Determination of Cost-Effectiveness Threshold for Health Care Interventions in Malaysia.

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.

Knowledge, attitudes, and quality of life of type 2 diabetes patients in Riyadh, Saudi Arabia.

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

Exploring the willingness to pay for a quality-adjusted life-year in the state of Penang, Malaysia.

INTRODUCTION: The incremental cost-effectiveness ratio (ICER) is typically compared with a reference value to support the cost-effectiveness of a decision. One method for estimating this value is to estimate the willingness-to-pay (WTP) for a quality-adjusted life-year (QALY). This study was conducted to explore the WTP for a QALY in the Malaysian population. METHODS: A cross-sectional, contingent valuation study was conducted in Penang, Malaysia. Respondents were selected from randomly chosen geographical grids of Penang. Respondents' sociodemographic information, qualities of life, and WTP for one additional QALY were collected using predesigned questionnaires in face-to-face interviews. WTP values were elicited using a double-bound dichotomous choice via a bidding game approach. The Heckman selection model was applied to the analysis of the mean WTP/QALY values, where the "protest zero" values, which may contribute to selection bias, were excluded. RESULTS: The mean value of WTP for an additional QALY gained was estimated to be MYR (Malaysian Ringgit) 29,080 (~USD 9,000). Key factors that affected the WTP include ethnicity and estimated monthly household income. CONCLUSION: The study findings suggested that the cost-effectiveness threshold value as studied in Penang, Malaysia was estimated to be MYR 29,080.

Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia.

BACKGROUND: Patient satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patient satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations. AIMS: The study aimed to assess patients' level of satisfaction with public healthcare services and to explore the association between socio-demographic and other study variables and patient satisfaction level. METHOD: A cross-sectional study was conducted using selfadministered questionnaires distributed to a convenience sample of the general public in Kedah, Malaysia. RESULTS: A total of 435 out of 500 people invited to participate in the study agreed to take part, giving a response rate of 87 per cent. In this study, only approximately half of the participants (n=198, 45.5 per cent) were fully satisfied with the current healthcare services. The majority of the participants agreed that doctors had given enough information about their state of health (n=222, 51 per cent) and were competent and sympathetic (n=231, 53.1 per cent). Almost half of the participants (n=215, 49.5 per cent) agreed that the doctors took their problems seriously. Only 174 (40 per cent) participants agreed that doctors had spent enough time on their consultation session. Some respondents (n=266, 61.2 per cent) agreed that healthcare professionals in the public health sector were highly skilled. The majority of the respondents described amenities, accessibility and facilities available in the public healthcare sector as good or better. In this study, waiting time was significantly associated with patient satisfaction as the results showed that those who waited longer than two hours were less satisfied with the services than those who waited under two hours. CONCLUSION: The study findings showed that approximately half of the respondents were fully satisfied with current healthcare services. In this study, waiting time was the main factor that affected patient satisfaction level. Other factors that influenced satisfaction level included the length of consultation sessions and the process of patient registration. Hence, improvement in the health services that leads to a shorter waiting time may increase the satisfaction level of patients.

Job satisfaction, organisation commitment and retention in the public workforce: a survey among pharmacists in Malaysia.

OBJECTIVES: The aims of the study were to assess job satisfaction and organisational commitment among pharmacists working in the public sector and its influence on their likelihood to stay within the public workforce. METHODS: A cross-sectional survey was conducted among all fully registered pharmacists (FRPs) in the northern states of Malaysia in 2009 (n = 467). The questionnaire consisted of three sections to capture the demographic characteristics of the respondents, assess job satisfaction and organisational commitment of the respondents and their likelihood of staying in public service. KEY FINDINGS: A total of 247 FRPs (response rate 52.9%) in the northern region of Malaysia participated in this survey. Majority of the respondents were women (n = 205, 83.0%), of Chinese ethnicity (n = 155, 62.8%), graduates from public universities (n = 173, 70.0%), single (n = 172, 69.6%), with a median age of 27 years (interquartile range (IQR) 2.0) and had worked with the Ministry of Health for a median of 2.75 years (IQR 1.63). The mean job satisfaction and organisational commitment score were 58.09 (standard deviation (SD) 11.83) and 53.46 (SD 6.65) respectively out of a maximum possible score of 90. Majority of the respondents claimed that they were likely to stay in public service (n = 176, 71.3%). Their likelihood of staying in public service was affected by respondents' gender, ethnicity, job satisfaction and organisational commitment. CONCLUSIONS: The findings from this study provide stakeholders with evidence on factors and issues affecting pharmacists' job satisfaction and commitment in the public workforce as well as the likely turnover rate with an early cohort of pharmacists affected by the compulsory service.

Importance of social pharmacy education in Libyan pharmacy schools: perspectives from pharmacy practitioners.

The present study aims to explore the perceptions among pharmacy practitioners in Libya on the importance of social pharmacy education. A qualitative methodology was employed to conduct this study. Using a purposive sampling technique, a total of ten Libyan registered pharmacists were interviewed. Based on the content analysis of the interviews, two major themes emerged, namely the understanding of social pharmacy education and the need for incorporating social pharmacy courses into the pharmacy education curriculum. The majority of the respondents knew about the concept. Of those that had no prior knowledge of this term, half of them expressed interest in knowing more about it. There was a positive perception of introducing social pharmacy into the undergraduate curricula among the respondents, and they believed that it is necessary for future pharmacists to know about social pharmacy components. The findings from the pharmacy practitioners' evaluation suggest the need to incorporate social pharmacy courses into the curricula of all pharmacy schools in Libya.

Influences on Malaysian pharmacy students' career preferences.

OBJECTIVES: To identify and evaluate factors affecting the career preferences of fourth-year bachelor of pharmacy (BPharm) students in Malaysia in the presence of a 4-year period of mandatory government service. METHODS: A validated self-administered questionnaire was used in this cross-sectional study to collect data from final-year BPharm students enrolled at 3 government-funded universities and 1 private university in Malaysia. Both descriptive and inferential statistics were used for data analysis. RESULTS: Three hundred fourteen students responded (213 from public universities and 101 from the private university). Approximately 32% of public university students and 37% of private university students ranked their own interest in pharmacy as the reason for undertaking pharmacy degree studies; 40.4% of public and 19.8% of private university respondents stated that they would enter a nonpharmacy-related career upon graduation if given the choice. Public university students ranked hospital pharmacy as their choice of first career setting (4.39, p = 0.001), while private students ranked community pharmacy first (4.1, p = 0.002). On a scale of 1 to 5, salary received the highest mean score (3.9 and 4.0, p = 0.854) as the extrinsic factor most influencing their career choice. CONCLUSIONS: Final-year students at Malaysian public universities were most interested in hospital pharmacy practice as their first career step upon graduation, while private university students were most interested in community pharmacy. The top 3 extrinsic factors rated as significant in selecting a career destination were salary, benefits, and geographical location.