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Azizam NA, Hussain M, Nauenberg E, Ang WC, Azzeri A, Smith J. Cost-effectiveness analysis of biologic sequential treatments for moderate-to-severe psoriasis: A Malaysian healthcare system perspective. PLoS One 2024; 19:e0307234. [PMID: 39240834 PMCID: PMC11379230 DOI: 10.1371/journal.pone.0307234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 07/02/2024] [Indexed: 09/08/2024] Open
Abstract
OBJECTIVE In Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia. METHODS A Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%. RESULTS First line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective. CONCLUSION Adding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia.
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Affiliation(s)
- Nor Azmaniza Azizam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Faculty of Business and Management, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia
| | - Mofakhar Hussain
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Nauenberg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wei Chern Ang
- Clinical Research Centre, Ministry of Health Malaysia, Hospital Tuanku Fauziah, Kangar, Malaysia
- Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia, Kangar, Malaysia
| | - Amirah Azzeri
- Faculty of Medicine and Health Sciences, Department of Primary Care, Public Health Unit, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Jacob Smith
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Tran BT, Tran TT, La NQ, Nguyen TTP, Nguyen MH, Huynh TMC, Vu HP. Willingness to Pay for a Quality-Adjusted Life Year among Gastrointestinal Cancer Patients at a Tertiary Hospital of Vietnam, 2022. Asian Pac J Cancer Prev 2024; 25:1725-1735. [PMID: 38809645 PMCID: PMC11318811 DOI: 10.31557/apjcp.2024.25.5.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Gastrointestinal (GI) cancer burden in Asia is increasing, and Vietnam is no exception. Assessing the affordability of achieving a quality-adjusted life year (QALY) in gastrointestinal cancer patients Vietnam, as well as identifying predictors of willingness to pay (WTP) per QALY, is crucial to decision-making around medical intervention prioritization and performing medical technology assessments for these cancers. OBJECTIVES Our study aimed to estimate WTP/QALY gained and associated factors among patients diagnosed with GI cancer at a tertiary hospital in Hue, Vietnam. METHODS A cross-sectional descriptive study, using contingent valuation methodology was conducted among 231 patients at tertiary hospital in 2022. A double limited dichotomous choice and the EQ-5D-5L were utilised to estimate WTP and QALY, respectively. Quantile regression was applied to determine predictors of WTP/QALY. RESULTS The mean and median maximum WTP/QALY gained among GI patients was $15,165.6 (42,239.6) and $4,365.6 (IQR: 1,586.5-14,552.0), respectively, which was equal to 3.68 times the 2022 gross domestic product (GDP) per capita in Vietnam. Additionally, cancer severity was found to have a significant impact on WTP per QALY gained, with a higher amount identified among patients with earlier stages of GI cancer. Furthermore, living in an urban dwelling and patients' treatment modalities were significantly associated with WTP/QALY. CONCLUSION Evidence from our study can be used to inform how decision-makers in Vietnam to determine the cost-effectiveness of GI cancer interventions.
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Affiliation(s)
- Binh Thang Tran
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Thi Tao Tran
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | - Ngoc Quang La
- Department of Epidemiology, Hanoi University of Public Health, Hanoi, Vietnam.
| | - Thi Thu Phuong Nguyen
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
| | | | | | - Hung Phuong Vu
- School of Trade & International Economics, National Economics University, Hanoi, Vietnam.
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Nu Vu A, Hoang MV, Lindholm L, Sahlen KG, Nguyen CTT, Sun S. A systematic review on the direct approach to elicit the demand-side cost-effectiveness threshold: Implications for low- and middle-income countries. PLoS One 2024; 19:e0297450. [PMID: 38329955 PMCID: PMC10852300 DOI: 10.1371/journal.pone.0297450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Several literature review studies have been conducted on cost-effectiveness threshold values. However, only a few are systematic literature reviews, and most did not investigate the different methods, especially in-depth reviews of directly eliciting WTP per QALY. Our study aimed to 1) describe the different direct approach methods to elicit WTP/QALY; 2) investigate factors that contribute the most to the level of WTP/QALY value; and 3) investigate the relation between the value of WTP/QALY and GDP per capita and give some recommendations on feasible methods for eliciting WTP/QALY in low- and middle-income countries (LMICs). A systematic review concerning select studies estimating WTP/QALY from a direct approach was carried out in seven databases, with a cut off date of 03/2022. The conversion of monetary values into 2021 international dollars (i$) was performed via CPI and PPP indexes. The influential factors were evaluated with Bayesian model averaging. Criteria for recommendation for feasible methods in LMICs are made based on empirical evidence from the systematic review and given the resource limitation in LMICs. A total of 12,196 records were identified; 64 articles were included for full-text review. The WTP/QALY method and values varied widely across countries with a median WTP/QALY value of i$16,647.6 and WTP/QALY per GDP per capita of 0.53. A total of 11 factors were most influential, in which the discrete-choice experiment method had a posterior probability of 100%. Methods for deriving WTP/QALY vary largely across studies. Eleven influential factors contribute most to the level of values of WTP/QALY, in which the discrete-choice experiment method was the greatest affected. We also found that in most countries, values for WTP/QALY were below 1 x GDP per capita. Some important principles are addressed related to what LMICs may be concerned with when conducting studies to estimate WTP/QALY.
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Affiliation(s)
- Anh Nu Vu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Minh Van Hoang
- Department of Health Economics, Hanoi University of Public Health, Hanoi City, Vietnam
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Klas Göran Sahlen
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Cuc Thi Thu Nguyen
- Department of Pharmaceutical Management and Economics, Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City, Vietnam
| | - Sun Sun
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
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Mohd Hassan NZA, Bahari MS, Raman S, Aminuddin F, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Wong MF, Mostapha M, Mohamad Nor AT, Shahari MR. Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia. BMC Health Serv Res 2024; 24:168. [PMID: 38321452 PMCID: PMC10848625 DOI: 10.1186/s12913-024-10557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH). METHODS A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model. RESULTS Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies. CONCLUSIONS The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.
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Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Mohd Shahri Bahari
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Sivaraj Raman
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Farhana Aminuddin
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Nur Amalina Zaimi
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Min Fui Wong
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Marhaini Mostapha
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
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Sim R, Chong CW, Loganadan NK, Saidoung P, Adam NL, Hussein Z, Chaiyakunapruk N, Lee SWH. Cost-Effectiveness of Glucose-Lowering Therapies as Add-on to Standard Care for People With Type 2 Diabetes in Malaysia. Value Health Reg Issues 2023; 38:9-17. [PMID: 37419012 DOI: 10.1016/j.vhri.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/21/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES This study aims to evaluate the cost-effectiveness of various glucose-lowering therapies as add-on to standard care for people with type 2 diabetes (T2D) in Malaysia. METHODS A state-transition microsimulation model was developed to compare the clinical and economic outcomes of 4 treatments: standard care, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT2is), and glucagon-like peptide-1 receptor agonists. Cost-effectiveness was assessed from a healthcare provider's perspective over a lifetime horizon with 3% discount rate in a hypothetical cohort of people with T2D. Data input were informed from literature and local data when available. Outcome measures include costs, quality-adjusted life-years, incremental cost-effectiveness ratios, and net monetary benefits. Univariate and probabilistic sensitivity analyses were performed to assess uncertainties. RESULTS Over a lifetime horizon, the costs to treat a person with T2D ranged from RM 12 494 to RM 41 250, whereas the QALYs gains ranged from 6.155 to 6.731, depending on the treatment. Based upon a willingness-to-pay threshold of RM 29 080 per QALY, we identified SGLT2i as the most cost-effective glucose-lowering treatment, as add-on to standard care over patient's lifetime, with the net monetary benefit of RM 176 173 and incremental cost-effectiveness ratios of RM 12 279 per QALY gained. The intervention also added 0.577 QALYs and 0.809 LYs compared with standard care. Cost-effectiveness acceptability curve showed that SGLT2i had the highest probability of being cost-effective in Malaysia across varying willingness-to-pay threshold. The results were robust to various sensitivity analyses. CONCLUSIONS SGLT2i was found to be the most cost-effective intervention to mitigate diabetes-related complications.
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Affiliation(s)
- Ruth Sim
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Navin Kumar Loganadan
- Department of Pharmacy, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Pantakarn Saidoung
- Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Noor Lita Adam
- Hospital Tuanku Jaafar, Ministry of Health Malaysia, Seremban Malaysia
| | - Zanariah Hussein
- Department of Medicine, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA; IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia; Center for Global Health, University of Pennsylvania, Philadelphia, PA, USA.
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Chugh Y, Jyani G, Trivedi M, Albert S, Kar SS, Patro B, Raman S, Rajsekar K, Baker RM, Donaldson C, Prinja S. Protocol for estimating the willingness-to-pay-based value for a quality-adjusted life year to aid health technology assessment in India: a cross-sectional study. BMJ Open 2023; 13:e065591. [PMID: 36797026 PMCID: PMC9936284 DOI: 10.1136/bmjopen-2022-065591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION To ensure that the evidence generated by health technology assessment (HTA) is translated to policy, it is important to generate a threshold value against which the outcomes of HTA studies can be compared. In this context, the present study delineates the methods that will be deployed to estimate such a value for India. METHODS AND ANALYSIS The proposed study will deploy a multistage sampling approach considering economic and health status for selection of states, followed by selection of districts based on Multidimensional Poverty Index (MPI) and identification of primary sampling units (PSUs) using the 30-cluster approach. Further, households within PSU will be identified using systematic random sampling and block randomisation based on gender will be done to select respondent from the household. A total of 5410 respondents will be interviewed for the study. The interview schedule will comprise of three sections including background questionnaire to elicit socioeconomic and demographic characteristics, followed by assessment of health gains, and willingness to pay (WTP). To assess the health gains and corresponding WTP, the respondent will be presented with hypothetical health states. Using time trade off method, the respondent will indicate the amount of time he/she is willing to give up at the end of life to avoid morbidities in the hypothetical health condition. Further, respondents will be interviewed about their WTP for treatment of respective hypothetical conditions using contingent valuation technique. These estimates of health gains and corresponding WTP will then be combined to ascertain the value of WTP per quality-adjusted life year. ETHICS AND DISSEMINATION The ethical approval has been obtained from the Institutional Ethics Committee (IEC) of Postgraduate Institute of Medical Education and Research, Chandigarh, India. The study outcomes will be made available for general use and interpretation of HTA studies commissioned by India's central HTA Agency.
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Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Mayur Trivedi
- Indian Institute of Public health, Gandhinagar, Gujarat, India
| | - Sandra Albert
- Indian Institutes of Public Health, Shillong, Meghalaya, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, JIPMER, Pondicherry, Pondicherry, India
| | - Binod Patro
- Department of Community Medicine & Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Orissa, India
| | - Swati Raman
- Academy of Management Sciences, Lucknow, Uttar Pradesh, India
| | - Kavitha Rajsekar
- Department of Health Research, India Ministry of Health and Family Welfare, New Delhi, Delhi, India
| | - Rachel Mairi Baker
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Cam Donaldson
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Ye Z, Abduhilil R, Huang J, Sun L. Willingness to Pay for One Additional Quality Adjusted Life Year: A Population Based Survey from China. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:893-904. [PMID: 35934772 PMCID: PMC9358064 DOI: 10.1007/s40258-022-00750-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the population's willingness to pay (WTP) for an additional quality-adjusted life-year (QALY) in China. METHODS The WTP for an additional QALY (WTP/Q) was estimated using a contingent valuation survey with quota sampling and snowball sampling, using a pre-designed questionnaire with 18 hypothetical scenarios. The change in health state was depicted by the EQ-5D-5L. The questionnaires were completed by telephone and face-to-face interviews. Two-part regression models were used to test validity and how different factors affect WTP/Q. RESULTS A total of 2008 people participated in this survey and provided 3265 WTP responses for further analysis. The average WTP/Q for the entire sample is 113,120 Renminbi (RMB) (USD 16,884), which is 1.75 times the gross domestic product (GDP) per capita. For the quality-of-life improvement scenarios, the mean WTP/Q is RMB 78,907 (USD 11,777, 1.22 times GDP per capita), which is significantly lower than the life extension scenarios (RMB 177,761, USD 26,531, 2.76 times GDP per capita). Age was found to be negatively related to positive WTP. Educational level was positively related to the probability of reporting positive WTP and the level of WTP/Q. Although the EQ-5D-5L utility scores of respondents did not prove to be statistically significant determinants of WTP/Q, the two dimensions of EQ-5D-5L, pain/discomfort and anxiety/depression, had an impact on WTP/Q. In addition, WTP/Q was higher when the health outcome had a 50% probability of occurring than when the health outcome was 100% certain. WTP/Q was higher when a lower health gain was presented to the respondent. CONCLUSION This study provides empirical evidence of the monetary value of an additional QALY from a sample of the Chinese population. In addition, a higher threshold for end-of-life therapies should be considered.
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Affiliation(s)
- Ziping Ye
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
- School of Public Administration, Hainan University, Hainan, China
| | - Raela Abduhilil
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
| | - Jiaxin Huang
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
| | - Lihua Sun
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
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Kouakou CRC, Poder TG. Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:277-299. [PMID: 34417905 DOI: 10.1007/s10198-021-01364-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 05/12/2023]
Abstract
The use of a threshold for cost-utility studies is of major importance to health authorities for making the best allocation decisions for limited resources. Regarding the increasing number of studies worldwide that seek to establish a value for a quality-adjusted life year (QALY), it is necessary to review these studies to provide a global insight into the literature. A systematic review on willingness to pay (WTP) studies focusing on QALY was conducted in eight databases up to June 26, 2020. From a total of 9991 entries, 39 studies were selected, and 511 observations were extracted for the meta-analysis using the ordinary least squares method. The results showed a predicted mean empirical value of $52,619.39 (95% CI 49,952.59; 55,286.19) per QALY in US dollars for 2018. A 1% increase in income led to an increase of 0.6% in the WTP value, while a 1-year increase in respondent age led to a decrease of 3.3% in the WTP value. Sex, education level and employment status had significant effects on WTP. Compared to face-to-face interviews, surveys conducted by the internet or telephone were more likely to have a significantly higher value of WTP per QALY, while out-of-pocket payment tended to lower the value. The prediction made for the province of Quebec, Canada, provided a QALY value of approximately USD $98,450 (CAD $127,985), which is about 2.3 times its gross domestic product (GDP) per capita in 2018. This study is consistent with the extant literature and will be useful for countries that do not yet have a preference-based survey for the value of a QALY.
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Affiliation(s)
- Christian R C Kouakou
- Department of Economics, School of Business, University of Sherbrooke, Sherbrooke, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'Île de Montréal, Montreal, Canada
| | - Thomas G Poder
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'Île de Montréal, Montreal, Canada.
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, Canada.
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Gloria MAJ, Thavorncharoensap M, Chaikledkaew U, Youngkong S, Thakkinstian A, Culyer AJ. A Systematic Review of Demand-Side Methods of Estimating the Societal Monetary Value of Health Gain. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1423-1434. [PMID: 34593165 DOI: 10.1016/j.jval.2021.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Although many reviews of the literature on cost-effectiveness thresholds (CETs) exist, the availability of new studies and the absence of a fully comprehensive analysis warrant a new review. This study systematically reviews demand-side methods for estimating the societal monetary value of health gain. METHODS Several electronic databases were searched from inception to October 2019. To be included, a study had to be an original article in any language, with a clearly described method for estimating the societal monetary values of health gain and with all estimated values reported. Estimates were converted to US dollars ($), using purchasing power parity (PPP) exchange rates and the gross domestic product (GDP) per capita (2019). RESULTS We included 53 studies; 45 used direct approach and 8 used indirect approach. Median estimates from the direct approach were PPP$ 24 942 (range 554-1 301 912) per quality-adjusted life-year (QALY), which were typically 0.53 (range 0.02-24.08) GDP per capita. Median estimates using the indirect approach were PPP$ 310 051 (range 36 402-7 574 870) per QALY, which accounted for 7.87 (range 0.68-116.95) GDP per capita. CONCLUSIONS Our review found that the societal values of health gain or CETs were less than GDP per capita. The great variety in methods and estimates suggests that a more standardized and internationally agreed methodology for estimating CET is warranted. Multiple CETs may have a role when QALYs are not equally valued from a societal perspective (eg, QALYs accruing to people near death compared with equivalent QALYs to others).
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Affiliation(s)
- Mac Ardy Junio Gloria
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anthony J Culyer
- Centre for Health Economics, University of York, York, England, UK
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Veettil SK, Kew ST, Lim KG, Phisalprapa P, Kumar S, Lee YY, Chaiyakunapruk N. Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis. BMC Gastroenterol 2021; 21:130. [PMID: 33743605 PMCID: PMC7981989 DOI: 10.1186/s12876-021-01715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/10/2021] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC). METHODS Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk-benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained. RESULTS According to NMA, the risk-benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective. CONCLUSION ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacotherapy, College of Pharmacy, The University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA.,Department of Pharmacy Practice, School of Pharmacy, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Siang Tong Kew
- Department of Internal Medicine, School of Medicine, International Medical University, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Kean Ghee Lim
- Department of Surgery, International Medical University, Negeri Sembilan, Jalan Rasah, 70300, Seremban, Malaysia
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Suresh Kumar
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, The University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA. .,School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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Ye Z, Ma J, Liu F, Wang C, Zhou Z, Sun L. A systematic review and meta-regression of studies eliciting willingness-to-pay per quality-adjusted life year in the general population. Expert Rev Pharmacoecon Outcomes Res 2021; 22:53-61. [PMID: 33464926 DOI: 10.1080/14737167.2021.1878881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES From the demand-side perspective, the monetary value of one additional quality-adjusted life year (QALY) is estimated as willingness-to-pay per QALY (WTPQ). This study aims to summarize the methods and contexts of elicitation of willingness-to-pay per quality-adjusted life year (WTPQ) in the general population and to investigate the heterogeneity of WTPQ estimates. METHODS Meta-regression analysis was conducted using Comprehensive Meta-Analysis Software. Sensitivity analyses were undertaken by replacing the lowest and highest 5% and 2.5% of WTPQ by percentiles. RESULTS 33 studies with 102 WTPQ estimates were included. The overall mean and median WTPQ estimates are $1,280,002 and $44,072, respectively. The meta-regressions demonstrated that types of health gain (quality of life or life length) and certainty of health outcomes are statistically significant factors. Furthermore, compared with online interviews, face-to-face interviews tend to yield lower WTPQ. Moreover, the declining trend of QALY gains and positive effect with statistical significance of the sample age were also noticed. CONCLUSION For valid and representative values of WTPQ, future researchers should therefore take into consideration various scenarios and investigate both health gain with certainty and uncertainty, health gain from both life length and quality of life, and different size of QALY gains.
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Affiliation(s)
- Ziping Ye
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Jia Ma
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Fuyao Liu
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Chen Wang
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Ziyang Zhou
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Lihua Sun
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
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12
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Ha TV, Hoang MV, Vu MQ, Hoang NAT, Khuong LQ, Vu AN, Pham PC, Vu CV, Duong LH. Willingness to pay for a quality-adjusted life year among advanced non-small cell lung cancer patients in Viet Nam, 2018. Medicine (Baltimore) 2020; 99:e19379. [PMID: 32118784 PMCID: PMC7478749 DOI: 10.1097/md.0000000000019379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.
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Affiliation(s)
- Thuy Van Ha
- Viet Nam Department of Health Insurance, Ministry of Health
| | | | | | | | | | - Anh Nu Vu
- Viet Nam Department of Health Insurance, Ministry of Health
| | | | - Chinh Van Vu
- Viet Nam Health Economics Association, Hanoi, Viet Nam
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13
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McDougall JA, Furnback WE, Wang BCM, Mahlich J. Understanding the global measurement of willingness to pay in health. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1717030. [PMID: 32158523 PMCID: PMC7048225 DOI: 10.1080/20016689.2020.1717030] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 05/05/2023]
Abstract
Objective: To understand the different methodologies used to elicit willingness to pay for health and the value of a statistical life year through surveys. Methodology: A systematic review of the literature was undertaken to identify studies using surveys to estimate either willingness to pay for health or the value of a statistical life year. Each study was reviewed and the study setting, sample size, sample description, survey administration (online or face to face), survey methodology, and results were extracted. The results of the studies were then compared to any published national guidelines of cost-effectiveness thresholds to determine their accuracy. Results: Eighteen studies were included in the review with 15 classified as willingness to pay and 3 value of a statistical life. The included studies covered Asia (n = 6), Europe (n = 4), the Middle East (n = 1), and North America (n = 5), with one study taking a global perspective. There were substantial differences in both the methodologies and the estimates of both willingness to pay and value of a statistical life between the different studies. Conclusion: Different methods used to elicit willingness to pay and the value of a statistical life year resulted in a wide range of estimates.
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Affiliation(s)
- Jean A. McDougall
- Health Economics and Outcomes Research, Elysia Group, LLC, New York, NY, USA
- Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Wesley E. Furnback
- Health Economics and Outcomes Research, Elysia Group, LLC, New York, NY, USA
| | - Bruce C. M. Wang
- Health Economics and Outcomes Research, Elysia Group, LLC, New York, NY, USA
- CONTACT Bruce C. M. Wang Elysia Group, LLC, 333 E 43rd Street, Apt., 1012, New York, NY10017, USA
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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14
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Ku Abd Rahim KN, Kamaruzaman HF, Dahlui M, Wan Puteh SE. From Evidence to Policy: Economic Evaluations of Healthcare in Malaysia: A Systematic Review. Value Health Reg Issues 2019; 21:91-99. [PMID: 31698173 DOI: 10.1016/j.vhri.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/26/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify and describe the various economic evaluation studies in Malaysia and to determine the range of incremental cost-effectiveness ratios (ICERs) as reported in these studies. METHODS A comprehensive search of the scientific electronic databases was conducted (Medline, EBM Reviews, Embase, and hand search) to identify all published economic evaluation studies related to Malaysian healthcare. Two researchers assessed the quality of selected studies using the Critical Appraisal Skills Programme (CASP) checklist and Quality of Health Economic Studies instrument. The assessment was also reviewed by expert members of the Technical Advisory Committee of Health Technology Economic Evaluations (TACHTEE). RESULTS A total of 64 full-text articles were assessed for eligibility and included in this systematic review. Thirty studies were partial economic evaluations; the full economic evaluations included 17 cost-effectiveness analyses and 17 cost-utility analyses. From all the reported ICERs, the majority (68%) were categorized as highly cost-effective (ICER of less than 1 gross domestic product (GDP) per capita per quality-adjusted life-years or disability-adjusted life-years gained). CONCLUSION This review identifies information gaps and loopholes in health economics research in Malaysia. Additionally, this study provides the information that the majority of published interventions in Malaysia fell within the cost-effectiveness threshold of 1 GDP per capita per quality-adjusted life-years or disability-adjusted life-years gained.
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Affiliation(s)
- Ku Nurhasni Ku Abd Rahim
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Federal Territory of Putrajaya, Malaysia
| | - Hanin Farhana Kamaruzaman
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Federal Territory of Putrajaya, Malaysia.
| | - Maznah Dahlui
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia
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15
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Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis. PLoS One 2019; 14:e0218422. [PMID: 31644577 PMCID: PMC6808325 DOI: 10.1371/journal.pone.0218422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/30/2019] [Indexed: 01/17/2023] Open
Abstract
Objectives In Malaysia, there is exponential growth of patients on dialysis. Dialysis treatment consumes a considerable portion of healthcare expenditure. Comparative assessment of their cost effectiveness can assist in providing a rational basis for preference of dialysis modalities. Methods A cost utility study of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was conducted from a Ministry of Health (MOH) perspective. A Markov model was also developed to investigate the cost effectiveness of increasing uptake of incident CAPD to 55% and 60% versus current practice of 40% CAPD in a five-year temporal horizon. A scenario with 30% CAPD was also measured. The costs and utilities were sourced from published data which were collected as part of this study. The transitional probabilities and survival estimates were obtained from the Malaysia Dialysis and Transplant Registry (MDTR). The outcome measures were cost per life year (LY), cost per quality adjusted LY (QALY) and incremental cost effectiveness ratio (ICER) for the Markov model. Sensitivity analyses were performed. Results LYs saved for HD was 4.15 years and 3.70 years for CAPD. QALYs saved for HD was 3.544 years and 3.348 for CAPD. Cost per LY saved was RM39,791 for HD and RM37,576 for CAPD. The cost per QALY gained was RM46,595 for HD and RM41,527 for CAPD. The Markov model showed commencement of CAPD in 50% of ESRD patients as initial dialysis modality was very cost-effective versus current practice of 40% within MOH. Reduction in CAPD use was associated with higher costs and a small devaluation in QALYs. Conclusions These findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective.
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16
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Ko CM, Koh CK, Kwon S. Willingness to pay for family education and counselling services provided by critical care advanced practice nurses. Int J Nurs Pract 2019; 25:e12782. [PMID: 31512357 PMCID: PMC9285694 DOI: 10.1111/ijn.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/06/2019] [Accepted: 08/10/2019] [Indexed: 11/28/2022]
Abstract
Aim The aim of this study was to estimate the economic value of a family education and counselling service provided by critical care advanced practice nurses in South Korea utilizing a contingent valuation approach. Methods A double‐bounded dichotomous choice contingent valuation method was utilized to estimate the public's willingness to pay value for an education and counselling service provided by critical care advanced practice nurses. A web‐based self‐administered survey was conducted. Results Median willingness to pay was 43 112 Korean won (35 US dollars). Higher income and younger age were associated with higher willingness to pay. Conclusion This study captured the economic value of an education and counselling service provided by critical care advanced practice nurses that is not on the benefit list under the fee‐for‐service system of the Korean National Health System. Policy makers should consider including such services in the health care system. What is already known about this topic?
Patients in intensive care units and their family members need education and counselling. Nurses and physicians recognize the importance of the education and counselling services provided by critical care advanced practice nurses. No studies have evaluated the economic value of the family education and counselling services provided by critical care advanced practice nurses.
What this paper adds?
The Korean people in this study recognized the economic value of a service provided by critical care advanced practice nurses. Income and age were found to be factors related to the economic value of the education service provided by critical care advanced practice nurses.
The implications of this paper:
This study captured the economic value of an education and counselling service provided by critical care advanced practice nurses, the fee for which is not reimbursed by the current Korean health care fee‐for‐service system. Policy makers should consider the public perception of the economic value of the education and counselling services provided by critical care advanced practice nurses when determining the benefits and the prices of services included in the Korean National Health Insurance System.
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Affiliation(s)
- Chung Mee Ko
- College of Nursing, Sungshin Women's University, Seoul, South Korea
| | - Chin Kang Koh
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Sangho Kwon
- Department of Tax and Accounting, Shingu College, Seongnam, South Korea
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17
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Gandola AE, Dainelli L, Zimmermann D, Dahlui M, Detzel P. Milk Powder Fortified with Potassium and Phytosterols to Decrease the Risk of Cardiovascular Events among the Adult Population in Malaysia: A Cost-Effectiveness Analysis. Nutrients 2019; 11:E1235. [PMID: 31151244 PMCID: PMC6627836 DOI: 10.3390/nu11061235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35-75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.
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Affiliation(s)
- Anita E Gandola
- Nestlé Research Center, 1000 Lausanne, Switzerland.
- Università della Svizzera Italiana, 6900 Lugano, Switzerland.
| | | | | | - Maznah Dahlui
- Centre of Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia.
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18
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Shafie AA, Chandriah H, Yong YV, Wan Puteh SE. Health Technology Assessment and Its Use in Drug Policy in Malaysia. Value Health Reg Issues 2019; 18:145-150. [PMID: 31082794 DOI: 10.1016/j.vhri.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/22/2019] [Accepted: 03/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the process and role of health technology assessment (HTA) in the context of drug policy in Malaysia. METHODS We summarized the HTA process through review of documents and reports available in the public domain combined with the authors' experience. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
| | - Haarathi Chandriah
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia; Pharmacy Practice & Development Division, Ministry of Health, Malaysia
| | - Yee Vern Yong
- Pharmacy Practice & Development Division, Ministry of Health, Malaysia
| | - Sharifa Ezat Wan Puteh
- United Nations University - International Institute for Global Health, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Yong YV, Shafie AA. Using a dynamic adherence Markov model to assess the efficiency of Respiratory Medication Therapy Adherence Clinic (RMTAC) on asthma patients in Malaysia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:36. [PMID: 30377414 PMCID: PMC6195711 DOI: 10.1186/s12962-018-0156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
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. Electronic supplementary material The online version of this article (10.1186/s12962-018-0156-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yee Vern Yong
- Formulary Management Branch, Pharmaceutical Services Programme, Ministry of Health Malaysia, Selangor, Malaysia
| | - Asrul Akmal Shafie
- 2Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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Loganathan T, Ng CW, Lee WS, Hutubessy RCW, Verguet S, Jit M. Thresholds for decision-making: informing the cost-effectiveness and affordability of rotavirus vaccines in Malaysia. Health Policy Plan 2018; 33:204-214. [PMID: 29228339 DOI: 10.1093/heapol/czx166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 12/21/2022] Open
Abstract
Cost-effectiveness thresholds (CETs) based on the Commission on Macroeconomics and Health (CMH) are extensively used in low- and middle-income countries (LMICs) lacking locally defined CETs. These thresholds were originally intended for global and regional prioritization, and do not reflect local context or affordability at the national level, so their value for informing resource allocation decisions has been questioned. Using these thresholds, rotavirus vaccines are widely regarded as cost-effective interventions in LMICs. However, high vaccine prices remain a barrier towards vaccine introduction. This study aims to evaluate the cost-effectiveness, affordability and threshold price of universal rotavirus vaccination at various CETs in Malaysia. Cost-effectiveness of Rotarix and RotaTeq were evaluated using a multi-cohort model. Pan American Health Organization Revolving Fund's vaccine prices were used as tender price, while the recommended retail price for Malaysia was used as market price. We estimate threshold prices defined as prices at which vaccination becomes cost-effective, at various CETs reflecting economic theories of human capital, societal willingness-to-pay and marginal productivity. A budget impact analysis compared programmatic costs with the healthcare budget. At tender prices, both vaccines were cost-saving. At market prices, cost-effectiveness differed with thresholds used. At market price, using 'CMH thresholds', Rotarix programmes were cost-effective and RotaTeq were not cost-effective from the healthcare provider's perspective, while both vaccines were cost-effective from the societal perspective. Using other CETs, both vaccines were not cost-effective at market price, from the healthcare provider's and societal perspectives. At tender and cost-effective prices, rotavirus vaccination cost ∼1 and 3% of the public health budget, respectively. Using locally defined thresholds, rotavirus vaccination is cost-effective at vaccine prices in line with international tenders, but not at market prices. Thresholds representing marginal productivity are likely to be lower than those reflecting human capital and individual preference measures, and may be useful in determining affordable vaccine prices.
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Affiliation(s)
- Tharani Loganathan
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.,Julius Centre University of Malaya, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Way-Seah Lee
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.,University Malaya Paediatrics and Child Health Research Group, Kuala Lumpur 50603, Malaysia
| | - Raymond C W Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, Geneva CH-1211, Switzerland
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Mark Jit
- Modeling and Economics Unit, Public Health England, London NW9 5EQ, UK and.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Lim KK, Yoon SY, Mohd Taib NA, Shabaruddin FH, Dahlui M, Woo YL, Thong MK, Teo SH, Chaiyakunapruk N. Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:395-406. [PMID: 29572724 DOI: 10.1007/s40258-018-0384-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. METHODS We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. RESULTS In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. CONCLUSIONS Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.
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Affiliation(s)
- Ka Keat Lim
- Health Systems and Services Research, Duke NUS Medical School, 8 College Road, 169857, Singapore, Republic of Singapore
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd Floor, MMA House, 124 Jalan Pahang, 53000, Kuala Lumpur, Malaysia
| | - Sook Yee Yoon
- Cancer Research Malaysia, 2nd floor, Outpatient Centre, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Fatiha Hana Shabaruddin
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Meow Keong Thong
- Department of Paediatrics, Faculty Of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, 2nd floor, Outpatient Centre, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Muang, Phitsanulok, Thailand.
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform , Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
- School of Pharmacy, University of Wisconsin, Madison, USA.
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Voon HY, Shafie AA, Bujang MA, Suharjono HN. Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit. J Obstet Gynaecol Res 2018; 44:109-116. [PMID: 29027315 PMCID: PMC5813149 DOI: 10.1111/jog.13486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/22/2017] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post-partum hemorrhage (PPH) during cesarean deliveries. METHODS A systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period. RESULTS Seven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70. CONCLUSION Reduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.
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Affiliation(s)
- Hian Yan Voon
- Department of Obstetrics and GynecologySri Aman HospitalSarawakMalaysia
| | - Asrul A. Shafie
- School of Pharmaceutical SciencesUniversity of Science MalaysiaPenangMalaysia
| | | | - Haris N. Suharjono
- Department of Obstetrics and GynecologySarawak General HospitalKuchingMalaysia
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Mohd-Tahir NA, Thomas P, Mohamed-Said MS, Makmor-Bakry M, Li SC. Cost-effectiveness of bisphosphonates for prevention of fracture related to glucocorticoid-induced osteoporosis in Malaysia. Int J Rheum Dis 2017; 21:647-655. [PMID: 29105349 DOI: 10.1111/1756-185x.13206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Glucocorticoid therapy is associated with an appreciable risk of bone loss leading to fractures that require expensive treatments. This study aimed to evaluate the cost-effectiveness of bisphosphonates for prevention of hip fracture in glucocorticoid-induced osteoporosis (GIOP) in Malaysia. METHOD Retrospective data were collected from GIOP patients referred to the Universiti Kebangsaan Malaysia Medical Centre. Fracture events and direct medical costs were compared between bisphosphonates and calcium/vitamin D combination. RESULTS Fracture events were reported in 28 out of 93 included patients, with hip and vertebral fractures representing 42.9% and 35.7%, respectively. Overall, the use of bisphosphonates could not be considered cost-effective for treatment of all GIOP patients. The presence of certain fracture risk factors was able to modify the cost-effectiveness of bisphosphonates. Bisphosphonates was considered cost-effective if started in patients more than 60 years old. However, the use of bisphosphonates was not cost-effective in GIOP patients with secondary osteoporosis. The incremental cost-effectiveness ratios (ICER) of bisphosphonates in patients with risk factors of previous fracture or rheumatoid arthritis were Malaysian Ringgits (MYR) 108 603.40 and MYR 25 699.21, respectively. CONCLUSION Fracture risk factors of age, previous fracture, rheumatoid arthritis and secondary osteoporosis may modify the cost-effectiveness outcomes of bisphosphonates. Bisphosphonates would be considered cost-effective in patients more than 60 years old as compared to calcium/vitamin D treatments. Further evaluation of the impact of fracture risk factors in larger populations would provide more precise information to better assist rational and economical use of anti-osteoporosis treatment in GIOP patients.
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Affiliation(s)
- Nurul-Ain Mohd-Tahir
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shu-Chuen Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
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Lim YW, Shafie AA, Chua GN, Ahmad Hassali MA. Determination of Cost-Effectiveness Threshold for Health Care Interventions in Malaysia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1131-1138. [PMID: 28964445 DOI: 10.1016/j.jval.2017.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 04/04/2017] [Accepted: 04/08/2017] [Indexed: 05/26/2023]
Abstract
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.
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Affiliation(s)
- Yen Wei Lim
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Gin Nie Chua
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Health Economics Research Unit/Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Mohammed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Thanimalai S, Shafie AA, Ahmad Hassali MA, Sinnadurai J. Cost-Effectiveness of Warfarin Medication Therapy Adherence Clinic versus Usual Medical Clinic at Kuala Lumpur Hospital. Value Health Reg Issues 2017; 15:34-41. [PMID: 29474176 DOI: 10.1016/j.vhri.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/04/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Subramaniam Thanimalai
- Universiti Sains Malaysia, Penang, Malaysia; Ministry of Health Malaysia, Putrajaya, Malaysia
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Shafie AA, Yeo HY, Coudeville L, Steinberg L, Gill BS, Jahis R. The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling. PHARMACOECONOMICS 2017; 35:575-589. [PMID: 28205150 DOI: 10.1007/s40273-017-0487-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, George Town, Penang, Malaysia.
| | - Hui Yee Yeo
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, George Town, Penang, Malaysia
| | | | - Lucas Steinberg
- Sanofi Pasteur Malaysia, Unit TB-18-1, Level 18, Tower B, Plaza 33, No. 1 Jalan Kemajuan, Seksyen 13, 46200, Petaling Jaya, Selangor, Malaysia
| | - Balvinder Singh Gill
- Disease Control Division, Ministry of Health Malaysia, Block E1, E3, E6, E7 and E10, Parcel E, Federal Government Administration Centre, 62590, Putrajaya, Malaysia
| | - Rohani Jahis
- Disease Control Division, Ministry of Health Malaysia, Block E1, E3, E6, E7 and E10, Parcel E, Federal Government Administration Centre, 62590, Putrajaya, Malaysia
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Moradi N, Rashidian A, Rasekh HR, Olyaeemanesh A, Foroughi M, Mohammadi T. Monetary Value of Quality-Adjusted Life Years (QALY) among Patients with Cardiovascular Disease: a Willingness to Pay Study (WTP). IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2017; 16:823-833. [PMID: 28979338 PMCID: PMC5603894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The aim of this study was to estimate the monetary value of a QALY among patients with heart disease and to identify its determinants. A cross-sectional survey was conducted through face-to-face interview on 196 patients with cardiovascular disease from two heart hospitals in Tehran, Iran, to estimate the value of QALY using disaggregated and aggregated approaches. The EuroQol-5 Dimension (EQ-5D) questionnaire, Visual Analogue Scale (VAS), Time Trade-Off (TTO) and contingent valuation WTP techniques were employed, first to elicit patients' preferences and then, to estimate WTP for QALY. The association of patients' characteristics with WTP for QALY, was assessed through Heckman selection model. The Mean willingness to pay per QALY, estimated by the disaggregated approach ranged from 2,799 to 3599 US dollars. It is higher than the values, estimated from aggregated methods (USD 2,256 to 3,137). However, in both approaches, the values were less than one Gross Domestic Product (GDP) per capita of Iran. Significant variables were: Current health state, education, age, marital status, number of comorbidities, and household's cost group. Our results challenge two major issues: the first, is a policy challenge which concerns the WHO recommendation to use less than 3 GDP per capita as a cost-effectiveness threshold value. The second, is an analytical challenge related to patients with zero QALY gain. More scrutiny is suggested on the issue of how patients with full health state valuation should be dealt with and what arbitrary value could be included in the estimation value of QALY when the disaggregated approach used.
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Affiliation(s)
- Najmeh Moradi
- School of Pharmacy ,Shahid Beheshti University of medical sciences, Tehran, Iran
| | - Arash Rashidian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Rasekh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Economics Department, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnoosh Foroughi
- cardiovascular research center, Shahid Beheshti University of medical sciences, Tehran, Iran
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