIFN+RBV or no treatment for chronic HCV genotype 1 for treatment-naïve and treatment-experienced cirrhotic and noncirrhotic patients in Malaysia. • This CE analysis reveals that the OBT/PTV/r+DSB±RBV regimen provides superior clinical outcomes versus the current standard of care in Malaysia (ie, PegIFN+RBV and no treatment) with fewer patients treated with the OBT/PTV/r+DSB±RBV regimen experiencing HCV-related complications of CC, DCC, HCC, and liver-related deaths. In turn, patients treated with the OBT/PTV/r+DSB± RBV regimen have a favorable CE profile with higher numbers of life-years (Lys) gained and quality-adjusted life-years (QALYs) than patients treated with standard of care. [ABSTRACT FROM AUTHOR]

To describe the process and role of health technology assessment (HTA) in the context of drug policy in Malaysia. We summarized the HTA process through review of documents and reports available in the public domain combined with the authors' experience. Health technology assessment plays an integral part in prioritizing treatment in public health facilities in Malaysia, particularly for the Ministry of Health Medicines Formulary (MOHMF). The MOHMF is the reference list of drugs allowed to be prescribed in the Ministry of Health (MOH) facilities. There are 2 organizations within the MOH that conduct HTA as their core activities, namely the Malaysian Health Technology Assessment Section and the Formulary Management Branch of Pharmacy Practice & Development Division. The assessment of pharmaceuticals for the purpose of listing medicines into the MOHMF is under the purview of the Formulary Management Branch. The evidence-based assessment focuses on safety, efficacy, effectiveness, and budget impact of the drug. Cost-effectiveness evidence is currently not mandatory but is of interest to the decision makers. The assessment outcomes are considered by the MOH Medicines List Review Panel for formulary decisions. Health technology assessment has supported formulary decisions in MOH. Evidence generation needs to progress beyond efficacy or effectiveness, safety, and budget impact to incorporate cost-effectiveness. Nevertheless, there are challenges to be met to achieve this. The impact of the HTA process is currently unknown and is yet to be evaluated formally. • There are 2 organizations conducting health technology assessment (HTA) activities in the Ministry of Health Malaysia with different scopes of activities. • Health technology assessment use for drug policy in the public sector is evident in the formulary decision-making process at the national level. • Though HTA is used as part of the Ministry of Health Formulary decision making process, there is still an avenue to improve the HTA process and expand its use in drug policy decisions. [ABSTRACT FROM AUTHOR]

Background Systematic anticoagulation management clinic is recommended to manage patients on chronic warfarin therapy. In Malaysia, the service was introduced as warfarin medication therapy adherence clinic (WMTAC), which is managed by pharmacists with a physician advisory. Objectives To assess the cost-effectiveness of WMTAC in comparison with usual medical clinic (UMC), which is managed by medical officers in Kuala Lumpur Hospital, a tertiary referral hospital in Malaysia. Methods Data from a 6-month retrospective cohort study comparing the two clinics and the mean percentages of time in the therapeutic range for the patients were used to estimate the cost-effectiveness. The mean clinic costs were estimated using the time-motion study. A Markov model with a 6-monthly cycle was used to simulate lifetime cost-effectiveness from the perspective of the health care service provider. The base-case analysis assumed a cohort of patients with atrial fibrillation, 57 years of age with comorbid illnesses. The transition probabilities of these clinic outcomes were obtained from a literature search. Future costs and effectiveness were discounted by 3% to convert to present values. All costs were in Malaysian ringgit standardized for the year 2007. Results The mean 6-month treatment cost was lower for the WMTAC, which was significantly lower ( P < 0.001). The UMC was found to be dominated by the WMTAC for both intermediate and lifetime analyses. The sensitivity analysis showed that clinic consultation costs had a major impact on the cost-effectiveness analysis. Conclusions WMTAC is a more cost-effective option than UMC in Kuala Lumpur Hospital. [ABSTRACT FROM AUTHOR]

Background Patients with asthma need long-term management to maintain optimal control. In addition to routine maintenance, urgent visits and hospitalizations may be required, as these patients are prone to acute exacerbations. The aim of this study was to estimate the costs of maintenance and acute exacerbation managements in patients with asthma in a suburban public hospital in Malaysia. Methods An activity-based microcosting approach was applied to estimate the unit cost of events from the hospital’s perspective. First, activities and resources that were involved in each cost center were identified and valued against a suitable form of unit. Thereafter, the mean cost of each resource per event was calculated by dividing the product of the quantity of the resource used and the unit cost of the resource by the number of events. The mean cost per event was the sum of the cost of resources for all cost centers involved. The costs were expressed in 2014 US dollars ($) and Malaysian Ringgit (RM). Results Data were collected from 15 maintenance, 20 acute exacerbation, and 50 hospitalization events. The mean (± SD) cost of maintenance management was $48.04 (± 10.10); RM154.68 (± 32.52). The cost of acute exacerbation management in the Emergency Department was $13.50 (± 2.21), RM43.46 (± 7.10); and in the medical ward, the cost was $552.13 (± 303.41), RM1777.86 (± 976.98), per hospitalization event. Conclusion The microcosting of management of asthma-related events provides more accurate estimates that could be used in local economic studies. However, its possible limited generalizability to other types of health care settings in Malaysia needs to be kept in mind. [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]

Abstract: Objective: To describe the health-related quality of life (HRQOL) among nonprescription medicine customers in Malaysia and the factors that affect it. Methods: A nationwide cross-sectional survey was conducted among pharmacy customers in 59 randomly selected community pharmacies in Malaysia. The self-administered questionnaire included the EuroQoL five-dimensional (EQ-5D) questionnaire, the EuroQol visual analogue scale (EQ-VAS), nonprescription medicines purchase, and demographic questions. Data were analyzed by using the multivariate analysis of variance and multiple logistic regressions. Results: A total of 2729 customers enrolled in this study, with a mean EQ-5D questionnaire score of 0.92±0.15 and a mean EQ-VAS score of 69.92±24.80. Compared with the Malaysian adult population, nonprescription medicine customers have a lower mean EQ-5D questionnaire score (t =−4.49, P<0.01) and EQ-VAS score (t =−25.87, P<0.01). We found that pain/discomfort (25.6%) and anxiety/depression (13.7%) were the major HRQOL problems. Locality, age, ethnicity, household income per month, type of occupation, and type of nonprescription medicine purchased were associated with health status of nonprescription medicine customers (F 22,5286 = 2.555; Wilks’ lambda = 0.979; P< 0.01). Conclusions: The HRQOL of nonprescription medicine customers is lower than that of the general Malaysian population. Lower health status was independently associated with older age, living in rural areas, having low income and education level, and purchasing blood and blood-forming medicines from community pharmacy. [Copyright &y& Elsevier]

Abstract: Purpose: Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population. Method: This was a prevalence-based retrospective chart review that included patients who attended a pediatric neurology clinic in a tertiary referral center in Malaysia. The total first-year medical care costs were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardized for the year 2010 (One Malaysian Ringgit MYR is equivalent to 0.26 Euro or 0.32 USD). Results: The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalization and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the first-year medical care costs. Similarly, child development, seizure type, therapy type (i.e., polytherapy versus monotherapy), and therapeutic drug monitoring utilization were also not associated with the cost of management. The first-year medical care costs positively correlated with seizure frequency (r s =0.294, p =0.001). However, the only variable that significantly predict the first-year medical care costs was the type of antiepileptic drugs (R 2 =0.292, F =7.772, p <0.001). Conclusion: This investigation was the first cost analysis study of epilepsy in Malaysia. The total first-year medical care costs for 120 patients with structural-metabolic epilepsy were MYR 202,816 (i.e., MYR 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management. [Copyright &y& Elsevier]

Abstract: Objectives: To explore the validity and reliability of a disease-specific health-related quality-of-life questionnaire—the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4)—in patients with schizophrenia in Malaysia. Methods: A total of 222 outpatients with schizophrenia receiving treatment at the Universiti Kebangsaan Malaysia Medical Centre completed the SQLS-R4 in either the Malay or the English language. A generic self-report health-related quality-of-life measure—the EuroQoL group EuroQol five-dimensional questionnaire—and a measure of symptom severity—the Clinical Global Impression-Schizophrenia scale—were also administered to assess validity. Results: Good internal consistency reliability was found for both the psychosocial and vitality domains (Cronbach''s α = 0.95 and 0.85, respectively). Most items were also significantly correlated with their own scale score (r s ranging from 0.29 to 0.74). There was a moderate correlation between the SQLS-R4 “vitality” domain and the EuroQol five-dimensional questionnaire “usual activities” domain (r s = 0.44) and a large correlation between the SQLS-R4 “psychosocial” domain and the EuroQol five-dimensional questionnaire “anxiety/depression” domain (r s = 0.44–0.57). Most of the symptom dimensions of the Clinical Global Impression-Schizophrenia scale were also moderately correlated with the SQLS-R4 subscale scores. Conclusions: The SQLS-R4 is a valid and reliable health-related quality-of-life instrument for use in minimally ill patients with schizophrenia in Malaysia, but some of the items may be redundant and irrelevant. Validation of SQLS-R4 in different types of patients and various levels of illness severity is required to further verify its application. [Copyright &y& Elsevier]