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Nemzoff C, Ahmed N, Olufiranye T, Igiraneza G, Kalisa I, Chadha S, Hakiba S, Rulisa A, Riro M, Chalkidou K, Ruiz F. Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:35. [PMID: 38689271 PMCID: PMC11059575 DOI: 10.1186/s12962-024-00545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda. METHODS A rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An 'adaptive' HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting. RESULTS The analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15-49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains. Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision. CONCLUSION Dialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.
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Affiliation(s)
- Cassandra Nemzoff
- London School of Hygiene and Tropical Medicine, London, UK.
- Center for Global Development, International Decision Support Initiative, iDSI, London, UK.
| | - Nurilign Ahmed
- Center for Global Development, International Decision Support Initiative, iDSI, London, UK
| | - Tolulope Olufiranye
- Rwanda Social Security Board, Kigali, Rwanda
- Clinton Health Access Initiative, Kigali, Rwanda
| | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | | | | | - Matiko Riro
- Clinton Health Access Initiative, Kigali, Rwanda
| | | | - Francis Ruiz
- London School of Hygiene and Tropical Medicine, London, UK
- Center for Global Development, International Decision Support Initiative, iDSI, London, UK
- Imperial College London, London, UK
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Varghese L, Chang PW, Juntarasiripas S, Pham H, Uster A. Cost-effectiveness of add-on empagliflozin versus standard of care in management of CKD in Malaysia, Thailand and Vietnam - findings from a modelling study assessing an EMPA-KIDNEY eligible population, using CKD progression model. J Med Econ 2024; 27:836-848. [PMID: 38916150 DOI: 10.1080/13696998.2024.2368990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/13/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Nearly one in ten individuals in South-East Asia are estimated to be affected by chronic kidney disease (CKD). The burden of end-stage kidney disease is significant and can be heavy on the healthcare system. The recent EMPA-KIDNEY trial demonstrated a significant reduction in the risk of kidney disease progression or cardiovascular death in patients with CKD with a broad range of kidney function using add-on empagliflozin versus standard of care (SoC) alone. The objective of this study was to estimate the economic benefit of empagliflozin for patients with CKD in Malaysia, Thailand and Vietnam. METHODS An individual patient level simulation model with an annual cycle that estimates the progression of kidney function and associated risk-factors was employed. Local costs and mortality rates were estimated from a wide range of published literature. A healthcare perspective was used over a 50-year time horizon. RESULTS The use of add-on empagliflozin versus SoC alone was found to be cost-saving in Malaysia and Thailand and cost-effective (ICER: 77,838,407 Vietnam Dong/QALY vs. a willingness to pay threshold of 96,890,026/QALY) in Vietnam. The bulk of the costs avoided over a lifetime is derived from the prevention or delay of dialysis initiation or kidney transplant - the cost offsets were nearly twice the additional treatment cost. The results were similar in patients with and without diabetes and across broad range of albuminuria. CONCLUSIONS The use of add-on empagliflozin in a broad population of patients with CKD is expected to be cost-saving in Malaysia and Thailand and cost-effective in Vietnam and will help alleviate the increasing burden of CKD in the region.
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Affiliation(s)
- Lijoy Varghese
- Boehringer Ingelheim Singapore Pte. Ltd, Singapore, Singapore
| | - Poh Wan Chang
- Boehringer Ingelheim (Malaysia) Sdn. Bhd, Kuala Lumpur, Malaysia
| | | | - Hien Pham
- Boehringer Ingelheim Vietnam LLC, Ha Noi, Vietnam
| | - Anastasia Uster
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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Chang JH, Kim YC, Song SH, Kim S, Jo MW, Kim S. Shared Decision Making for Choosing renAl Replacement Therapy in Chronic Kidney Disease Patients (SDM-ART trial): study protocol for randomized clinical trial. Kidney Res Clin Pract 2023; 42:751-761. [PMID: 37098669 DOI: 10.23876/j.krcp.22.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/04/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) should be educated about their condition so that they can initiate dialysis at the optimal time and make an informed choice between dialysis modalities. Shared decision-making (SDM) empowers patients to select their own treatment and improves patient outcomes. This study aimed to evaluate whether SDM affects the choice of renal replacement therapy among CKD patients. METHODS This is a multicenter, open-label, randomized, pragmatic clinical trial. A total of 1,194 participants with CKD who are considering renal replacement therapy were enrolled. The participants will be randomized into three groups in a 1:1:1 ratio: the conventional group, extensive informed decision-making group, and SDM group. Participants will be educated twice at months 0 and 2. Videos and leaflets will be provided to all patients. Patients in the conventional group will receive 5 minutes of education at each visit. The extensive informed decision-making group will receive more informed and detailed education using intensive learning materials for 10 minutes each visit. Patients in the SDM group will be educated for 10 minutes each visit according to illness perception and item-based analysis. The primary endpoint is the ratio of hemodialysis to peritoneal dialysis and kidney transplantation among the groups. Secondary outcomes include unplanned dialysis, economic efficiency, patient satisfaction, patient evaluation of the process, and patient adherence. DISCUSSION The SDM-ART is an ongoing clinical study to investigate the effect of SDM on the choice of renal replacement therapy in patients with CKD.
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Affiliation(s)
- Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine and BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Soojin Kim
- Division of Communication and Media, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Busink E, Kendzia D, Kircelli F, Boeger S, Petrovic J, Smethurst H, Mitchell S, Apel C. A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:377-392. [PMID: 35716316 PMCID: PMC10060297 DOI: 10.1007/s10198-022-01478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients. METHODS A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]). RESULTS In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions. CONCLUSIONS Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.
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Affiliation(s)
- Ellen Busink
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany.
| | - Dana Kendzia
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | - Fatih Kircelli
- Global Medical Information & Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Sophie Boeger
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | - Jovana Petrovic
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | | | | | - Christian Apel
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
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Sangthawan P, Ingviya T, Thokanit NS, Janma J, Changsirikulchai S. Time-dependent incidence rates and risk factors for transferring to hemodialysis in patients on peritoneal dialysis under the Thai PD-First Policy. ARCH ESP UROL 2023; 43:64-72. [PMID: 35236182 DOI: 10.1177/08968608221081521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Haemodialysis (HD) transfer (HDT) is the major challenge of peritoneal dialysis (PD). This study aimed to analyse the time-dependent incidence rates and risk factors for permanent HDT in patients under Thailand's PD First policy. METHODS The records of 20,545 patients from January 2008 to June 2018 were studied. The time on therapy (TOT) was divided into 0-3, 3-12, 12-24, 24-36, 36-48 and more than 48 months. The time-dependent incidence rates and causes of PD dropout were investigated. The risk factors for HDT were analysed by multivariable Poisson regression model and presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS The main cause of PD dropout was death (45.7%) with 17.4% of the patients transferred to HD. The median (25th to 75th interquartile range) dialysis vintage was 1.4 (0.5-2.7) years. The incidence rates of HDT increased with TOT. Patients with universal coverage were transferred to HD less frequently than those with other health schemes. Patients who were illiterate or only had primary school education had a higher risk of being transferred to HD after 48 months of TOT (IRR 1.41 (95% CI 1.07-1.89)). Peritonitis within the first year of PD was the risk for HDT during 13-48 months of PD. The reasons for HDT changed with TOT. Mechanical complications followed by peritonitis were the main causes of HDT during the first 3 months, and after that peritonitis was the main reason. CONCLUSIONS The incidence of HDT increased with TOT. The risks for HDT changed over time on PD.
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Affiliation(s)
- Pornpen Sangthawan
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Thammasin Ingviya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Nintita Sripaiboonkit Thokanit
- Ramathibodi Comprehensive Cancer Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jirayut Janma
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Siribha Changsirikulchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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Putri S, Nugraha RR, Pujiyanti E, Thabrany H, Hasnur H, Istanti ND, Evasari D, Afiatin. Supporting dialysis policy for end stage renal disease (ESRD) in Indonesia: an updated cost-effectiveness model. BMC Res Notes 2022; 15:359. [PMID: 36474238 PMCID: PMC9724412 DOI: 10.1186/s13104-022-06252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are main modalities for end stage renal disease (ESRD) patients, and those have been covered by National Health Insurance (NHI) scheme since 2014 in Indonesia. This study aims to update the cost-effectiveness model of CAPD versus HD in Indonesia setting. RESULTS Compared to HD, CAPD provides good value for money among ESRD patients in Indonesia. Using societal perspective, the total costs were IDR 1,348,612,118 (USD 95,504) and IDR 1,368,447,750 (USD 96,908), for CAPD and HD, respectively. The QALY was slightly different between two modalities, 4.79 for CAPD versus 4.22 for HD. The incremental cost-effectiveness ratio (ICER) yields savings of IDR 34,723,527/QALY (USD 2460).
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Affiliation(s)
- Septiara Putri
- grid.9581.50000000120191471Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java Indonesia 16424 ,grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Ryan R. Nugraha
- grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Eka Pujiyanti
- grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Hasbullah Thabrany
- grid.9581.50000000120191471Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java Indonesia 16424 ,grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Hanifah Hasnur
- grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Novita D. Istanti
- grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Diah Evasari
- grid.9581.50000000120191471Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java Indonesia 16424
| | - Afiatin
- grid.11553.330000 0004 1796 1481Internal Medicine Department, Faculty of Medicine, Universitas Padjajaran, Bandung, West Java Indonesia 45363
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Assanatham M, Pattanaprateep O, Chuasuwan A, Vareesangthip K, Supasyndh O, Lumpaopong A, Susantitaphong P, Limkunakul C, Ponthongmak W, Chaiyakittisopon K, Thakkinstian A, Ingsathit A. Economic evaluation of peritoneal dialysis and hemodialysis in Thai population with End-stage Kidney Disease. BMC Health Serv Res 2022; 22:1384. [PMID: 36411422 PMCID: PMC9677653 DOI: 10.1186/s12913-022-08827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This study aimed to conduct a cost-utility analysis of the "Peritoneal Dialysis (PD)-First" policy in 2008 under a universal health coverage scheme and hemodialysis (HD) in Thai patients with End-stage Kidney Disease (ESKD) using updated real-practice data. METHODS Markov model was used to evaluate the cost-utility of two modalities, stratified into five age groups based on the first modality taken at 20, 30, 40, 50, and 60 years old from government and societal perspectives. Input parameters related to clinical aspects and cost were obtained from 15 hospitals throughout Thailand and Thai Renal Replacement Therapy databases. Both costs and outcomes were discounted at 3%, adjusted to 2021, and converted to USD (1 USD = 33.57 Thai Baht). One-way analysis and probabilistic sensitivity analysis were performed to assess the uncertainty surrounding model parameters. RESULTS From the government perspective, compared to PD-first policy, the incremental cost-effectiveness ratio (ICER) was between 19,434 and 23,796 USD per QALY. Conversely, from a societal perspective, the ICER was between 31,913 and 39,912 USD per QALY. Both are higher than the willingness to pay threshold of 4,766 USD per QALY. CONCLUSION By applying the updated real-practice data, PD-first policy still remains more cost-effective than HD-first policy at the current willingness to pay. However, HD gained more quality-adjusted life years than PD. This information will assist clinicians and policymakers in determining the future direction of dialysis modality selection and kidney replacement therapy reimbursement policies for ESKD patients.
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Affiliation(s)
- Montira Assanatham
- grid.10223.320000 0004 1937 0490Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, 10400 Bangkok, Thailand ,grid.10223.320000 0004 1937 0490Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road., Ratchathewi, Bangkok, Thailand
| | - Anan Chuasuwan
- grid.414501.50000 0004 0617 6015Nephrology Division, Department of Medicine, Bhumibol Adulyadej Hospital, 10220 Bangkok, Thailand
| | - Kriengsak Vareesangthip
- grid.10223.320000 0004 1937 0490Renal Division, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ouppatham Supasyndh
- grid.414965.b0000 0004 0576 1212Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Adisorn Lumpaopong
- grid.414965.b0000 0004 0576 1212Pediatric Nephrology Division, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Paweena Susantitaphong
- grid.7922.e0000 0001 0244 7875Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Chutatip Limkunakul
- grid.412739.a0000 0000 9006 7188Division of Nephrology, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Bangkok, Thailand
| | - Wanchana Ponthongmak
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road., Ratchathewi, Bangkok, Thailand
| | - Kamolpat Chaiyakittisopon
- grid.412620.30000 0001 2223 9723Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakorn Pathom, Thailand
| | - Ammarin Thakkinstian
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road., Ratchathewi, Bangkok, Thailand
| | - Atiporn Ingsathit
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road., Ratchathewi, Bangkok, Thailand
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Mc Laughlin L, Williams G, Roberts G, Dallimore D, Fellowes D, Popham J, Charles J, Chess J, Williams SH, Mathews J, Howells T, Stone J, Isaac L, Noyes J. Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways. Health Expect 2022; 25:579-606. [PMID: 34964215 PMCID: PMC8957730 DOI: 10.1111/hex.13391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 08/27/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Too many people living with chronic kidney disease are opting for and starting on hospital-based dialysis compared to a home-based kidney replacement therapy. Dialysis services are becoming financially unsustainable. OBJECTIVE This study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability. DESIGN A 2-year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public. SETTING AND PARTICIPANTS A national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study. FINDINGS Coproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies. DISCUSSION AND CONCLUSIONS Patient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services. PATIENT OR PUBLIC CONTRIBUTION Involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.
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Affiliation(s)
- Leah Mc Laughlin
- School of Medical and Health SciencesBangor UniversityBangorWalesUK
| | - Gail Williams
- Welsh Renal Clinical NetworkWelsh Health Specialised Services CommitteePontypriddWalesUK
| | | | - David Dallimore
- School of Medical and Health SciencesBangor UniversityBangorWalesUK
| | | | | | - Joanna Charles
- Centre for Health Economics and Medicines EvaluationBangor University, School of Medical and Health SciencesBangorWalesUK
| | - James Chess
- Swansea Bay University Health BoardSwanseaWalesUK
| | | | - Jonathan Mathews
- Welsh Renal Clinical NetworkWelsh Health Specialised Services CommitteePontypriddWalesUK
| | | | | | | | - Jane Noyes
- School of Medical and Health SciencesBangor UniversityBangorWalesUK
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Cheo SW, Low QJ, Lim TH, Mak WW, Yip CAK, Wong KW. A practical approach to chronic kidney disease in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:10-19. [PMID: 35440962 PMCID: PMC9004436 DOI: 10.51866/rv1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease (CKD), a common clinical problem in primary care, can be defined as any abnormality of the kidney structure and/or function that has been present for at least 3 months. Over the past 20 years, the incidence and prevalence of CKD have been increasing in Malaysia in line with the rising number of non-communicable diseases. At present, CKD has no cure. The treatment of CKD is very much dependent on early diagnosis and prevention of CKD progression. In this article, we aim to illustrate a practical approach to CKD in primary care, including diagnosis, evaluation, and management of CKD.
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Affiliation(s)
- Seng Wee Cheo
- MRCP (UK), Department of Internal Medicine, Hospital Lahad Datu, Lahad Datu Sabah, Malaysia.
| | - Qin Jian Low
- MRCP (UK), Department of Internal Medicine, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia
| | - Tzyy Huei Lim
- MRCP (UK), Department of Internal Medicine, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia
| | - Woh Wei Mak
- MRCP (UK), Department of Internal Medicine, Hospital Bentong, Bentong, Pahang, Malaysia
| | - Chow Alexander Kok Yip
- MRCP (UK), Department of Internal Medicine, Hospital Raja Permaisuri Bainun Ipoh, Perak, Malaysia
| | - Koh Wei Wong
- MRCP (UK), Nephrology Unit, Department of Internal Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
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10
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Zhang S, Li H, Cai X, Zhao C, Cao J. The association between serum cystatin C and residual renal function in peritoneal dialysis patients. Ther Apher Dial 2022; 26:1241-1246. [PMID: 35253373 DOI: 10.1111/1744-9987.13832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suojian Zhang
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Haitao Li
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Xiaoqin Cai
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Caixia Zhao
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Juan Cao
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
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11
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Liu S, Tang X, Li X, Cao F, Luo J, Zou F. Efficacy of continuous ambulatory peritoneal dialysis combined with hemodialysis versus single hemodialysis in patients with end-stage renal disease. Am J Transl Res 2021; 13:10485-10492. [PMID: 34650718 PMCID: PMC8507083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy of single hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) combined with HD in the treatment of end-stage renal disease. METHODS Seventy patients with end-stage renal disease in our hospital from January 2019 to December 2020 were included and divided into 35 patients in the single group (SG) and 35 patients in the combination group (CG) according to a random number table. The SG received HD treatment and the CG received CAPD combined with HD treatment. RESULTS Hemoglobin and serum albumin levels were higher, blood urea nitrogen (BUN) and serum creatinine (Scr) levels were lower, and interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) levels were lower in the CG than in SG at the end of treatment (P < 0.05). Ca2+ levels were higher and P3+ levels were decreased at the end of treatment in both groups compared with those before treatment (P < 0.05), and Ca2+ and P3+ levels at the end of treatment in the CG were not different from those in the SG (P > 0.05). The complication rate in the CG was 5.71%, which was lower than 25.71% in the SG (P < 0.05). Quality of life scores were higher in the CG than in the SG at the end of treatment (P < 0.05). CONCLUSION CAPD combined with HD can improve renal function and nutritional levels more significantly, control inflammatory responses more effectively, and reduce complications compared to single HD treatment in patients with end-stage renal disease.
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Affiliation(s)
- Shufeng Liu
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Xianhu Tang
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Xiaosheng Li
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Feng Cao
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Juan Luo
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Fangqin Zou
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
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12
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Wang H, Jin H, Cheng W, Qin X, Luo Y, Liu X, Fu Y, Jiang G, Lu W, Jin C, Pennington M. Cost-effectiveness analysis of hemodialysis plus hemoperfusion versus hemodialysis alone in adult patients with end-stage renal disease in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1133. [PMID: 34430574 PMCID: PMC8350641 DOI: 10.21037/atm-21-1100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022]
Abstract
Background This study evaluates the cost-effectiveness of hemodialysis (HD) plus hemoperfusion (HP) with HD alone in adult patients with end-stage renal disease (ESRD) in China. Methods A Markov model was constructed to assess the cost-effectiveness of interventions over a lifetime horizon. Model parameters were informed by the HD/HP trial, the first randomized, open-label multicenter trial comparing survival outcomes and incidence of cardiovascular disease (CVD) for HD + HP versus HD alone, and supplemented by published literature and expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) with respect to quality adjusted life-years (QALY). The robustness of the results was examined in extensive sensitivity analyses. Analyses were conducted from a healthcare perspective. Costs were reported in both Chinese Renminbi (RMB) and US Dollars (USD) in 2019 values. Results The base case ICER of HD + HP is RMB 174,486 (USD 25,251) per QALY, which is lower than the RMB 212,676 (USD 30,778) willingness-to-pay threshold of three times Gross Domestic Product. This conclusion is sensitive to the mortality for patients with no severe CVD events, the incidence of CVD events, and the cost of HP and HD. At a willingness-to-pay threshold of RMB 212,676 (USD 30,778) per QALY gained, the probability that HD + HP is cost-effective is 58%. Conclusions Our results indicate a potential for HD + HP to be cost-effective for patients with ESRD. Further evidence on the longer-term impact of HD + HP on CVD event rates and mortality unrelated to CVD is needed to robustly demonstrate the cost-effectiveness of HD + HP. Trial Registration The HD/HP trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-16009332).
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Affiliation(s)
- Haiyin Wang
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Wendi Cheng
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Xiaoxiao Qin
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Yashuang Luo
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Xin Liu
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Yuyan Fu
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Gengru Jiang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Lu
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunlin Jin
- Health Technology Assessment Research Department, Shanghai Health Development Research Centre, Shanghai, China
| | - Mark Pennington
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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13
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Ethier I, Johnson DW, Bello AK, Ye F, Osman MA, Levin A, Harris DCH, Kerr P, Liew A, Wong MG, Lunney M, Saad S, Zaidi D, Khan M, Jha V, Tonelli M, Okpechi IG, Viecelli AK. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Oceania and South East Asia. Kidney Int Suppl (2011) 2021; 11:e86-e96. [PMID: 33981474 DOI: 10.1016/j.kisu.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022] Open
Abstract
Oceania and South East Asia (OSEA) is a socioeconomically, culturally, and ethnically diverse region facing a rising epidemic of noncommunicable diseases, including chronic kidney disease (CKD). The second iteration of the International Society of Nephrology Global Kidney Health Atlas aimed to provide a comprehensive evaluation of kidney care in OSEA. Of the 30 countries/territories in OSEA, 15 participated in the survey, representing 98.5% of the region's population. The median prevalence of treated kidney failure in OSEA was 1352 per million population (interquartile range, 966-1673 per million population), higher than the global median of 787 per million population. Although the general availability, access, and quality of kidney replacement therapy (i.e., dialysis and transplantation) was high in OSEA, inequalities in accessibility and affordability of kidney replacement therapy across the region resulted in variability between countries. According to the survey results, in a third of the participating countries (mostly lower-income countries), less than half the patients with kidney failure were able to access dialysis, whereas it was readily available to all with minimal out-of-pocket costs in high-income countries; similar variability in access to transplantation was also recorded. Limitations in workforce and resources vary across the region and were disproportionately worse in lower-income countries. There was little advocacy for kidney disease, moderate use of registries, restricted CKD detection programs, and limited availability of routine CKD testing in some high-risk groups across the region. International collaborations, as seen in OSEA, are important initiatives to help close the gaps in CKD care provision across the region and should continue receiving support from the global nephrology community.
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Affiliation(s)
- Isabelle Ethier
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Kerr
- Nephrology, Monash Medical Centre, Victoria, Australia
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Muh Geot Wong
- Department of Renal Medicine, Royal North Shore Hospital, University of Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
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14
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Mak WY, Leong CT, Ong LM, Bavanandan S, Mushahar L, Goh BL, Wong HS, Ahmad G, Liew YF, Ching CH, Liu WJ, Rahmat K, Tan CHH, Ahmad MK, Hassan WHHW, Chan FS, Harun Z, Loh CL, Teng KS, Tye YL, Khan SSF, Koh KH, Abdullah R, Hooi LS. Clinical effectiveness of a Malaysian-manufactured CAPD product: A randomised trial. Perit Dial Int 2021; 41:273-283. [DOI: 10.1177/0896860821993954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:We compared the clinical effectiveness of a new peritoneal dialysis (PD) product with polyvinyl chloride-containing tubing (Stay Safe Link®, SSL) with the plastic-free alternative (Stay Safe®, STS) in patients on continuous ambulatory peritoneal dialysis (CAPD).Method:A multicentre, parallel, randomised, controlled, open-label, non-inferiority trial was conducted. Adult patients receiving CAPD were randomised in a 1:1 ratio to SSL or STS. The primary outcome was the rate of peritonitis after 1 year of follow-up.Results:A total of 472 subjects were randomised (SSL, n = 233; STS, n = 239). One subject in each group was excluded from the analysis as they withdrew consent before the first dialysis dose. Four hundred and seventy subjects (SSL, n = 232; STS, n = 238) were included in the modified intention-to-treat analysis. Non-inferiority between two groups was established as no significant difference was found in peritonitis rate (incident rate ratio: 0.91, 95% CI: 0.65–1.28). No significant difference was detected in weekly Kt/V ( p = 0.58) and creatinine clearance ( p = 0.55). However, the average ultrafiltration volume was significantly lower in SSL, with a mean difference of 93 ml ( p < 0.01). SSL also demonstrated a 2.57-times higher risk of device defect than STS (95% CI: 1.77–3.75).Conclusion:SSL was non-inferior in peritonitis rate compared to plastic-free STS over 1 year in patients requiring CAPD. There was no difference in the delivered dialysis dose, but there was a higher rate of device defects with SSL.
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Affiliation(s)
- Wen Yao Mak
- Clinical Research Centre, Penang Hospital, Ministry of Health Malaysia, George Town, Malaysia
| | - Chin Tho Leong
- Institute of Clinical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Loke Meng Ong
- Department of Medicine, Penang Hospital, Ministry of Health Malaysia, George Town, Malaysia
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Lily Mushahar
- Department of Nephrology, Tuanku Ja’afar Hospital, Ministry of Health Malaysia, Seremban, Malaysia
| | - Bak Leong Goh
- Clinical Research Centre, Serdang Hospital, Ministry of Health Malaysia, Kajang, Malaysia
| | - Hin Seng Wong
- Clinical Research Centre, Selayang Hospital, Ministry of Health Malaysia, Selangor, Malaysia
| | - Ghazali Ahmad
- Department of Nephrology, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Yew Fong Liew
- Department of Medicine, Penang Hospital, Ministry of Health Malaysia, George Town, Malaysia
| | - Chen Hua Ching
- Department of Medicine, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Wen Jiun Liu
- Department of Medicine, Sultanah Aminah Hospital, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Korina Rahmat
- Department of Nephrology, Melaka Hospital, Ministry of Health Malaysia, Melaka, Malaysia
| | - Clare Hui-Hong Tan
- Department of Nephrology, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Mohd Kamil Ahmad
- Department of Medicine, Tengku Ampuan Afzan Hospital, Ministry of Health Malaysia, Kuantan, Malaysia
| | | | - Fei Sia Chan
- Nephrology Unit, Department of Medicine, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Zaiha Harun
- Department of Nephrology, Sultanah Nur Zahirah Hospital, Ministry of Health Malaysia, Kuala Terengganu, Malaysia
| | - Chek Loong Loh
- Department of Nephrology, Raja Permaisuri Bainun Hospital, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Kok Seng Teng
- Department of Nephrology, Taiping Hospital, Ministry of Health Malaysia, Taiping, Malaysia
| | - Yi Loon Tye
- Department of Medicine, Sultanah Fatimah Hospital, Ministry of Health Malaysia, Muar, Malaysia
| | - Shahnaz Shah Firdaus Khan
- Department of Medicine, Tengku Ampuan Rahimah Hospital, Ministry of Health Malaysia, Klang, Malaysia
| | - Keng-Hee Koh
- Department of Medicine, Miri Hospital, Ministry of Health Malaysia, Miri, Malaysia
| | - Rafidah Abdullah
- Department of Medicine, Sultan Haji Ahmad Shah Hospital, Ministry of Health Malaysia, Temerloh, Malaysia
| | - Lai Seong Hooi
- Department of Medicine, Sultanah Aminah Hospital, Ministry of Health Malaysia, Johor Bahru, Malaysia
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