Economic evaluation of initial HAART regimen for HIV patients

Although highly active antiretroviral regimen' (HAART) reduces HIV-related morbidity and mortality, it affects patients and induces HIV viral resistance which could lead to more complex therapeutic regimens. The present study evaluated and compared the cost-effectiveness of a protease inhibitor based highly active antiretroviral regimen' (PHAART) with a non nucleoside reverse transcriptase inhibitor based highly active antiretroviral regimen' (NHAART) in HIV-patients. The impact of initial HAART was investigated using retrospective cost analysis over a 10-year period and 6 months prospective HRQoL analysis of 150 patients (male 125, mean age 40 years) attending the Cardiff Royal Infirmary and the University Hospital of Wales. Data was collected on each patient's care resource utilization and their health-related quality of life (HRQoL) assessed using the Health Utility Index Mark III (HUI3) questionnaire. The effect of the HAART regimen, demographic attributes and clinical characteristics on costs and HRQoL were analyzed using a multilevel model of change. A Markov Monte Carlo model was then developed to simulate the impact, and evaluate the cost effectiveness, of both regimens beyond the study time horizon. The mean monthly outpatient cost for all patients was estimated to be 237.59. Patients receiving NHAART as the initial regimen cost significantly more (p 0.01, mean 262.19) than patients receiving PHAART (mean 234.98). Other factors associated with higher costs were being a non-British national, having a low CD4 count, a high viral load, and having AIDS. Patients receiving an initial NHAART regimen had a significantly better HRQoL (p 0.05). Factors associated with a higher HRQoL included being in employment and being in the asymptomatic stage of HIV. With respect to lifetime cost-effectiveness analysis, PHAART was found to be more cost-effective as an initial regimen since the incremental cost-effectiveness ratio of 8,871 per quality adjusted life years (QALY) gained, was below the UK threshold of 30,000 per QALY. The findings of this study indicate that patients receiving NHAART as their initial regimen had higher outpatient costs than those initiated on PHAART, but had a better HRQoL. In the long term, however, PHAART was estimated to be more cost- effective than NHAART as an initial regimen for HIV patients

A qualitative study exploring perspectives towards rational use of medicines in Pakistan's Malaria Control Program (MCP)

A malária é um dos mais importantes problemas sanitários globais, que ameaça a saúde população devido às condições socioeconômicas e por razões epidemiológicas no Paquistão. Este estudo qualitativo focou-se nas perspectivas no sentido do uso racional da intervenção médica entre os funcionários do programa de controle da malária. Oito entrevistas semiestruturas com todos os funcionários que trabalham no programa de controle da malária foram conduzidas em Islamabad. As entrevistas, que eram gravadas e transcritas, foram avaliadas por análise temática do conteúdo e por todos os autores. Todos os respondentes concordaram com o êxito da implementação do programa de controle da malária no Paquistão por meio do aprimoramento do diagnóstico e de facilidades do tratamento, promovendo a gestão racional por meio do treinamento dos prescritores. Entretanto, o financiamento é, ainda, o principal desafio enfrentado para a implementação futura do programa.Malaria is one of the most important global public health problems threatening the health of the population owing to prevailing socio-economic conditions and epidemiological reasons in Pakistan. This qualitative study has focused on the perspectives held towards the rational use of medicine intervention among malaria control program officials. Eight semi-structured interviews with all officials working for the malaria control program in Islamabad were conducted. The interviews, which were audio-taped and transcribed verbatim, were evaluated by thematic content analysis and by all authors. All respondents agreed on successful implementation of the malaria control program in Pakistan for controlling malaria by improving diagnostic and treatment facilities and promoting rational case management through training of prescribers. However, funding is still the major challenge faced by the program for its future implementation

Determination of chest x-ray cost using activity based costing approach at Penang General Hospital, Malaysia

Background: Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure. Methods: Human resource cost was calculated by multiplying the mean time spent by employees doing specific activity to their per-minute salaries. The costs of consumables and clinical equipments were obtained from the procurement section of the Radiology Department. The cost of the building was calculated by multiplying the area of space used by the chest X-ray facility with the unit cost of public building department. Moreover, straight-line deprecation with a discount rate of 3% was assumed for calculation of equivalent annual costs for building and machines. Cost of electricity was calculated by multiplying number of kilo watts used by electrical appliance in the year 2010 with electricity tariff for Malaysian commercial consumers (MYR 0.31 per kWh). Results: Five activities were identified which were required to develop one chest X-ray film. Human resource, capital, consumable and electricity cost was MYR 1.48, MYR 1.98, MYR 2.15 and MYR 0.04, respectively. Total cost of single chest X-ray was MYR 5.65 (USD 1.75). Conclusion: By applying ABC approach, we can have more detailed and precise estimate of cost for specific activity or service. Choice of repeating a chest X-ray can be based on our findings, when cost is a limiting factor. Pan African Medical Journal 2012; 12:4

Consensus among healthcare stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia; a Delphi study

1.1 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. 1.2 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. 1.3 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. 1.4 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 Malaysi

Understanding and perceptions of final-year Doctor of Pharmacy students about generic medicines in Karachi, Pakistan: a quantitative insight

General objective: To evaluate the understanding and perceptions of generic medicines among final-year Doctor of Pharmacy students in Karachi, Pakistan. Methods: A 23-item survey instrument that included a question on the bioequivalence limits and Likert-type scale questions regarding the understanding and perceptions of generic medicines among the students was executed. Cronbach’s alpha was found to be 0.62. Results: Responses were obtained from 236 final-year Doctor of Pharmacy students (n=85 from a publicly funded institute; n=151 from a privately funded institute). When comparing a brand-name medicine to a generic medicine, pharmacy students scored poorly on bioequivalence limits. More than 80% of the students incorrectly answered that all the products that are rated as generic equivalents are therapeutically equivalent to each other (P<0.04). Half of the students agreed that a generic medicine is bioequivalent to the brand-name medicine (P<0.001). With regard to quality, effectiveness, and safety, more than 75% of the students disagreed that generic medicines are of inferior quality and are less effective than brand-name medicines (P<0.001). More than 50% of the students disagreed that generic medicines produce more side effects than brand-name medicines (P<0.001). Conclusion: The current study identified a positive perception toward generic medicines but also gaps in the understanding of generic medicines. Pharmacy students lacked a thorough understanding of the concepts of bioequivalence. Pharmacy academia should address these issues, which will help build confidence in generic medicines and increase the generic medicine use in Pakistan

Smoking cessation intervention: Can diabetic patients’ change their motivation to quit and nicotine dependence?

Introduction: Considering smoking tobacco is a bad habit that drive smokers to nicotine dependence; that argue an urgent need to evaluate factors keep them smoke and how a smoking cessation intervention can affect these factors and minimize their effect. As well as intervention impact on their nicotine dependence and motivation to quit. Methods: This was a randomised controlled trial involving patients with diabetes who smoked tobacco and attended the out-patient diabetes clinic at Hospital Pulau Pinang in Malaysia. Results: Among 126 participants followed over the study period, Malays represent about 41% of the participants. No significant difference between the patients in the two groups with respect to their nicotine dependence. However repeated measures test showed a significant difference over the study period but not with respect to the groups (intervention and control) Fagerström test F (2,220) = 3.663. Significant main effects were found among participants in the different groups with respect to their motivation to quit F (1,110) = 3.975. Conclusion: changing patients behaviour may need consistent and comprehensive intervention for longer time. © 2018, Pharmainfo Publications. All rights reserved

Rigor: An Essentiality in Qualitative Research

Type: Lette

Socio-demographic, cognitive status and comorbidity determinants of catastrophic health expenditure among elderly in Malaysia

An ageing population has a significant impact in terms of health care costs to the elderly, their families and societies. The elderly consume a greater volume of health care facilities and bear out-of-pocket (OOP) health expenditure for their age-related diseases (ARD) physically or mentally. The most common ARD that relates to cognitive functions is mild cognitive impairment (MCI) and dementia. The purpose of this study was to examine the socio-demographic, cognitive status and comorbidities and hospital utilisation factors that affect the likelihood of catastrophic health expenditure (CHE) among the elderly in Malaysia. A survey using multi-stage random sampling techniques recruited 2274 elderly people (60 years and above) in Johor, Perak, Selangor and Kelantan. Overall, the incidence of CHE among the elderly is 2% and the highest is in the MCI category at 2.4%. Based on logistic regression analysis, the results suggest that CHE among elderly in Malaysia are affected by socio-demographic indicators at a 5% significance level. Among the comorbidities that we studied, cancer is the only comorbidity that influenced CHE among elderly. Findings from this study should prompt policy action to financially support the poor elderly who are at risk of CHE in Malaysia especially those with MCI and dementia