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2 n d P h a r m a c o e c o n o m i c s a n d O u t c o m e R e s e a r c h C o n f e r e n c e 2 0 1 4

“ P h a r m a c o e c o n o m i c s i n H e a l t h c a r e T r a n s f o r m a t i o n : T o w a r d s U n i v e r s a l C o v e r a g e ”1

“PHARMACOECONOMICS IN HEALTHCARE TRANSFORMATION:TOWARDS UNIVERSAL COVERAGE”

2nd PHARMACOECONOMICS ANDOUTCOME RESEARCH CONFERENCE 2014

THE ROYALE CHULAN, KUALA LUMPUR, MALAYSIA • 7-9 MARCH 2014

ORGANISING COMMITTEE

Conference Advisor : Prof. Dato’ Dr. Syed Mohamed AljunidOrganising Chairperson : Dr. Soraya AzmiSecretaries : Lee Sit Wai and Nurul Azwani Nadia MansorTreasurer : Kathleen Yeoh

SUB-COMMITTEE

VOLUNTEERS

COMMITTEES CHAIRPERSON MEMBERS

Secretariat Zaiton Kamarruddin Lee Sit WaiNurul Azwani Nadia MansorAinil Hawa MohammedZulhelmi Ghazali

Registration Noormah Darus Noorharlina Che ZakariaHong Li Wen

Scientific committee Prof. Dato’ Dr. Syed Mohamed Aljunid Dr. Faridah Aryani Md. YusofDr. Soraya Azmi

Poster and Podium Assoc. Prof. Sharifa Ezat Wan Puteh Assoc. Prof. Asrul Akmal ShafieJudging Committee Dr. Nurnajayati Omar

Siti Athirah Zafirah

Treasury and Finance Kathleen Yeoh

Sponsorship Azuana Ramli

Protocol Prof. Dr. Samsinah Hj Hussain Anis TalibRosliza LajisNorhana Nawawi SuriCelynn Lim Ian Rhan

Publicity and Publication Dr. Ramli Zainal Nametjan MemetAdrian Goh

Audio-visual Dr. Zafar Ahmed Al-abed Ali AhmedMahpirat Abduweli

Secretariat Sarah Diyana ShafieMohd Naqib Zainal AbidinAngeline Lim

Registration Nurul Rahmah Abdul RahimSiti Suhaila HashimSafura SaadNoor Atiqah Mat Yusoff

Protocol Asmahani MaheranNoorul Aimi DaudPuteri Juanita Zamri

Treasury and Finance Malyanah SuparmanFelix Emperit

COMMITTEES VOLUNTEERS

Content

ì 2ORGANISING COMMITTEE

ì 2SUB-COMMITTEE

ì 2VOLUNTEERS

ì 3FOREWORD fromTHE HONOURABLE MINISTER OF HEALTH, MALAYSIA

ì 3WELCOME MESSAGE from Founding President, MYSPOR

ì 3Message from the Organizing Committee *ChairS

ì 4Conference At a Glance

ì 5Pre-Conference Workshop

ì 6SYNOPSIS OF PRESENTATIONS

ì 9List of Abstract

ì 16Scientific abstract

ì 26PROFILE OF SPEAKERS



First and foremost, I would like to thank theorganizers for the invitation to pen a few

words on the occasion of the 2ndPharmacoeconomics and OutcomeResearch Conference 2014. Heartiestcongratulations to the organizers of thisimportant conference - the Malaysian Societyfor Pharmacoeconomics and OutcomeResearch (MySPOR), which is a chapter ofthe International Society forPharmacoeconomics and OutcomesResearch (ISPOR). I would also like to thankthe United Nations University-InternationalInstitute for Global Health (UNU-IIGH) andthe Pharmaceutical Services Division of theMinistry of Health, as co-organisers of thissignificant event, for their invaluablecontribution towards the success of thisconference as well as their endeavour topromote pharmacoeconomic research.

Healthcare delivery systems all aroundthe world are faced with the perennial

problem of rising costs and thus, efforts arebeing made to enhance efficiency. In thiscost-conscious era, pharmacoeconomicresearch has evolved to become a significantfield of research and clearly has an importantrole to play. Pharmacoeconomic evaluationidentifies measures and compares the costsand benefits of pharmaceutical products andservices in order to make rational therapeuticchoices, thus enhancing efficiency.

The theme of this conference,“Pharmacoeconomics in Healthcare

Transformation: Towards UniversalCoverage”, reflects our noble goal ofachieving universal health coverage inMalaysia, which I am pleased to say, we arewell on the road to achieving. I am alsopleased that this conference will bringtogether local experts as well as expertsfrom abroad to exchange ideas and learnfrom one another, with the noble aim ofensuring that our patients, who are after allthe centre of the healthcare Universe, willultimately benefit from our concerted efforts.We are after all, a nation working together forbetter health.

Finally, allow me to congratulate allcommittee members as well as everyone

concerned, for their hard work and dedicationin ensuring the success of this conference.Wishing all of you a fruitful and memorableconference.

It gives me great pleasure to welcome allparticipants to this Second

Pharmacoeconomics and Outcome ResearchConference 2014. We have chosen the themethis year as “Pharmacoeconomics in HealthcareTransformation: Towards Universal Coverage”.Our focus on universal coverage is in-line withthe efforts made by many developing countries inthe world today in re-shaping their health caresystems to extend health services to cover allsectors of the population. Researchers in the fieldof pharmacoeconomics will have the opportunityto deliberate on how we can contribute to assistpolicy makers in these countries to stretch scarceresources to achieve this noble goal. Continuingincrease in cost of drugs and medical equipmentposed major challenges for developing countriesto meet healthcare needs and demand of thegrowing population. MYSPOR, since its inceptionfive years ago, set our mission to promoteresearch and development inpharmacoeconomics. We are confident that theoutcome of these studies will be utilised bydecision makers in providing sustainable solutionto current issues affecting our nation’s healthsystem. MYSPOR is also established to serve asa platform for those interested inpharmacoeconomics to sharpen their skills andknowledge in this discipline.

On behalf of MYSPOR, I would like to thankMinistry of Health Malaysia and United

Nations University International Institute forGlobal Health (UNU-IIGH) for providing thesupport to co-organize this Conference. Oursponsors from the industries have given us greathelp to enable us to bring in speakers especiallyfrom outside Malaysia.

I would like to thank members of the organizingcommittee who has been working diligently to

prepare the programme and bring in experts fromvarious part of the world to this conference eventhough they are working with the constraints oftime and finance. I would like to acknowledge allour advisors who have given us valuable input toimprove the organization as well as the content ofthe conference programme.

Finally, it is my sincere hope that you will havean enjoyable as well as fruitful time in the next

three days and I look forward to meeting all ofyou in this Conference.

On behalf of the organizing committee, it is apleasure to welcome you all to the second

biennial event that MySPOR is organizing as asociety. Since the last conference in 2012, therehas been an increasing interest in the fieldparallel to evolving changes within thegovernment submission processes particularly atthe Pharmaceutical Services Division. As thecountry aspires to become a developed nation in2020, it is heartening to see evidence-baseddecision-making being given an even greaterpriority, in line with practices in other developedcountries in the region and the world. With thesesteps, after Thailand, Malaysia is the secondnation in South East Asia to take onpharmacoeconomics in formulary decisions.

The current conference programme has beendeveloped to build upon discussions and

content presented at the last conference. Thecontent was developed with several foldintentions, which were to delve deeper into thevarious methods currently being usedinternationally, to give researchers space to sharetheir research work with the addition of postersand podium presentations this time around and,most importantly, to give an opportunity for allstakeholders to discuss issues and challengesfaced especially given the context of healthcaretransformation that has been very topical. At thesame time, we have also endeavoured to keepsome basic and informative sessions to helpcolleagues that are newly exposed to catch up tothis rich and complex field of research whichmelds clinical research with economics.

To truly be able to conduct world-class andreliable research, good collaboration between

different stakeholders is needed, ranging fromgovernment to private institutions, NGOs andacademia. Researchers, users of research andhealth professionals from all backgrounds, mustcome together to contribute in the pursuit foranswers to important research questions. Weanticipate that the formal discussions during theevent as well informal discussions throughout thenext two days will offer a chance for everyone toseek new ways of working together andexchanging information to build a strong platformto conduct good pharmacoeconomic research.Results of such research will help to make moreinformed choices toward improving the lives andhealth of the population.

I take this opportunity to thank all the sponsorsof the conference for their generosity and

support. Finally, I would also like to thank all myfellow organizing committee members, as well asall the volunteers for their hard work. With that, Iwish you all a great conference!

Y.B. Datuk Seri Dr. S. Subramaniam Prof Dato’ Dr Syed Mohamed Aljunid Dr. Soraya Azmi

FOREWORD fromTHE HONOURABLEMINISTER OF HEALTH,MALAYSIA

WELCOME MESSAGE fromFounding President,MYSPOR

Message from the OrganiSingCommittee Chair

CONFERENCE AT A GLANCE


09:00-12:00pm MORNING SHORT COURSEì WORKSHOP 1: INTRODUCTION TO PHARMACOECONOMICS AND

CRITICAL APPRAISAL OF ECONOMIC EVALUATION • ProfessorSamsinah Haji Hussain, University Malaya; Dr Ramli Zainal, Institute ofHealth Systems Research

ì WORKSHOP 2: CONDUCTING PHARMACO-EPIDEMIOLOGY RESEARCHProfessor Li Shu Chuen, University of Newcastle, Australia

14:30-17:30pm AFTERNOON SHORT COURSEì WORKSHOP 3: ACTIVITY-BASED COSTING • Professor Dato’ Syed

Mohamed Aljunid, UNU-IIGH; Dr Amrizal Muhammad Nur, Dr ZafarAhmed, ITCC

ì WORKSHOP 4: QOL INSTRUMENTS AND CALCULATION OFUTILITY VALUES • Adrian Goh, Azmi Burhani Consulting; Assoc.Professor Asrul Akmal Shafie, Universiti Sains Malaysia



7 MARCH, FRIDAY

08:00-09:00am EDUCATIONAL WORKSHOPì PHARMACOECONOMICS 102: INTERPRETING RESULTS: COST,

OUTCOME, CE, ICERS • Dr Soraya Azmi & Dr Goh Bak Leong

09:00-10:45am PANEL 4ì COST-EFFECTIVENESS vs. COST-REDUCTION: THE BALANCE

BETWEEN ACCESSIBILITY, AFFORDABILITY AND AVAILABILITY• COST-EFFECTIVENESS VS. COST REDUCTION – AN

AUSTRALIAN CASE STUDY • Professor Li Shu Chuen, NewcastleUniversity, Australia

• COST-EFFECTIVENESS OF TREATING TO TARGETS WITHBIOLOGICS IN IMIDS • Dr. Carol Bao, AbbVie, USA

• THE CHALLENGE FOR PUBLIC HEALTH: PROVIDINGUNIVERSAL COVERAGE AND COST-EFFECTIVE TREATMENT •Dr. Feisul Idzwan Mustapha, Ministry of Health, Malaysia

10:45-11:00am BREAK, EXHIBITS & POSTERS

11:00-12:20pm PANEL 5ì PHARMACOECONOMICS RESEARCH – ARE WE READY FOR IT?

• WHAT ARE THE COMPONENTS NEEDED TO CONDUCTPHARMACOECONOMICS RESEARCH? Adrian Goh, Azmi BurhaniConsulting

• DATA AVAILABILITY FOR PHARMACOECONOMICS RESEARCH •Professor Dato’ Syed Mohamed Aljunid, United Nations University

• HOW TAIWAN BUILT CAPACITY TO CONDUCT HTAASSESSMENTS • Dr Jasmine Pwu, Director of HTA, Center for DrugEvaluation, Taiwan

• PHARMACOECONOMICS AS A TOOL FOR EVIDENCE-BASEDMEDICINE • Dr. Sunita Bavanandan, Nephrologist, Hospital KualaLumpur

12:20-13:20PM LUNCH SYMPOSIUMì HEALTH TECHNOLOGY APPROACHES AND FIT FOR PURPOSE IN

DEVELOPING HEALTH CARE SYSTEMS • Christoph Glaetzer, Janssen

13:20-13:50pm BREAK, EXHIBITS & POSTERS

13:50-14:50pm RESEARCH PODIUM PRESENTATIONì Track 1: Quality of Lifeì Track 2: Cost & Cost effectivenessì Track 3: Pharmacoepidemiology, health services research,

utilisation and policy

14:50-16:25pm PANEL 6ì PHARMACOECONOMICS AND HEALTHCARE TRANSFORMATION–

COLLABORATIONS FOR THE FUTURE• STRENGTHENING DECISION-MAKING THROUGH COLLABORATIVE

EFFORT • Dr Salmah Bahri, Ministry of Health Malaysia• INDUSTRY’S ROLE - JOINING TOGETHER TO STRENGTHEN

PHARMACOECONOMICS RESEARCH IN MALAYSIA • Yew WeiTarng, President of PHAMA

• A PEEK INTO THE FUTURE MALAYSIAN HEALTHCARELANDSCAPE • Datuk Dr. Jeyaindran Tan Sri Sinnadurai, DeputyDirector-General (Medical), Ministry of Health, Malaysia

16:25-16:50 PRIZES & RECOGNITIONì PRIZES PRESENTATION – PODIUM & POSTER

16:50-17:00pm CLOSING REMARKSì Professor Dato Syed Mohamed Aljunid, MySPOR President

17:00pm TEA & END

17:00 - 18:00pm AGM MySPOR

9 MARCH, SUNDAY

08:15-09:45am KEYNOTE & LAUNCHì KEYNOTE ADDRESS • Dato’ Dr Noor Hisham Abdullah, Director-

General, Ministry of Health, Malaysiaì Conference Launch: WELCOME ADDRESS • Professor Dato Syed

Mohamed Aljunid, MySPOR Presidentì OPENING SPEECH & CONFERENCE LAUNCH • Y.B. Dato' Seri Dr S.

Subramaniam, Minister of Health, Malaysia

09:45-10:30am BREAK, EXHIBITS & POSTERS10:30-11:00am EDUCATIONAL WORKSHOPì PHARMACOECONOMICS 101: DEMYSTIFYING PHARMACOECONOMIC

TERMINOLOGY • Adrian Goh, Azmi Burhani Consulting

11:00-12:30am PANEL 1ì PHARMACOECONOMICS IN DECISION-MAKING – SHARING

REGIONAL EXPERIENCES• AUSTRALIAN EXPERIENCE • Professor Li Shu Chuen, Newcastle

University, Australia• THAILAND EXPERIENCE • Professor Nathorn Chaiyakunapruk,

Sunway Monash University, Malaysia• TAIWAN EXPERIENCE • Dr Jasmine Pwu, Director of HTA,

Center for Drug Evaluation, Taiwan

12:30-13:30pm LUNCH Symposiumì UNIVERSAL COVERAGE: PHARMACOECONOMICS AND PATIENTS

ACCESS ISSUES AND CHALLENGES • Mendel Grobler, Pfizer

13:30-14:00pm BREAK, EXHIBITS & POSTERS14:00-15:45pm PANEL 2ì PHARMACOECONOMICS IN HEALTHCARE TRANSFORMATION

• ROLE OF PHARMACOECONOMICS IN MOH DECISION MAKING •Anis Talib, Ministry of Health, Malaysia

• THE FUTURE OF HEALTH INFORMATION SYSTEMS –POTENTIAL USE FOR OBSERVATIONAL RESEARCH • Dr MdKhadzir Sheikh Ahmad, Ministry of Health, Malaysia

• HTA IN MALAYSIA MOVING FORWARD • Noormah Darus, Ministry ofHealth, Malaysia

15:45-16:00pm BREAK, EXHIBITS & POSTERS16:00-17:30pm PANEL 3ì BRIDGING SCIENCE TO POLICY WITH PHARMACOECONOMICS

• INTRODUCTION TO THE CE THRESHOLD • Assoc. ProfessorSharifa Ezat Wan Puteh, Universiti Kebangsaan Malaysia

• DO WE NEED A THRESHOLD FOR MALAYSIA? • Assoc.Professor Asrul Akmal Shafie, Universiti Sains Malaysia

• VALUE-BASED PRICING • Professor Kenneth Lee, Sunway MonashUniversity, Malaysia

• MULTI-CRITERIA DECISION ANALYSIS (MCDA) AND OTHERNEW IDEAS • Dr Soraya Azmi, Azmi Burhani Consulting

8 MARCH, SATURDAY



PRE-CONFERENCE WORKSHOPS


WORKSHOP 1

PRINCIPLES OFPHARMACOECONOMICS AND CRITICAL APPRAISAL OFECONOMIC ANALYSIS

Date/Time : FRIDAY, 7 MARCH 20149.00am to 12.15pm

Speakers : Professor Samsinah Haji Hussain, Universiti ofMalayaDr. Ramli Zainal, Institute for Health Systems Research

The workshop is aimed to describe the fundamental principles ofeconomic evaluation and provide an introduction to its

interpretation. Different pharmaco-economic analysis will be sharedincluding Cost Minimisation Analysis, Cost Effectiveness Analysis,Cost Utility Analysis and Cost Benefit Analysis. The workshop willalso provide tutorial of an appraisal of a published economicevaluation study based on the fundamental principles using theDrummond 10-point checklist.

WORKSHOP 2

CONDUCTINGPHARMACOEPIDEMIOLOGICRESEARCH

Date/Time : FRIDAY, 7 MARCH 20149.00am to 12.15pm

Speaker : Professor Li Shu Chuen, University of Newcastle, Australia

The workshop will provide a brief summary of the types ofpharmacoepidemiological research being conducted and their

usefulness to public health as well as to decision makers. Theworkshop will start with a short introduction of some of the basicepidemiologic and other concepts used in conductingpharmacoepidemiologic studies. This will be followed by hands-onexercises on drug utilization review and pharmacoeconomicevaluation.

WORKSHOP 4

USING QUESTIONNAIRES TOMEASURE QUALITY OF LIFE

Date/Time : FRIDAY, 7 MARCH 20142.30pm to 5.30pm

Speakers : Adrian Goh, Azmi Burhani Consulting Assoc. Professor Asrul Akmal Shafie, Universiti Sains Malaysia

This workshop will introduce the concepts of Quality of Life (QOL)and health utility, and their measurement using Patient Reported

Outcome (PRO) instruments. The workshop will describe theselection of appropriate PRO instruments and the use of PRO datato quantify QOL and health utility. The workshop will include apractical session. Participants will be required to bring a laptopinstalled with Microsoft Excel, version Excel 97 or later.

WORKSHOP 3

ACTIVITY-BASEDCOSTING

Date/Time : FRIDAY, 7 MARCH 20142.30pm to 5.30pm

Speakers : Prof. Dato’ Dr. Syed Mohamed Aljunid, UnitedNations University-International Institute for GlobalHealthDr. Amrizal Muhammad Nur, International TrainingCentre for Casemix and Clinical CodingDr. Zafar Ahmed, International Training Centre forCasemix and Clinical Coding

Activity based costing is one of the costing methods used in Case-Mix system. It can be defined as an accounting method that

enables the organization to determine the true costs related with theirservice based on the resources that are consumed. This workshop issuitable for those who involved in hospital management, hospitalbudget planning, and hospital information management. Thisworkshop will include a practical session.

SYNOPSIS OF PRESENTATIONS




PHARMACOECONOMICS IN DECISION-MAKING – SHARING REGIONAL EXPERIENCES: EXPERIENCE FROM AUSTRALIAProfessor Shu Chuen Li, Newcastle University, Australia

The presentation will provide a brief history of the development of using pharmacoeconomics in decision making in Australia, the first country to requiresupplying economic data from pharmaceutical companies as mandatory requirement for drug reimbursement applications. The rationale for the

introduction of such requirement is discussed and the impact as observed from different stakeholders with the introduction of pharmacoeconomic evaluationin decision-making will be evaluated. Finally the long-term effectiveness of such approach in reimbursement decision making is discussed.

HEALTH ECONOMICS IN DECISION-MAKING – SHARING THAILAND EXPERIENCES Professor Chaiyakunapruk, Sunway Monash University, Malaysia

Health economics data become an important piece of information used during decision making in Thailand. National List of Essential Medicine underministry of health requires health economics data for some pharmaceutical products. It is recommended to include health economics data during the

dossier submission. National Health Security office, the largest payer for more than 75% of Thai population, has commissioned research organizations toconduct health technology assessment (including health economics) of interventions including diagnostics, pharmaceuticals, and programs. The findings areused to assist policy decision makers to consider whether the interventions will be included in their health benefit package. Health economics data are mostlybased on local data and need to be provided to decision makers in a timely fashion. Key facilitators for having health economics studies used for decisionmaking in Thailand are the followings: 1) Thai health technology assessment guideline 2) repository of health economics database in Thailand 3) Thai costingmenu (including unit cost for most medical care services and average values for direct non-medical and indirect cost) and 4) the strong interest of policymakers in using such data as part of their decision making process.

PHARMACOECONOMICS IN DECISION-MAKING – SHARING REGIONAL EXPERIENCES (TAIWAN EXPERIENCE)Dr Jasmine Raoh-Fang Pwu, Centre for Drug Evaluation, Taiwan

The reimbursement and listing mechanism of National Health Insurance adopted that of the earlier Labor/Government Employee Insurances era, and ithas been gradually modified into the current system. Unlike most other countries, the system allows National Health Insurance Administration (NHIA) to

set reimburse prices based on the clinical value. Budget impact is weighted more in the decision making process, especially in the second-generation NHIera. However a price mark-up design (up to 10% if meets good quality local cost-effectiveness analysis criteria) has been introduced and it encouraged thedevelopment of the local capacity to conduct proper cost-effectiveness analysis. The following effects are observed: the willingness to invest on local studies(epidemiologic distribution, treatment patterns, cost analysis, and modelling), more acceptances on the concept of incremental cost-effectiveness ratio(ICER) or cost-effectiveness from all parties.

THE FUTURE OF HEALTH INFORMATION SYSTEM – POTENTIAL USE FOR OBSERVATIONAL RESEARCHDr Md Khadzir Bin Sheikh Hj Ahmad, Ministry of Health, Malaysia

Health Information System gathers encounters of patient at any healthcare facilities. The system of collection is migrating from manual to electronic formand from collecting aggregated to granular data. The direction is to move into Health Data Warehouse that is a trusted source of information, which meet

the diverse needs of timely health information provision and management, and acts as a platform for the standardization and integration of health data froma variety of sources. This can be leveraged to better manage the health system, provide surveillance information and in addition provides a valuable sourceof data for research. The data collected opens up to various cross sectional studies of a patient encounter across various spectrums of illnesses or services.Among others is the potential to link data marts such as a study of stroke patient attending outpatient department to being admitted as in patient and laterbeing followed up by physiotherapist or speech therapist. Study can also be conducted in time series since the data are census and dynamic in nature. Asthe system mature and with more data marts linked more potential use can be demonstrated especially in the area of monitoring Key Performance Indexes.HTA in Malaysia, Past and Present

HTA IN MALAYSIA MOVING FORWARDNoormah Mohd Darus, Ministry of Health, Malaysia

Health Technology Assessment (HTA) is a multi-disciplinary activity which systematically examines the safety, clinical efficacy, effectiveness, cost, cost-effectiveness, organizational implications, social consequences, legal and ethical considerations of the application of a health technology usually a drug,

medical device or clinical/surgical procedure. HTA broadly focuses on two questions: Clinical effectiveness – how do the health outcomes of the technologycompare with available treatment alternatives; cost-effectiveness – are these improvements in health outcomes commensurate with the additional costs ofthe technology? HTA acts as ‘a bridge’ between evidence and policy-making. The Health Technology Assessment (HTA) Unit was set up in Malaysia in August1995 in the Ministry of Health Malaysia and has since grown tremendously in size and resources. To date, fifty-six in-depth assessments have been carriedout, and the recommendations of these assessments were subsequently implemented. In addition, approximately 232 rapid assessment reports wereproduced in response to requests from mainly governmental policy and decision makers. HTA has been able to provide input into formulation of national andMinistry of Health Malaysia policies such as purchasing decisions. HTA also provides a basis for clinical practice guidelines development (seventy-five CPG’sproduced till date), control of drugs as well as non-drugs and medical devices, matters pertaining to regulation of medical practices, as well as advertisementsrelated to health. In Malaysia, a major challenge is sustainability of the program, to be able to have competent trained personnel, a need to have constantefforts to create awareness on the utilities of HTA so that its full potential can be realized. The scope of services may also need to be expanded to includean early warning system such as the horizon scanning. Malaysia has successfully implemented a health technology program that has had some major impact(to a certain extent) on policy formulation and decision making at various levels in government and private health care delivery systems.

INTRODUCTION TO THE CE THRESHOLDAssociate Professor Dr.Sharifa Ezat Wan Puteh,

Cost effectiveness analysis (CEA) studies have gained momentum and regarded as one of the most important step, assisting countries and national healthprograms around the world in determining the most acceptable cost effective strategy. CEA studies are needed beside data on intended interventions'

efficacy, effectiveness and safety. The CEA thus looks at the ICER (Incremental cost effectiveness ratio) i.e. the ratio of difference in cost over the differences



in outcomes between different strategies; may it be drugs, vaccinations, programs or medical technologies. One of the most common ICER used nowadaysis QALY (quality adjusted life years) saved/gained between intended interventions. This threshold level is then compared between different threshold values,such as GDP per capita of the country as advocated by WHO or proposed levels proposed by different related organizations. The presentation will outline afew accepted methods of ICER threshold determinations, its strengths and drawbacks.

DO WE NEED A THRESHOLD IN MALAYSIA?Associate Professor Asrul Akmal Shafie, Universiti Sains Malaysia

In contrast to other economic discipline, health economics usually employs cost-utility analysis in evaluation of alternatives. However, most new treatmentsare characteristically more expensive but also more effective. This requires external criterion in deciding its cost-effectiveness outside the net monetary

benefit framework. The criterion, also called threshold was traditionally set at arbitrary value based on unknown origin or GDP per capita per disability-adjusted life year (DALY). There is a recent drive to seek empirical value of the threshold through monetary valuation of health. Although such empiricalefforts can be traced back to other non-health economic studies in estimating value-of-a statistical-life (VSL), many health economists argued that the valueshould somehow reflect the preferences of the population which is affected by them both as potential recipients of medical services (patients) and as payersof taxes or social insurance contributions. Gains (or avoidance of losses) in (more) healthy lifetime are the typical target of health care and thus empiricalvalue based on preference is of greater relevance in the economics of health care. This presentation would first introduce the rational and application of thethreshold in economic evaluation. This is followed by overview of the theoretical framework as well as the strengths and shortfalls of the previous attemptsmade in Asia and Europe. Finally, the conceptual framework, tools, plans, and preliminary results of a current survey in Japan, Korea, Malaysia, and Thailandthe threshold value and potential in Malaysia will be discussed.

VALUE-BASED PRICINGProfessor Kenneth KC Lee, Sunway Monash University, Malaysia

Health care spending is increasingly a global issue especially in those high spending areas such as oncology, rheumatology and gastroenterology due tothe introduction of many new innovative medicines. Many authorities have therefore implemented various measures to ensure expenditures are

contained or if money has to be spent, it is spent in the most cost-effective manner. The concept of the “value” of a medicine has increasingly replaced thetraditional parameters of “efficacy”, “safety” and “cost” in assessing a new therapeutic agent. Value is now measured as “the health outcomes achieved perdollar spent” to ensure every dollar spent on health care is based on sound evidence and hence as a result, achieve a maximum return and a most favourableoutcome. It is expected that new pricing strategies based on the value of a medicine will bring about a paradigm shift in the health care arena by becomingthe corner stone for price determination in many jurisdictions. They are however relatively new concepts in most parts of Asia. It is hoped that the 20minpresentation on “Value-based pricing” would throw some light to the future direction in health care financing in this part of the world.

MULTI-CRITERIA DECISION ANALYSIS (MCDA) AND OTHER NEW IDEASDr. Soraya Azmi, Azmi Burhani Consulting

Although the use of pharmacoeconomics and outcomes research as part of the formal decision making process is still evolving and new to Malaysia, thistype of research has been around for many years beginning since the 1990s. The sub-categories of research that make up the field are many; ranging

from patient reported outcomes (PROs) to decision analysis and modelling to cost-effectiveness and cost-utility analysis. Challenges faced by researchersand decision-makers constantly push the research boundaries to expand to greater breadth and depth with new thinking being applied. Internationally, amongthe newer issues and methods being discussed are personalized medicine and network meta-analysis, how to measure PRO in children and the use ofelectronic PRO instruments. One of the interesting recent debates has been about the use of multi-criteria decision analysis (MCDA), which aims to movethe conversation beyond cost-effectiveness analysis and incremental cost effectiveness ratios (ICERs), to include other concerns decision-makers may have.This is an example of how this field of research is being used to further improve the ability to make informed and transparent decisions. The debate alsoillustrates that one size may not fit all.

COST EFFECTIVENESS VS. COST REDUCTION: AN AUSTRALIAN CASE STUDY Professor Shu Chuen Li, Newcastle University, Australia

The presentation will discuss the theoretical argument as whether the implementation of economic evaluation is a strategy to promote cost-effectivenessin health care delivery or a cost reduction measure in disguise. The presentation will examine the process of applying economic evaluation in drug

reimbursement decision making and various methods used to promote cost-effective use of drug listed in the Pharmaceutical Benefits Scheme. Finally, acase of how incremental cost-effectiveness ratio can be used to negotiate a reduced acquisition price for a pharmaceutical product for the PharmaceuticalBenefits Scheme is presented.

COST EFFECTIVENESS OF TREATING TO TARGETS WITH BIOLOGICS IN IMIDSDr Carol Bao, AbbVie , USA

Treat To Target, or T2T, is an international initiative to define RA treatment targets and recommendations to measure disease severity and encourageearlier diagnosis and optimize treatment. While this guidance is gaining acceptance in clinical practice, the economic implications of such practice remain

to be fully ascertained. In this presentation, the cost-effectiveness of three T2 strategies for achieving and maintaining remission among early RA patientsis evaluated from German perspective. The treatment strategies are: (A) first-line adalimumab (ADA) + methotrexate (MTX); (B) first-line MTX monotherapy,followed by a hybrid approach with ADA + MTX for patients with high disease activity and one DMARD + MTX for patients with low or moderate diseaseactivity after MTX failure; and (C) (current German treatment sequence): ADA + MTX after 2 conventional DMARDs. Both direct and indirect costs areassessed and utility is mapped based on disease severity measured by the Disease Activity Score (DAS) 28. The assessment shows strategies A and B tobe cost effective compared with the current German sequence and the indirect costs savings are found to be critical in achieving cost effectiveness withearlier treatment.

THE CHALLENGE FOR PUBLIC HEALTH: PROVIDING UNIVERSAL COVERAGE AND COST-EFFECTIVE TREATMENTDr Feisul Idzwan Mustapha, Ministry of Health, Malaysia

The prevalence of non-communicable diseases (NCDs) and NCD risk factors in Malaysia have risen substantially in the last two decades. This has resultedin significant pressure to the public health systems in providing appropriate and quality care to patients partly due to the shift from an acute care model

to a more chronic care model as well as the existing separation of the public and private healthcare services in Malaysia. No country in the world has theanswer on how best to provide universal coverage and cost effective treatment especially for NCDs. Even with the best treatment available, patients andtheir families play a major role in determining how well their disease is controlled and thus reducing the risk of complications and premature deaths. Thereis now a global monitoring framework for the prevention and control of NCDs with 25 indicators and 9 voluntary global targets which forms part of the GlobalAction Plan for the Prevention and Control of NCDs, adopted at the 66th World Health Assembly in May 2013. The World Health Organization has provideda menu of cost effective interventions and universal health coverage is pivotal in this endeavour.

WHAT ARE THE COMPONENTS NEEDED TO CONDUCT PHARMACOECONOMICS RESEARCH?Adrian Goh, Azmi Burhani Consulting

This presentation will describe the types of resources required to perform pharmacoeconomic analyses. It will touch upon the importance of the availabilityof local data and briefly discuss the options available to researchers in situations where such data is not readily available.



DATA AVAILABILITY FOR PHARMACOECONOMICS RESEARCHProfessor Dato’ Dr Syed Mohamed Aljunid

All research agendas including pharmacoeconomics turn data from various sources into valuable information for decision-making. While the important oftimely, accurate and reliable data is an important asset of any health system, getting access into such data is a major problem in developing countries.

Pharmacoeconomics research requires at least two types of data: costing data on certain interventions and outcome data to reflect effectiveness of suchinterventions. There a number of important reasons why these two sets of data are very scarce in less developed countries. Firstly, most health systems ofdeveloping countries do not invest enough resources to collate routinely data on cost and outcome. Secondly, lack of trained personnel with adequateknowledge and skill to plan and implement health management information system where data can be systematically collected. Thirdly, there is inadequatepolicy to support the concept of data sharing among major players in research and development. Academic staff in universities and higher learninginstitutions that have the technical capacity to use these data many a times faced bureaucratic obstacles to access data generated in government agencieseven though the data was collected using fund from tax payers. It might also be true that sometimes certain data and information was protected from publicaccess to cover-up corrupt practice, unprofessional conduct and provision of substandard care. Systematic transformation of the national health system isrequired if we are serious in encouraging the use of evidence to support decision-making. For the start, health policy makers in developing countries shouldembark on an open-door policy to facilitate data sharing among researchers in different sectors.

HOW TAIWAN BUILT CAPACITY TO CONDUCT HTA ASSESSMENTSDr Jasmine Raoh-Fang Pwu, Centre for Drug Evaluation, Taiwan

Capacity building is one of the most important issues when building up a Health Technology Assessment (HTA) system. Capacity in this area may becategorized into: clinical effectiveness assessors, economic (include utilization) assessors, system impact assessors, other ethical/legal/social impact

(ELSI) experts, and who understands the HTA concept and help integrate the concept into decision-making mechanism. Each function requires variety oftraining, e.g., basic HTA concepts, basic specialty training (epidemiology, statistics, clinical medicine, economics, etc.), state-of-art assessment methodology(systematic review, meta-analysis, modelling studies, etc.), and ELSI courses. There are no Master or PhD degrees designed for HTA workers in Taiwan’suniversities, although specific courses can be found. Under these circumstances, we have made today by exploring the following routes: a) attend the decisionmaking meetings whenever possible; b) identify the necessary core abilities and locate and invite proper trainers to provide coursers; c) study the advancedHTA agency reports, especially their integration with decision making processes; d) hold workshops/symposium to promote HTA and hear from all parties.

THE RELEVANCE OF HEALTH ECONOMICS AND OUTCOMES IN CLINICAL PRACTICEDr. Sunita Bavanandan, Ministry of Health, Malaysia

The increasing influence of Evidence-based Medicine and Health Technology Assessment in policy-makers’ decisions, clinical practice guidelines, andlocal management decisions may sometimes lead to the misperception that clinicians have lost their clinical freedom and play a secondary role in

therapeutic decision-making. However, there is a need to reconcile the doctor’s duty of responsibility to the individual patient to provide the most effective orbest available alternative, regardless of cost, with the same doctor’s population-health ethic of efficiency, based on providing the population with the bestoption according to limited available resources. This lecture will use examples taken from literature on diabetes, hyperlipidemia and chronic kidney diseaseto explore how clinicians may use the results of economic evaluations in their daily clinical practice, making decisions about cost-effectiveness on a case-by-case basis, and addressing both the patient's and society's needs. Through these examples, we can see the relevance of Health Economics in clinical practice 1. to help prioritize interventions2. to identify target sub-populations for whom technology may be particularly cost-effective, thus facilitating individualised therapy 3. to identify factors with great impact on cost-effectiveness results - these can then be modified by clinicians for more efficient use of resources.

HEALTH TECHNOLOGY APPROACHES AND FIT FOR PURPOSE IN DEVELOPING HEALTH CARE SYSTEMSChristoph Glaetzer, Janssen

The use of concept of health economics (HE) and Health technology assessments (HTA) to determine the value of treatment has been a cornerstone incoverage decisions in many countries with reimbursed healthcare system. There are two main approaches in these, the use of clinical effectiveness as

primary decision criterion and/or the use of cost effectiveness implemented to address specific question in the respective market. . Both are aimed to improvesystem efficiency and health outcomes as a whole under the umbrella of healthcare coverage. They represent however two different “schools of thought”that are different in methodology and the role in assisting decision making and therefore sometimes leading to similar and sometimes to different outcomeson coverage decisions. To adopt either approach in countries where the healthcare coverage is under development needs all-inclusive consideration forfactors shown below. To understand the areas intended outcome to be improved and achieved is crucial before considering any model. Different approacheswill provide different outcomes thus it must be “fit for purpose”. Requirement in evidence and technical expertise for any model needs to be considered tobe “feasible and customary” in a country contextual environment.The talk will briefly recapture the main aspects and differences of both models and highlightthe relevant aspects and considerations in evaluating usefulness in emerging healthcare systems.

INDUSTRYS ROLE - JOINING TOGETHER TO STRENGTHEN PHARMACOECONOMICS RESEARCH IN MALAYSIAYew Wei Tarng, PHAMA, Malaysia

The Healthcare landscape is rapidly changing and is moving in the direction of One Healthcare where access to innovative medicine plays a key role. Itis a key strategic component in our National Medicine Policy (DUNas). We agree strongly on the need to promote use of HTA in national frameworks and

strengthening PE research. We can collaborate with all relevant stakeholders to ensure we provide technical assistance, technology and knowledgetransfers. The increase in demand and cost, coupled with scarcity in resources are key barriers. We need to develop our capability and capacity to ensurewe are able to generate local data.Herein lays the opportunity for us to work together and through better policy framework and guidelines we are able todevelop and set reputable centres for research. At the moment, the industry has been providing strong supports in Clinical Research and we need to take astep further to align this well with the policy framework and also provide incentives. Finally we need to develop a clear roadmap together with strongcollaboration from all stakeholders and sponsors from the government. Our goal is to ensure that we could provide access of innovative medicines to thepatients and ensure best patient care and outcomes.



LIST OF ABSTRACT


PODIUM PRESENTATIONSQuality of Life

Abstracts# Title

5 Bring Back Medication: A Study of Patients’ Awareness, Cost Saved and Storage Practice in Selayang Hospital.

7 Clinical Impact of Empirical Antifungal Therapy on the Survival from Infection in Chemotherapy-Induced Febrile Neutropaenic Adult Patients.

21 Incidence and Causality in Adverse Drug Reaction-Related Admission to Hospital: A Systematic Review.

27 Perception, Acceptance and Tolerability of Patients Taking Innovator versus Generic Escitalopram.

29 Study on the Clinical Outcome of Pharmacist-Managed Diabetes Patients.

57 Health Related-Quality of Life (HRQoL) in Type 2 Diabetes Mellitus: A Study in Selangor District Hospitals.

Cost and Cost-effectiveness

Abstracts# Title

11 Cost-Effectiveness of Warfarin Medication Therapy Adherence Clinic (WMTAC) Compared to Usual Medical Clinic (UMC) in Kuala Lumpur Hospital.

12 Cost-Effectiveness of Insulin Glargine for Type 2 Diabetes Mellitus.

13 Pilot Evaluation of Two Childhood Obesity Prevention Programs in Malaysia.

35 Cost Analysis of the Extemporaneous Preparation of Folic Acid 1mg/mL Syrup in Sungai Buloh Hospital Out Patient Pharmacy Department with the Use of either Simple Syrup or X-Temp Suspension as a Suspension Vehicle.

53 Exploring the Willingness to Pay for Voluntary Community-Based Health Insurance in Malaysia.

70 Measuring Childhood Obesity Based on Three Different Approaches: WHO, CDC and IOTF Criteria.

Pharmacoepidemiology, Health Services Research, Healthcare Utilization and Policy

Abstracts # Title

2 Glycaemic Control of Diabetic Patients in Pharmacist-Managed Telephonic Insulin Titration.

19 Antibiotic Use, Expenditure and Outcomes at Kajang Hospital: The Impact of Antibiotic-Medifact Program.

61 Medication Reconciliation in Hospital Banting Medical Wards: Identifying the Types and Factors Contributing to Medication Discrepancies.

63 An Audit of the Diabetes Medication Therapy Adherence Clinic (DMTAC) in Serdang Hospital.

66 Potential Drug-Drug Interaction among Elderly Admitted to Medical Wards of Serdang Hospital: A Prospective Study.

68 Gentamicin Pharmacokinetics in Neonates: Identification of Factors and Predictors for Local Pharmacokinetic Equations Of HTAR, Klang.

POSTER PRESENTATIONS

Pharmacoepidemiology

1 The Incidence of Adverse Effects due to Fluorouracil, Epirubicin and Cyclophosphamide (FEC) Chemotherapy in Breast Cancer Patients at Hospital Tengku Ampuan Rahimah (HTAR), Klang.

9 Withdrawn

16 Evaluating the Prescribing Dosing Trends of Opioid Substitution Treatment Programme in Private Medical Practitioner Clinics by Calculating the Estimated Average Daily Dose (EADD) of Methadone and Buprenorphine After the Implementation of Psychotropic Permit in Malaysia.

22 Economic Evaluation of Food Water Borne Disease in Malaysia.

24 Overview of the Sampling Pattern of Suspected Paracetamol (PCM) Poisoning In Hospital Sungai Buloh (HSB).

28 Patient's Own Drugs: Profile of Drugs Cost and Wastage

30 Usage of IV NAC in ICU Patient with Renal Insufficiency to Prevent Contrast-Induced Nephropathy

32 Correlation of Phenytoin Level with Rhabdomylosis and Thrombocytopenia in Critically Ill Patients with Hypoalbuminaemia

34 Pending Authorization in Outpatient Pharmacy of Hospital Sungai Buloh

38 Prescribing Pattern of Broad-Spectrum Antibiotics in the Medical Wards of Hospital Sungai Buloh

48 Outcome Status and Duration of Dual Antiplatelet Use Among Post-PCI Patients.

49 Length of Stay and Prognostic Factors for 30-day Readmission for Post-PCI Patients with Dyslipidaemia, Hypertension and Diabetes.

55 A Study on Drug Information Utilization and Accessibility at Kajang Hospital.



58 Incidence of Hypersensitivity Reaction in HIV-Infected Patient Starting NNRTI-Containing Regime: A Cross Sectional Study on HTAR Patients.

65 A Study of Patient’s Satisfaction & Adherence to Ministry of Health Malaysia (MOH) Guidelines on Dispensing Methadone in Agensi Anti Dadah Kebangsaan (AADK) Hulu Langat, Selangor.

71 To Evaluate the Effectiveness of Medication Therapy Adherence Clinic (MTAC) in Psoriasis Patients in Selayang Hospital.

73 A Retrospective Analysis of Medication Possession Ratio in Predicting Virologic Outcomes among HIV Infected Adults on Second Line Antiretroviral Therapy in Sungai Buloh Hospital (HSB).

Quality of Life

4 A Study of Cephalosporin Use in Female Medical Ward in Hospital Banting.

10 Unauthorized Prescription in Outpatient Pharmacy Hospital Ampang.

14 Systematic Review of Economic Evaluation Models used for Cost-effectiveness Assessments of Health Promotion Programs for Childhood Obesity.

15 Determination of Cost-Effectiveness Threshold for Malaysia.

17 Economic Evaluation of Enhanced Asthma Management: A Systematic Review.

18 Health-Related Quality of Life (HRQOL) among Mothers with Thalassemia Children in Malaysia.

20 Drug Utilization and Cost of Antipsychotic in the Treatment of Schizophrenia at Kajang Hospital.

23 Economic Evaluation of Zoonotic Disease in Malaysia.

26 Factors Affecting Job Satisfaction amongst Public Sector Hospital Pharmacists Working in Selangor, Malaysia.

31 Pregnancy Outcomes in Insulin Treated Gestational Diabetes Mellitus Patient from Different Ethnicity in Hospital Sungai Buloh.

33 Tenofovir-Induced Renal Impairment in HIV-Infected Patients.

36 Evaluation of Continuous Infusion Vancomycin in Hospital Sungai Buloh: Retrospective Observational, Single-Centred Cohort Study.

44 Knowledge, Attitudes and Practice toward DRG System among Turkish Health Care Providers.

50 Relationship between Beliefs, Adherence and Quality of Life (QOL) Among Chronic Kidney Disease (CKD) Patients on Haemodialysis in Penang General Hospital.

51 Validation of EQ-5D-5L in the General Population of Malaysia.

52 Cost Effectiveness Study of Pantoprazole and Esomeprazole in the Treatment of Upper Gastrointestinal Bleeding at Hospital Taiping

59 Comparing the Treatment Outcome for Anthral Gastritis and Non Ulcer Dyspepsia Using Pantoprazole versus Esomeprazole in an Outpatient Setting in Hospital Tengku Ampuan Rahimah (HTAR).

60 The Outcome of Home Medication Review Programme in Empowering Psychiatric Patients at HTAR Klang.

62 Clinical Outcomes of Premature Infants Receiving Total Parenteral Nutrition (TPN) Solution with Amino Acid Concentration of 2.5%W/V Versus 2.8%W/V in NICU, Hospital Selayang.

64 A Survey to Evaluate the Techniques of Medication Administration through Enteral Feeding Catheters (EFC) for Adult Patients in Nursing Practice in Serdang Hospital.

72 Structured Intervention for Acute Low Back Pain in Primary Care: A Randomised Control Trial Study.

Cost and Cost-effectiveness

6 Assessment of Healthcare Professionals’ Knowledge on Interactions of Warfarin with Drugs, Supplements and Nutrients in Hospital Ampang, Malaysia.

8 Coagulation Factor Concentrates Usage in Malaysia 2012.

25 Survey on Awareness of High Alert Medications among Doctors, Pharmacists and Nurses in Hospital Sungai Buloh (HSgB).

39 A Study on the Awareness and Compliance towards the After Office Hour Value Added Service in Hospital Sungai Buloh.

45 Prescriptions Study to Assess Drug Utilization Pattern and Estimate Direct Drug Cost: A Review of Existing Literature.

46 The Epidemiologic and Economic Impact of a Quadrivalent Human Papillomavirus Vaccine (6/11/16/18) in Malaysia's Gender Neutral Setting.

47 Formulary List Review of Sulphonylureas Using Medicines Scoring System (MedSS): Any Cost Savings Offered?

69 A Survey on Self-Medication by Caregivers/Parents of Paediatric Patients in Hospital Tengku Ampuan Rahimah.

Health Services Research, Healthcare Utilization and Policy

3 Primary Care Setting in Klang: Are Antibiotics Usage Justified?

40 A Survey on Knowledge of Oral Extemporaneous Preparations Amongst Pharmacist and Pharmacist’s Assistants in Hospital Sungai Buloh.

41 The Effects of Pharmacist Patient Education on the Occurrence of Return Medications in an Inpatient Setting.

42 A Survey on the Performance of Clinical Pharmacists by Medical Providers in Hospital Sungai Buloh.

43 Review of Off Label Prescribing in Paediatric Patients in Hospital Sungai Buloh: A Prospective Study.

54 The State of Health Economics Research in Malaysia.

56 Analysis of Medication Returned to Hospital Outpatient Pharmacy: A Qualitative focus Group Study.

67 A Study to Evaluate Patient’s Knowledge and Satisfaction to the Topical Treatment in Chronic Skin Disease.

Other

37 Study on the Use of the Intravenous Fish Oil Lipid Emulsion in Premature Neonates Requiring Parenteral Nutrition.



SCIENTIFIC ABSTRACTS


judicious use of antibiotics by prescribers in nonspecific upper respiratorytract infection (URTI). Methods: A total of 2,359 prescriptions with adiagnosis of infection from 24 – 28 June 2013 were collected from 10government clinics. Prescriptions for nonspecific URTI were then randomlyselected to review the appropriateness of antibiotic use based on theMcIssac Score, choice of antibiotics, and dosing. Results: The top threediagnoses were nonspecific URTI (62.2%), soft tissue injury (STI) (9.1%)and urinary tract infection (UTI) (9.5%). The antibiotic prescribing rate fornonspecific URTI was 27%, STI 85%, and UTI 83.9%. The most commonlyprescribed antibiotics were amoxicillin (52.7%) for URTI, cloxacillin (89.1%)for STI, and cephalexin (52.2%) for UTI. The most preferred choice ofantibiotic for nonspecific URTI and UTI, deviates from local guidelines i.e.phenoxymethylpenicillin for URTI and trimethoprim for UTI. For non-specificURTI, 84.1% of patients prescribed with antibiotics had McIsaac score of <2(antibiotic is likely to be not necessary). Also, 95.2% of patients were first-visit patients – indicating that the antibiotic delay strategy is not popularamong prescribers. Conclusions: This study revealed the choice ofantibiotic for both URTI and UTI were inconsistent with local guidelines andthat there was inappropriate prescribing in URTI. Besides adhering toprescribing guidelines, healthcare providers could have a collaborative effortto improve antibiotic prescribing.

ABSTRACT #4A STUDY OF CEPHALOSPORIN USE IN FEMALE MEDICAL WARD INHOSPITAL BANTINGTe CY1, Azwa A1, Norhamiza H1, Nurul Izzaty A1

Department of Pharmacy, Banting Hospital1Introduction: Bacterial infections continue to present a major threat tohuman health. Nowadays there are more than 100 of antimicrobials in themarket. The proper selection antimicrobial therapy is based on severalfactors. The cephalosporin are the largest and most diverse family of beta-lactam antibiotics. Inappropriate use of antimicrobials is a risk factor for theemergence of antibiotic resistant bacteria. Hence, we conducted a study ofcephalosporin use in medical ward in Hospital Banting. Objectives: Theobjective of the present study was to evaluate the appropriateness use ofcephalosporins in female medical wards Hospital Banting in term ofindication, dose, frequency and duration of antibiotics. Methods: A crosssectional study was done for patients in the female medical ward (ward 3)who was treated with any of the cephalosporin antibiotics between Januaryand April 2013. National Antibiotic Guideline, Sanford Antibiotic Guide 2000were used to determine the appropriateness. All statistical analyses wereperformed using SPSS version 17 (SPSS Inc, Chicago, IL) and comparedusing chi-square (X2) tests. Results: The proportion of inappropriatetherapy with Cephalosporin was higher in empiric therapy compared withtreatment with 61.4% and 38.6% respectively. More patients receiveinappropriate therapy when bacteria investigations were not done (50%)compared with those whom bacteria growth was proven (13.6%) and nogrowth was proven (36.3%) by bacteria investigations. There was asignificance association between the type of antibiotic and inappropriate useof Cephalosporin (p<0.006). The most common antibiotic that has beenused inappropriately is Ceftriaxone with 45.5%. Conclusions: The use ofantibiotics in this study was not fully in line with the compared antibioticsguidelines especially the duration of antimicrobial therapy. More patientsreceive inappropriate therapy during empirical treatment. Future studies areneeded to promote rationale use of cephalosporin antibiotics in femalemedical ward in Hospital Banting.

ABSTRACT #5BRING BACK MEDICATION: A STUDY OF PATIENTS’ AWARENESS,COST SAVED AND STORAGE PRACTICE IN SELAYANG HOSPITALKhoo HF1, Ang YJ1, Lim XY1, Cheok KY1, Sabastian SS1, Lim CH1, Geh SW1,Leong SL1

Department of Pharmacy, Selayang Hospital1Introduction: “Bring Your Medications” awareness has been introduced tocreate patients’ awareness to bring along their medications during wardadmission, where medication reconciliation can be done to minimizewastage and save cost. However, these medications are no longer assuredof their quality due to unknown storage conditions. Objectives: This studyaim to determine the awareness of patients in bringing their medication uponward admission, cost saved and to survey on patients’ general storage

THE CONTENTS OF THESE ABSTRACTS MAY NOT REFLECT THEVIEWS OF, AND MAY NOT BE ENDORSED BY THE SOCIETY. THISDOCUMENT IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY

ABSTRACT #1THE INCIDENCE OF ADVERSE EFFECTS DUE TO FLUOROURACIL,EPIRUBICIN AND CYCLOPHOSPHAMIDE (FEC) CHEMOTHERAPY INBREAST CANCER PATIENTS AT HOSPITAL TENGKU AMPUANRAHIMAH (HTAR), KLANG.Norima MN1, Mazni MTN1, Yeow WJ1, Chong YT1, Yeoh JJJ1

Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1Objectives: This study aimed to determine the incidence of adverse effectsdue to FEC chemotherapy in HTAR Klang. Methods: Sampling populationof 20 patients were obtained with the inclusion criteria of female patientsmore than 18 years old given at least one cycle of FEC regimen in hospitalin the year 2012. All haematological and non-haematological adverse effectsand its management were recorded. Results: The incidences ofhaematological adverse events were neutropenia (20%), neutropaenicsepsis (15%) and anaemia (5%) while the incidences of non-haematologicaladverse events were nausea and vomiting (20%), alopecia (20%),extravasation (5%), cough (5%) and headache (5%). Dose delay and dosereduction due to adverse events were observed in 30% and 15% of patientsrespectively. Secondary prophylaxis with GCSF and antibiotic were used in8.3% and 1.6% of the total cycle delivered for management of neutropeniaor neutropenia sepsis. Supportive care such as anti-emetics and scalpcooling were given to patients who experienced non-haematologicaladverse events to improve quality of life. Conclusions: Adverse eventsobserved in this study were generally in line with published data andliterature. A prospective study is recommended in near future to add moreinformation on the incidence and clinical management of FEC relatedadverse events.

ABSTRACT #2GLYCAEMIC CONTROL OF DIABETIC PATIENTS IN PHARMACIST-MANAGED TELEPHONIC INSULIN TITRATIONRamelan A1, Lin SN1, Woon SM1, Mohd Noh FA1, Wong KM1, Ibrahim NF1

Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Klang1

Objectives: To compare the reduction of HbA1c between patients who areunder pharmacist-managed insulin titration-by-phone program compared tostandard care and to study the association between the frequencies oftelephone contacts by pharmacists with the reduction in HbA1c. Methods:A retrospective study on diabetic patients under endocrine clinic follow-up inone year between June 2011 and June 2012 in HTAR was conducted.Patients with uncontrolled type 1 or type 2 diabetes mellitus and whoseHbA1cis>7% were included. Reduction in HbA1c within a minimum of 12months of referral to the service when compared to baseline was evaluated.Results: A total of 110 patients with 57 patients in the pharmacist-managedinsulin titration-by-phone group and 55 patients standard care group wereincluded in the analysis. Between-group comparison demonstrated asignificant difference in median change in HbA1c favouring pharmacistmanagement (0.9% for pharmacist-managed group; 0.1% for standard care,p=0.027). Within-group comparisons demonstrated significant correlationbetween frequency of telephone contacts by pharmacists and reduction inHbA1c level from baseline (r=0.351, p=0.08) in the pharmacist-managedtitration-by-phone group. Conclusions: Pharmacist-managed insulintitration-by-phone service under the DMTAC program resulted in significantimprovement in HbA1c levels compared to standard care in patients withdiabetes mellitus, and the magnitude of reduction in HbA1c correlates withthe frequency of contacts by pharmacists.

ABSTRACT #3PRIMARY CARE SETTING IN KLANG: ARE ANTIBIOTICS USAGEJUSTIFIED?Cheang CYM1, Norharlina S1, Gan KZ1

Pharmacy Unit, Klang District Health Office1

Objectives: To study the antibiotics prescribing pattern in governmentprimary care clinics in Klang; detailing the type of antibiotics used for theinfections treated in primary care. This study further investigates the



practice of medication. Methods: This was a prospective, non-interventionalstudy. 170 of patients admitted into Selayang Hospital’s Nephrology andMedical wards in 30 days who brought along their medications wererecruited. CP1 Medication History Assessment Forms were used to assessand record patients’ previous medications. Interview sessions wereconducted by pharmacists using an adapted version of a previouslyvalidated questionnaire to survey patients’ storage practice of medication.Upon discharge, the number of pills saved was estimated according topatients’ balance medication from previous supply which can still be used.The total cost saved was estimated with reference to the hospital’s cost list.Patients’ awareness was expressed in terms of percentage of patients whobrought back medications upon admission. Results: 53% of patientsbrought back their medications on admission. There is an increase of 40.3%from the 12.7% achieved from an earlier study in 2011. This may beattributed to the continuous “Bring Back Medication” awareness promotedhospital wide. A total of 20,450 pills with a total cost of RM 4,647.82 weresaved. 77.4% of patients brought their medications in the original packaging.62.3% of the patients kept their medications in drawers/cabinets, 28.5% inopen area, 4.2% in the fridge, and 5.0% in other conditions e.g. in car andbags. Of the 239 patients interviewed, 28% were aware of and checked theexpiry dates of medications, 60.3% were aware of but did not check theexpiry dates and only 11.7% were not aware of the expiry dates.Conclusions: Patients’ awareness of bringing back their medications uponadmission has increased since 2011. A total cost of RM 4,647.82 was saved.Majority stored their medications in appropriate conditions but did not checkfor expiry dates. Continuous promotion for patients to bring backmedications need to be carry out to further increase the awareness to atarget of 80% as agreed by the hospital administrative level.

ABSTRACT #6ASSESSMENT OF HEALTHCARE PROFESSIONALS’ KNOWLEDGE ONINTERACTIONS OF WARFARIN WITH DRUGS, SUPPLEMENTS ANDNUTRIENTS IN HOSPITAL AMPANG, MALAYSIA.Lo SH1, Md Shukor NZA1, Md Yunus YA1, Kong SS1, Foo WF1, Lee WLW1,Lim YS1

Department of Pharmacy, Ampang Hospital1Introduction: Warfarin is a highly effective anticoagulant in themanagement of thromboembolic disease. Anticoagulants are identified bythe National Patient Safety Agency (NPSA) as one of four high riskmedications that require multidisciplinary interventions to ensure its safeuse. Besides, frequent drug and food interactions limit warfarin’s use due topotential fluctuations of INR. Objectives: This study aims to evaluatehealthcare professionals’ knowledge towards interaction of warfarin withdrugs, supplements and dietary vitamin K in Hospital Ampang. Methods:Healthcare professionals were surveyed using a validated questionnairethat are comprised of Part I: Drug-Supplement Interactions with OralWarfarin and Part II: Food Interactions with Oral Warfarin. The study sampleincluded 127 healthcare professionals consisting of 82 physicians, 40pharmacists and 5 dieticians based on proportional stratified sampling. Thiswas a prospective study using a survey that took three months to complete.Results: The mean scores (±SD) on the overall test were 60.17±1.3 fordieticians, 55.43±10.1 for pharmacists and 44.6 ±8.1 for physicians, with100 being the perfect score. Test results revealed that pharmacists scoredsignificantly highest in Part I drug- supplement interactions with 45.62±13.3.For Part II food interactions, dieticians scored significantly highest withmean score of 84.5±1.1 (p<0.05). Physicians from HaematologyDepartment scored significantly higher than physicians from the otherdepartments for the Part I and overall scores (p<0.05). Besides, healthcareprofessionals were able to correctly identify Vitamin K rich food, scoring anaverage of 86-100 %. Conclusions: Pharmacists and dieticians scored wellin their respective areas of expertise, which is the drug and food interactionsrespectively, but did not perform so well in other areas. Physicians exhibitedlack of knowledge in drug-nutrient interactions of warfarin. Thus, additionaltraining and collaboration between specialties are vital to ensure optimaltherapeutic outcomes.

ABSTRACT #7CLINICAL IMPACT OF EMPIRICAL ANTIFUNGAL THERAPY ON THESURVIVAL FROM INFECTION IN CHEMOTHERAPY-INDUCED FEBRILENEUTROPAENIC ADULT PATIENTSChong SC1, Thomas PT2, Birinder K3

Department of Pharmacy, Ampang Hospital1; Faculty of Pharmacy, NationalUniversity of Malaysia2; Department of Pharmacy, UKM Medical Centre3

Introduction: Invasive fungal infections (IFIs) are severe complications inneutropaenic cancer patients. They often receive empirical antifungaltherapy when fever does not resolve after 4-7 days of broad-spectrumantibiotics. In 40-50% of febrile neutropaenic patients received empiricalantifungal therapy, the incidence of IFI is only 10-15%. By taking intoconsideration of high antifungal drug costs and the risk of unnecessaryinitiation of empirical antifungal drugs, is the empirical approach reallybeneficial to those persistent febrile, neutropaenic patients? Changingepidemiology of IFIs and availability of new, effective and safer antifungaldrugs prompt the need to re-evaluate the older paradigms for this strategy.

Objectives: To study the effect of empirical antifungal therapy on thesurvival from infection in persistent febrile, neutropaenic patients treated forhaematological malignancies. Methods: This study was conducted fromApril to December 2012 and from January to March 2013 in PPUKM. Adult(>18 years old) patients who were hospitalised to receive chemotherapy forhaematological malignancies and developed neutropenia with absoluteneutrophil count ≤ 1.0 x 109/L for at least 72 hours, had persistent fever?380C with unknown source, had received empirical antibiotic for at least 72hours and were given empirical antifungal therapy were included in thestudy. Haematopoietic stem cell transplant patients were excluded. Results:38 patients were enrolled in this study. 31 patients (81.6%) responded toempirical antifungal therapy while 7 patients (18.4%) did not respond.Survival at 30 days after the last dose of the antifungal drug was 92.1%.There was only 1 case of IFI-attributable mortality during the therapy. Olderpatients (mean age 63 ± 9 years) had poorer response compared to youngerpatients (42 ± 15 years; p=0.001) (r=0.467; p=0.002). Patients who did notrespond to empirical antifungal were associated significantly with prolongedneutropaenic period (19 ± 4.5 days versus 10 ± 7 days; p=0.001) (r=0.508;p=0.001) and severe neutropenia (ANC 0.17 ± 0.21 x 109/L versus 0.57 ±0.31 x109/L; p=0.002) (r=-0.478; p=0.001). Amphotericin B (42.9%) was themost common empirically prescribed antifungal agent. However, almost halfof the patient population treated with amphotericin B (11/38, 28.9%)experienced drug-related side effects especially hepatic dysfunction, renalinsufficiency and hypokalaemia. All patients recovered from the side effectswhen they were switched from amphotericin B to newer antifungal drugs.

ABSTRACT #8COAGULATION FACTOR CONCENTRATES USAGE IN MALAYSIA 2012Nursabrina AA1, Gan CB1, Nasreen N1, Heng SC1, Lim YS1

Department of Pharmacy, Ampang Hospital1Introduction: In Malaysia, the number of patient diagnosed with haemophiliais increasing throughout the years in Malaysia from 1,034 patients in year2006 to 1,188 patients in year 2010. Thus, so is the usage of clotting factorconcentrates from 2006 to 2010; 10,250,000IU to 14,810,000IU for factorVIII and 5,000,000IU to 8,590,000IU for factor IX. Objectives: To estimatethe cost and budget required for the coming year from usage of coagulationfactor concentrated in year 2012. Methods: A cross sectional study wascarried out by distributing a data collection form to a total of 132 governmenthospitals listed on Kementerian Kesihatan Malaysia (KKM) from 1stDecember 2012 until 30th March 2013. Results: From this study, eachhospital did use different brand and types of coagulation factorconcentrates, mostly depending on patient treatment requirement andavailability. The highest usage is factor VIII brand Alleviate® (35534 vials),and least used are combination clotting factor concentrates brand Feiba®(111 vials). Conclusions: A total of RM 28,054,079.85 was estimated asbudget required for clotting factor concentrates in 2013.

ABSTRACT #9 (WITHDRAWN)

ABSTRACT #10UNAUTHORIZED PRESCRIPTION IN OUTPATIENT PHARMACYHOSPITAL AMPANGSithambaranathan C1, Zakiah BA1, Erliana NR1, Lam WY1, Loh YF1,Jamaliah J1, Haiza MMN1

Department of Pharmacy, Ampang Hospital1Introduction: Outpatient Department (OPD) provides optimal pharmaceuticalcares to the patient. Since OPD is frequently a patient’s first experience withthe hospital, achieving waiting time less than 30 minutes has been set asone of the Key Performance Index (KPI) by Ministry of Health Malaysia inorder to provide positive experience and satisfaction among patients.Unauthorized prescription is one of the examples of incomplete prescriptionwhich could contribute to increase in waiting time. Objectives: This studyhelps to identify the extent to which unauthorized prescription contributes tototal waiting time more than 30 minutes in OPD Hospital Ampang. Methods:A cross sectional study was carried out by using a data collection form whichwas place at the dispensing counter of OPD Hospital Ampang andgenerated data from e-His from 25th February 2013 until 30th June 2013.Results: Throughout 18 weeks of this study, an average processing timeobtained was 14.8 minutes. It was found that, 2,467 (3.85%) out of total64,061 prescriptions had waiting time more than 30 minutes. Out of this, 136(5.4%) over total of 2,498 unauthorized prescriptions took more than 30minutes to be dispensed meanwhile 240 (9.61%) unauthorized prescriptionswere authorized between 15 to 30 minutes. Conclusions: At the end of thisstudy, it was found that unauthorized prescription does increased the totalwaiting time in OPD. Although the result obtained showed that unauthorizedprescription only causes a small percentage in affecting waiting time morethan 30 minutes, a future research could be conducted to further identifyfactors which could possibly lead to an increase in waiting time.



ABSTRACT #11COST-EFFECTIVENESS OF WARFARIN MEDICATION THERAPYADHERENCE CLINIC (WMTAC) COMPARED TO USUAL MEDICALCLINIC (UMC) IN KUALA LUMPUR HOSPITALSubramaniam T1, Shafie AA1, Mohamed Azmi AH1, Jeyaindran S2Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia,Malaysia1; Department of General Medicine, Kuala Lumpur Hospital,Malaysia2

Objectives: Structured anticoagulation management clinic is recommendedto manage warfarinized atrial fibrillation (AF) patient. In Malaysia, theservice is recently introduced as pharmacist managed Warfarin MedicationTherapy Adherence Clinic (WMTAC). The primary objective of this studywas to assess the cost-effectiveness of WMTAC compared to the usualmedical clinic (UMC) from the provider perspective in Kuala LumpurHospital, Malaysia. Methods: This was a six month retrospective cohortstudy of the anticoagulation management models. A random numbergenerator was used to recruit patients. The mean total cost of clinic includesthe cost of monitoring, clinic consultation, drug and adverse event. As foreffectiveness, the mean proportions of time within target range were used.Incremental cost-effectiveness ratios (ICERs) were calculated anduncertainty was explored by one-way sensitivity analysis and bootstrapping.Results: A total of 92 patients were sampled from each clinic where the 6month cost (SD) was MYR 537.38 (352.39) for the UMC and MYR 352.62(180.21) for WMTAC, which was significantly higher (p<0.001). The averagecost (SD) per patient per month attending UMC was MYR 73.39 (21.07),whereas the WMTAC was MYR 54.61 (18.32). Proportions of TTR were alsosignificantly higher in the WMTAC patients than in UMC (66.1% vs. 48.3%;p<0.001). WMTAC dominated over the UMC, with a high probability of costeffectiveness. The study was not powered to detect adverse events.Conclusions: WMTAC produced better anticoagulation control, lowerhospitalization rate and more cost-effective for managing warfarinized atrialfibrillation (AF) patient than UMC. These findings will impact local warfarinpatient management services.

ABSTRACT #12COST-EFFECTIVENESS OF INSULIN GLARGINE FOR TYPE 2DIABETES MELLITUSAzmi S1, Goh A1

Azmi Burhani Consulting1

Objectives: To assess the cost-effectiveness of insulin glargine (Lantus)compared to neutral protamine hagedorn insulin (NPHI) in Malaysian adulttype 2 Diabetes Mellitus (T2DM) patients who are uncontrolled with oral anti-diabetics (OADs). Methods: A Markov decision-analytical model wasdeveloped using TreeAge Pro 2013 to simulate the cost and effects oftreatment with Lantus and NPH for T2DM patients uncontrolled on OADs.Based on transition rate probabilities, the patients could end each yearlycycle in one of nine health states, including alive, dead or one of the 7complications of DM. Model inputs were derived from local data andsupplemented by published information from various sources. The basecase model was analysed over 5 years with all cost and outcomesdiscounted at 3% per year to the analysis reference year of 2013. Theanalysis was performed from the perspective of the Ministry of Health.Results: The base case analysis showed that over 5 years, treatment withNPHI would cost RM 6,949 to gain 3.514 QALY as compared to RM 12,521for 3.646 QALY gained with Lantus. The incremental cost effectiveness ratio(ICER) for Lantus compared to NPHI was RM 42,002 per QALY. Results ofone-way and scenario sensitivity analyses did not substantially differ fromthe base case analysis. Conclusions: Lantus would be a cost-effectivetreatment compared to NPHI for T2DM patients uncontrolled with OADs,based on the WHO cost-effectiveness threshold of between one and threetimes GDP per capita.

Abstract #13PILOT EVALUATION OF TWO CHILDHOOD OBESITY PREVENTIONPROGRAMS IN MALAYSIALim CC1, Shafie AA1, Ahmad Hassali MA1, Baba Y2, Hamzah F2

School of Pharmaceutical Sciences, Universiti Sains Malaysia1; MySihat2

Introduction: Programs that prevent childhood obesity are vital to reduceobese adult and CVD problem. Therefore, programs’ effectiveness must beevaluated to optimize resources for childhood obesity prevention programs.Objectives: To assess intermediate cost-effectiveness of childhood obesityhealth promotion program. Methods: This quasi-experimental studycompared intermediate outcomes between NGOs, Sahabat Sihat (SS) andBe Best (BB), childhood obesity health promotion programs within a 6months period. Data on health related quality of Life (EQ-5D and EQ-VAS),KAP questionnaire and biomedical data were obtained from health bookletsprepared by MySihat for health promotion programs for childhood obesity.Data on cost was obtained from expenditure records of the respective healthpromotion programs. The association between EQ-5D, EQ-VAS, knowledgescore, attitude score, practice score and biomedical was explored usingMann-Whitney and Friedman test. Descriptive statistics were utilized in theanalysis of the cost results. Results: BB and SS were successful in

preventing 100% of overweight respondents becoming obese. Attitudescore was higher among SS’s cohort but practice score was higher amongBB’s cohort. BB had a lower average cost per participants and more cost-effective compared to SS. Conclusions: In summary, BB was moreeffective and cost-effective than SS in reducing the percentage of obesecohort and improving the level of knowledge, and practice after 6 months.

ABSTRACT #14SYSTEMATIC REVIEW OF ECONOMIC EVALUATION MODELS USEDFOR COST-EFFECTIVENESS ASSESSMENTS OF HEALTHPROMOTION PROGRAMS FOR CHILDHOOD OBESITYLim CC1, Shafie AA1, Ahmad Hassali MA1, Baba Y2, Hamzah F2

School of Pharmaceutical Sciences, Universiti Sains Malaysia1; MySihat2

Introduction: Childhood obesity leads to obesity and cardiovasculardiseases. Long term evaluation of health promotion program for childhoodobesity is difficult to be conducted, costly and time consuming. This reviewexplores the current methods utilized to evaluate health promotion programfor childhood obesity. Objectives: To evaluate and compare economicevaluation models used for cost-effectiveness assessments of healthpromotion programs for childhood obesity. Methods: The search waslimited to studies published in English language, covering literature untilJanuary 2013. First stage screening was done at title-keyword-abstractlevel. In second stage screening, full text of included studies were obtainedand screened for true full economic evaluation. Results: The literaturesearch identified thirteen studies used to model health promotion programfor childhood obesity. Currently, there are only four variations of modelsused for economic evaluation of health promotion programs for childhoodobesity. All modelling methods utilized transition probabilities to modellifetime progression of childhood obesity. The current models were able torelate cost averted (DALYs) and benefit gained (QALYs) with interventionbut health states chosen were based on demographic groups and notclinical events in the development of cardiovascular diseases model forchildhood obesity. Conclusions: It is essential, that improvement in themodel for childhood obesity based on clinical events, that relates tocardiovascular diseases is explored based on the perspectives of healthpolicy decision makers.

ABSTRACT #15DETERMINATION OF COST-EFFECTIVENESS THRESHOLD FORMALAYSIALim YW1, Shafie AA1, Chua GN1, Hassali MA1

School of Pharmaceutical Sciences, Universiti Sains Malaysia1

Objectives: Decision on the cost-effectiveness (CE) of healthcaretechnologies usually creates an argument especially when alternatives aremore expensive but more effective. In this situation, external criterion in theform of CE threshold or willingness-to-pay for a quality-adjusted life-year(WTP/QALY) needs to be applied to decide on its CE. Nevertheless, the lackof empirical and well-accepted CE threshold in Malaysia is recognized asone of the most important barriers in using health technology assessment inpolicy decisions. This study is mainly to determine the monetary values of aQALY across Malaysian population. Methods: A cross-sectional, contingentvaluation study was conducted using stratified multistage cluster randomsampling technique in Penang, Kedah, Selangor and Kuala Lumpur.Respondents were asked for the socioeconomic background, quality of lifeand their WTP for a hypothetical scenario (treatment, extended life interminal illness and lifesaving situations with three severities and two QALYgained levels – 0.2 QALY and 0.4 QALY) using pre-designedquestionnaires. Interval model analysis was applied to determine the CEthreshold. Results: One thousand thirteen respondents aged between20–60 years old who can understand either English or Malay language wereinterviewed face-to-face. The mean value of CE threshold was determinedat the range of MYR 19,919.00 to MYR 28,495.00 (~ USD 6,200 to USD8,900). Conclusions: By comparing our results to Malaysian GDP percapita in the year 2011; ~ MYR 50,560 (~ USD 15,800), we noted that meanWTP/QALY ranged between 0.39–0.56 times of GDP per capita.

ABSTRACT #16EVALUATING THE PRESCRIBING DOSING TRENDS OF OPIOIDSUBSTITUTION TREATMENT PROGRAMME IN PRIVATE MEDICALPRACTITIONER CLINICS BY CALCULATING THE ESTIMATEDAVERAGE DAILY DOSE (EADD) OF METHADONE ANDBUPRENORPHINE AFTER THE IMPLEMENTATION OFPSYCHOTROPIC PERMIT IN MALAYSIADzafarullah D1, Mohd Bokhari MN1, Bahirah B1, Mohd Nazri MD2

Pharmacy Enforcement, Ministry of Health, Malaysia1; Pharmacy Practice &Development, Ministry of Health, Malaysia2

Objectives: The psychotropic permit to purchase and use methadone andbuprenorphine was introduced in 2011 to promote rational prescribing topatients under the opioid substitution treatment program in private medicalpractitioner clinics in Malaysia. This study aims to evaluate the prescribingdosing trends and to compare them with the average daily doserecommended by the Ministry of Health Clinical Guidelines Practice



(MOHCGP) for methadone and buprenorphine. Methods: The quota andthe number of patients estimated from the psychotropic permits that hadbeen issued from 2011 to 2013 were studied. A formula to calculate theestimated average daily dose (EADD) of buprenorphine and methadonewas derived as follows: “Estimated Average = Estimated Quota (mg)/Daily Dose (mg)Estimated Number of Patients x 365 days”Results: From the EADD calculations, the results obtained were: (a) 2011–methadone (20.8mg), buprenorphine (3.93mg), (b) 2012-methadone(18.96mg), buprenorphine (1.84mg), (c) 2013 - methadone (11.31mg),buprenorphine (1.2mg). The EADD of methadone and buprenorphineprescribed were found to be lower than average daily dose recommendedby the MOHCGP for methadone (30mg-60mg) and buprenorphine (8mg-16mg). Conclusions: Patients who have undergone opioid drug addictiontreatment programme at private medical practitioner clinics were found notto have been prescribed with the recommended daily dose of methadoneand buprenorphine. Accreditation of private medical practitioners should bemade a prerequisite to apply for the permit which would help practitioners toprovide better treatment to their patients.

ABSTRACT #17ECONOMIC EVALUATION OF ENHANCED ASTHMA MANAGEMENT: ASYSTEMATIC REVIEWYong YV1


Objectives: To evaluate, compare, and assess the quality of the studies onthe cost-effectiveness of enhanced management (either as adjunct to usualcare or alone) vs. usual care alone or none at all. Methods: Scientificdatabases (Science Direct, Wiley Online Library, (Ebsco Host– MEDLINE,CINAHL, PSYInfo), (OvidSP– EMBASE, MEDLINE), and Scopus) weresearched for published journal articles in English language from year 1990to 2012, using the search terms “asthma AND (intervene OR manage) AND(pharmacoeconomics OR economic evaluation OR cost effectiveness ORcost benefit OR cost utility)”. Hand search was done for local publishing.Only studies with full economic evaluation on enhanced management(either as adjunct to usual care or alone) were included. Selected studieswere data abstracted and assessed for their quality of economic evaluationusing the Quality of Health Economic Studies (QHES) instrument, andquality of evidence. Results: A total of 14 studies were included. There werethree distinct modes reviewed: environmental control, self-management,education. Most of the enhanced managements were found to be cost-effective with ICER ranged from dominant to $26,700.00 per unit ofoutcome. Overall, the mean score of QHES was 76.69% (SD 9.26).Evidence sources for all data components in the 14 studies were rankedhigh quality except one study’s source for ‘utilities’ component ranked lowquality because it used visual analogue scale to obtain patient preferencevalues. Conclusions: Despite the moderate qualities of the reviewedstudies, it overall suggests that enhanced management (either as adjunct tousual care or alone) is mostly cost-effective than the usual care or none atall.

ABSTRACT #18HEALTH-RELATED QUALITY OF LIFE (HRQOL) AMONG MOTHERSWITH THALASSEMIA CHILDREN IN MALAYSIAMohd Miskam H1, Juhari R1, Yaacob SN1, Abu Talib M1

Department of Human Development and Family Studies, Faculty of HumanEcology, University Putra Malaysia, Selangor, Malaysia1

Objectives: This study aspires to examine the level of and factors thatsignificantly predict health-related quality of life of mothers with Thalassemiachildren. Methods: This cross-sectional study was conducted using face toface interview involving 388 mothers who have children with Thalassemiafrom ten government hospitals in Malaysia. National Medical ResearchRegistration (NMRR) approval was obtained prior to the study. Establishedand reliable instruments were used to measure key variables, namely,SF12v2 were used to measuring HRQOL, Parental Stress Scale to measurematernal stress, Financial Concern for financial problem and SeverityAssessment Tools for severity of child illness. Reliability of SF12v2 wasestimated using internal consistency and factor analysis was extractedusing EFA. Multiple linear regression analysis was used to identifypredictors of the dependent variable. Results: Results illustrated thatmaternal stress, financial concern and severity of illness were significantlyand negatively related to both PCS ad MCS. Interestingly, financial concernwas found to be the strongest predictor of maternal health related quality oflife – Mental Component (MCS) (beta=-0.310), whereas severity of illnesswas the strongest predictor for the Physical Component – PCS (beta=-0.260). Conclusions: In conclusion, financial concern and severity of childillness played significant roles in shaping health-related quality of life ofmothers with Thalassemia children in Malaysia. Mothers who are burdenedfinancially and in constant worries due to the severity of the child’s illnessseemed to be more impaired. Intervention programs should not neglect theimportance of these two factors in helping these mothers to cope with thecircumstances.

ABSTRACT #19ANTIBIOTIC USE, EXPENDITURE AND OUTCOMES AT KAJANGHOSPITAL: THE IMPACT OF ANTIBIOTIC-MEDIFACT PROGRAMSarah Diyana S1, Farizan AG1, Zaiton K1, Lim LL1, Ling TC1, Ramadas A1,Yee CP1, Zarif Naim A1

Department of Pharmacy, Kajang Hospital1Introduction: In 2010, among ten government hospitals in Selangor,Kajang Hospital was reported to be the ‘top users’ for 6 types of antibioticsand had the highest expenditure for antibiotics. These may indicateexcessive and inappropriate usage of antibiotics. Objectives: The purposeof this study is to evaluate the impact of a multidisciplinary antibiotic program(Antibiotic-MEDIFACT) on the antibiotic consumption, expenditure andbacterial resistance. Methods: The program was formed in June 2011 with4 strategies: Standard antibiotic order forms with preauthorizationrequirements for 9 restricted antibiotics, education, audits and feedbacks.Use of antibiotics was recorded in defined daily doses per 1000 patient-days. Costs of antibiotic expenditures were collected 1.5 years before and1.5 years after the intervention. Fluctuation in drug prices were eliminatedby using the average cost of each antibiotic dosage form over the 3 years ofthe study period. Average bed occupancy over 3 years of the study periodwas used in order to avoid overestimation of economic impacts of theintervention. Bacterial resistance rates were recorded based on antibiogramdata from pathology laboratory data. Results: The intervention wasassociated with a significant reduction of use of Cefoperazone/Sulbactam(p=0.007), Ceftriaxone (p=0.019) and Vancomycin (p=0.007). Usage ofother antibiotics i.e. Cefuroxime, Meropenem, Imipenem, Piperacillin/Tazobactam and Polymyxin B has reduced but it was not statisticallysignificant. Total reduction in antibiotic expenditure was RM 268,069.60 andreduction in expenditure of 9 restricted antibiotics was RM 15768 per monthin post intervention period (95% CI RM 6259–RM 25278; p=0.001). Thefrequency of Ceftazidime-resistant Pseudomonas aeruginosa strains havebeen decreased from 22% to 7% (p=0.04). The frequency of Polymyxin B-resistant Acinetobacter baumannii strains, Pseudomonas aeruginosa strainsand Escherichia coli strains have been decreased from 11%, 5% and 3% to0%, 1%, and 1% respectively. Conclusions: The Antibiotic-MEDIFACT programwas associated with reduction in antibiotic use, cost and bacterial resistance.This results support the notion that a systematic antibiotic program.

ABSTRACT #20DRUG UTILIZATION AND COST OF ANTIPSYCHOTIC IN THETREATMENT OF SCHIZOPHRENIA AT KAJANG HOSPITAL.Shafie SD1, Kamarruddin Z1, Tan KZ1, Zainal Abidin MN1, Zainal H1, Tey SY1,Bakhtiar A1, Aziz MS1, Abdullah AS1, Shukhairi AN1, Roslee AR1, ZakariahMH1, Yusoff MD1

Department of Pharmacy, Kajang Hospital1Introduction: Examination of antipsychotics (AP) medication use patternshas suggested that current prescribing practices do not mirrorrecommended treatment guidelines and may have adverse economicconsequences. Objectives: To describe medication treatment patterns ofSchizophrenia patients with reference to Malaysian Clinical PracticeGuidelines for Schizophrenia, among Ministry of Health (MOH) and Ministryof Higher Education (MOE) psychiatrists practicing in Kajang Hospital.Methods: A retrospective cross sectional drug utilization study ofprescriptions for schizophrenia patients was conducted from January 2012until December 2012 in outpatient pharmacy. Preparation of the protocolwas as per the WHO – DUS guidelines. Results: Total number of drugencounters for 678 prescriptions was 1,477. Average number of drugs perprescription was 2.18 + 1.03 SD. Monotherapy prescribing were morefrequently observed as compared to polytherapy prescribing by both MOH(79.2%;N=590) and MOE (87.5%;N=88) psychiatrists (p=0.067). Inmonotherapy treated patients (N=544), significantly higher number ofatypical AP (AAP) drugs prescribed as compared to typical AP drugs by bothMOH (71.9%;N=467) and MOE (83.1%;N=77) psychiatrists (p=0.040). BothMOH (53.7%; N=467) and MOE (40.3%; N=77) prescribed most commonlyRisperidone (51.6%). Other commonly prescribed AP were Chlorpromazine(16.8%) and Olanzapine (13%). Perphenazine (0.9%) and Zuclopenthixol(0.4%) were the least prescribed. In polytherapy treated patients (N=134),variation in combination therapies were as followed: oral AAP with depot APpreparations (36.6%), oral typical AP with depot AP preparations (25.4%),oral AAP and oral typical AP (20.1%) and combination of both oral typical AP(5.9%). Combinations of both oral AAP found during switching from one toanother oral AAP and for treatment of resistant schizophrenia were 8.2%and 3.7% respectively. Co-prescribed drugs (N=665) were centralanticholinergic drug (49.8%), anti-anxiety drugs (35.9%), selective serotoninreuptake inhibitors (13.4%) and mood stabilizers (0.9%). Centralanticholinergic drug was co-prescribed in 39% patients on AAPmonotherapy. Conclusions: Overall, the principles of rational prescribingwith reference to guideline were followed by both MOH and MOEpsychiatrists. The practice of using combination of AP was as per currentrecommendations. Combination of both oral typical AP requiresconsideration/attention to adverse events and drug interactions. Rationaluse of anti-anxiety drugs requires attention to duration of usage with AP.



Routine use of anticholinergic drug along with AAP could not be justified andshould be used only in selected cases of patients.

ABSTRACT #21INCIDENCE AND CAUSALITY IN ADVERSE DRUG REACTION-RELATED ADMISSION TO HOSPITAL: A SYSTEMATIC REVIEWSiti MK1, Yvonne HM1, Amudha PS1

Department of Pharmacy, Kajang Hospital1Introduction: Adverse drug reaction related hospitalization has related tothe increase in the physical cost of treatment, admissions rates to get acutetreatments, prolonged bed occupancy, as well as time and energy for thestaff to accommodate the congestion. Objectives: To assess the incidenceof reported adverse drug reaction related admissions to hospitals includingpresentation in various hospital departments. Methods: A systematicliterature review in Medline. Papers included were preventable and non-preventable adverse drug reactions admitted to hospital following the WHOdefinition of adverse drug reactions, adult patients (above 18 years old) andpapers that were published from year 1973 until present. Trial drugs,intentional drug overdosing, expert opinions, editorials as well asconference abstracts and non-English papers were excluded. MeSH termsand keywords such as adverse drug reactions, drug toxicity, drughypersensitivity, hospitalization, hospital admission and adult were used.The review followed PRISMA statement guidelines. The data abstractiontool were used to extract the data and finally cross-reviewed by twoassessors. Results: The median percentage for incidence rate was 5.5%that ranges from 0.1% to 53% according to the included studies. The medianpercentage of preventable adverse drug reaction related admissions was63% ranging from 2.6% to 91%. Common drugs causing adverse drugreactions were antipsychotics (23.5%) followed by analgesics (12.4%) andcardiovascular agents (10.8%). Apparently, the body systems that weremost affected by adverse drug reactions were gastro-intestinal (12.2%), skin(11.4%) and circulatory system (10.2%). Eight studies reported more than70% preventability rate particularly in the geriatric population while deathdue to ADRs were reported from 0.05% (n=1) to 0.23% (n=73). TheNewcastle-Ottowa quality assessment scale by Wells et al (2009) wastested on 31 cohorts, 22 cross-sectional and five case control studies. Of theincluded studies, 82.2% scored a minimal five point and above and can thusbe categorized as moderate to good study quality. Conclusions: Thefindings from this systematic review suggest that the frequencies for theincidence rates and preventable ADRs reported during hospital admissionswere widely varied between eligible studies. The incidence rates have notchanged significantly over the years despite the high rates of potentialpreventability.

ABSTRACT #22ECONOMIC EVALUATION OF FOOD WATER BORNE DISEASE INMALAYSIAMohd Dawam ND1, Wan Puteh SE1

Department of Community Medicine, UKM Medical Centre1

Introduction: Food borne disease causing a significant impact on economicif the incidence of the disease is keep increasing without proper surveillanceand outbreak control. Food borne disease in Malaysia is in the rise and thedirect and indirect cost management of these diseases will become one ofthe most common issues to face by the government. Therefore, these studywill analyse the cost involve in managing food water borne disease and howit related to economic burden to the individual, provider and community.Objectives: To determine economic burden of food water borne disease inMalaysia by calculating the cost and DALY of Cholera, Typhoid and FoodPoisoning specifically. Methods: A cross-sectional study to be carried out inApril 2014 until December 2014 that combines economic evaluationmethods and Disability Adjusted Life Year (DALY) to estimate the economicburden of food and water-borne diseases as well as the costs involved in themanagement of this disease specifically for Cholera, Typhoid and FoodPoisoning. These study locations are in National University Hospital, KajangHospital, Kuala Lumpur Hospital and two districts namely Hulu Langat andPetaling. Results: Expected results of the study are the total cost of foodwater borne disease in view of healthcare provider and patient. Other thanthat, the burden of the food borne disease will be show by calculating theDisability Adjusted Life Years. At the end of the study expected to show theeconomic burden of the food water borne disease by calculating cost perdisability adjusted life years (DALY). Conclusions: Economic evaluationstudies of food water borne disease are intended to show the real burden offood water borne disease by showing the total cost and calculating cost perdisability adjusted life years.

ABSTRACT #23ECONOMIC EVALUATION OF ZOONOTIC DISEASE IN MALAYSIAOmar N1, Wan Puteh SE1

Department of Community Medicine, UKM Medical Centre1

Introduction: Zoonoses have been defined as diseases and infections thatare naturally transmitted between vertebrate animals and humans. Globally,zoonoses are said to account for 60% of all infectious disease pathogens

and 75% of all emerging pathogens. Objectives: To determine economicburden of three prevalent zoonotic diseases in Malaysia which isLeptospirosis, Malaria and Chikugunya by calculating the provider’s cost inmanaging the cases involved. Methods: This cross sectional study will beconducted from June 2014 till December 2014. The cost of treatment ofthree zoonotic diseases will be calculated based on Clinical Pathways andActivity Based Costing methods. Secondary data from the Ministry of Healthwill be used to estimate the cost. Results: This study is expected to give thetotal cost of the three zoonotic diseases in view of provider’s cost. Costmodelling of burden and projected burden for the next 5 years also expectedto be calculated from this study. Conclusions: The current and projectedcost burden estimations can help the nation to place strategic managementfocus on areas of neglect and improve collaborative efforts between themedical and veterinary fraternity for the further future progress andimprovement in these areas.

ABSTRACT #24OVERVIEW OF THE SAMPLING PATTERN OF SUSPECTEDPARACETAMOL (PCM) POISONING IN HOSPITAL SUNGAI BULOH(HSB)Nurfareeza NK1, Ang SY1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Paracetamol (PCM) is a popular poisoning agent. Mainconcern with paracetamol overdose is the hepatoxicity effect and N-acetylcysteine (NAC) known to be its effective antidote. Wrong samplingtime and delayed results obtained may lead to mismanagement of PCMpoisoning. Hence, the aim of the study is to observe the sampling pattern ofthe TDM in the management of the suspected PCM poisoning in HSB.Objectives: To evaluate the appropriateness of the sampling time andprocessing time of the acetaminophen TDM samples, the factors identifiedfor delayed release of the acetaminophen level result and also theappropriate use of NAC in the management of acetaminophen toxicity.Methods: This cross sectional study was conducted in HSB. All orders sentfor TDM PCM toxicity from 1st January 2012 to 31st October 2012 wascollected through the electronic hospital information system (eHIS).Incomplete data and rejected sample was excluded. Appropriateness ofsampling and processing time as well as usage of NAC were expressed inpercentage while the identified factors (status of order (urgent/ routine) andtime of sample received) affecting the delay of processing time wasanalysed using chi-square test where p<0.05 were considered significant.Results: 26% of the 185 samples are suspected of PCM poisoning andothers are of other poisoning. This inadequate practice may cause wastageof reagent and manpower. 34% of the samples were taken correctly, 4-24hours post PCM ingestion. Most samples are processed within 2 hours uponsample received. 59.4% of samples ordered as urgent compared to routinewas processed within 2 hours after sample received. However, it isinsignificant (p=0.490). Significant results of sample received after officehours will take more than 2 hours to be processed. About 40% of cases withNAC were non-toxic while about 50% of these cases are not applicable asthe sample taken was less than 4 hours. Conclusions: Sampling time andinappropriate practices in HSB need to be improved and revised by adheringto the guidelines in managing paracetamol poisoning.

ABSTRACT #25SURVEY ON AWARENESS OF HIGH ALERT MEDICATIONS AMONGDOCTORS, PHARMACISTS AND NURSES IN HOSPITAL SUNGAIBULOHSia HP1, Bay EL1, Tei YM1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Improving medication safety for High Alert Medications(HAMs) remains a major concern for health professionals. Most medicationerrors may cause no harm to patients but inappropriate administration ofHAMs can cause serious injuries and deaths. The purpose of this researchis to assess the awareness of HAMs among the health professionals inHSgB. Objectives: This study is done to explore the awareness of HighAlert Medication among health professionals, to assess the awareness ofstaffs on interventions done by the High Alert Medication committee atimproving awareness about High Alert Medication and to identify commoncauses of medication errors involving High Alert Medication based on staffperception. Methods: A cross-sectional survey based study was conducted.Survey comprising of 15 items were randomly distributed within 2 weeks to77 participants which included doctors, pharmacists and nurses serving inselected critical and non-critical wards of HSgB. Selected critical wardsinclude Intensive Care Unit (ICU), High Dependency Ward (HDW) andCoronary Care Unit (CCU) while selected non-critical wards include Ward4A, 4C, 4D, 5C and 7B. SPSS Software and Microsoft Excel were used fordata analysis. Data was analysed using descriptive statistics. Results: Outof the 77 respondents, 32.5% were doctors, 14.3% were pharmacists and53.3% were nurses. Only 46.8% respondents attended HAM briefing beforetaking part in this study. 81.8% respondents considered the measuresimplemented were able to increase their awareness and knowledge on HAMwhile 75.3% felt that these able to help prevent or reduce medication error



involving HAM. 87% respondents practiced close monitoring on adversereactions and medication errors involving HAM in their setting. 63.6% wereaware about the changes of brand or packaging of HAM. Look Alike SoundAlike (LASA) medications ranked as the top reason for the occurrence ofmedication error involving HAM (51.9%). Conclusions: The awareness ofHAM among doctors, pharmacists and nurses in HSgB was found to besatisfactory, with the highest awareness among the nurses.

ABSTRACT #26FACTORS AFFECTING JOB SATISFACTION AMONGST PUBLICSECTOR HOSPITAL PHARMACISTS WORKING IN SELANGOR,MALAYSIAHing YL1, Ezmiza N1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Job satisfaction (JS) studies targeting public sector hospitalpharmacists working in Malaysia is still largely an unexplored area. Thus, JSlevels and factors affecting them were measured amongst public sectorhospital pharmacists working in the state of Selangor, Malaysia. Methods:A previously validated JS questionnaire was mailed to all 327 activepharmacists working in all Selangor public hospitals. Data was collectedfrom mid-April to end of June 2012. The questionnaire contained questions;graded with a 5-point “strongly agree” (5) to “strongly disagree” (1) scale;that examined extrinsic and intrinsic factors and assessed job satisfactionlevels via two separate scales, abbreviated as JS1 and JS2, to allowreliability and correlativity cross checking with analysed factors. Results:179 completed questionnaires were returned, eliciting a response rate of54.7%. Most pharmacists were somewhat satisfied with their job, scoring onaverage 3.09 + 0.92 and 3.20 + 0.89 for JS1 and JS2 respectively.Spearman correlation scores indicated significant correlation betweenintrinsic factors (rJS1=0.55, rJS2=0.47, P<0.01) and extrinsic factors(rJS1=0.66, rJS2=0.52, P<0.01) with JS. Most intrinsic factors wereaddressed fairly well, with job creativity and importance as significantpredictors for JS. Management concern and opportunity for advancementwere extrinsic factors that needed improvement given they are significantlylinked to JS. Stepwise multiple regression revealed only extrinsic factorswere significantly correlated with JS (r2JS1=0.56, P<0.0001; r2JS2=0.27,P<0.0002), implying that extrinsic factors are predominant significantpredictors towards JS. Such findings may be due to socioeconomic andcultural influences of Malaysian society towards JS. Conclusions: Overall,Selangor hospital pharmacists were quite satisfied with their job. Moreattention should be paid to extrinsic factors which have stronger influenceover job satisfaction compared to intrinsic factors.

ABSTRACT #27PERCEPTION, ACCEPTANCE AND TOLERABILITY OF PATIENTSTAKING INNOVATOR VERSUS GENERIC ESCITALOPRAMHing YL1, Lim SY1.Department of Pharmacy, Sungai Buloh Hospital1Introduction: Generic drugs have been introduced into governmenthospitals to help reduce healthcare expenditure. A study aiming to evaluatepatient’s perception and acceptance towards the generic version ofEscitalopram (Espran®) after switching from the innovator version(Lexapro®) was conducted in Sungai Buloh Hospital. Methods: A list of 67patients who were on innovator Escitalopram (Lexapro®) during Septemberand October 2012 were generated via the hospital’s computer database (e-HIS). Throughout the study period from 1st of September 2012 to 31stMarch 2013, all sampled patients were switched from innovatorEscitalopram (Lexapo®) to generic Escitalopram (Espran®). Patients weresurveyed before and after switching their medication via an interviewer-administered validated questionnaire through phone on demographicbackground, acceptance and side effect tolerability, knowledge on genericmedicines, preference towards innovator or generic medicines and thereasons behind their choices. Patients were excluded if they receivedEscitalopram treatment for less than a month, refused to participate, notcontactable, did not switch to generic, or stopped treatment. Results: 38patients completed the survey. 43% have heard of the term ‘Innovator’ and'Generic’. However, two-thirds of the samples do not understand the term 'Generic' and 5% misunderstood the meaning of 'Generic’ drug. 48.5% of thesample preferred innovator Escitalopram (Lexapro®), 30% preferredgeneric Escitalopram (Espran®) and 21.5% had no preference. There wasa significant difference in patient’s acceptance (p=0.038) plus incidence andtolerability of side effects (p=0.038) which favoured the innovator version. Anear 50% increment in side effect cases were reported after patientsswitched to generic Escitalopram. Patient’s preference towards whichversion of the medication was directly correlated to patient’s acceptancetowards the medication (p=0.001). Conclusions: Generic Escitalopram wasless preferred and accepted by patients as compared to innovatorEscitalopram because of lesser efficacy and significantly associated withmore intolerable adverse effects.

ABSTRACT #28PATIENT’S OWN DRUGS: PROFILE OF DRUGS’ COST AND WASTAGETan JN1, Nadia AR1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Patient’s Own Drugs (PODs) are medications that patientshave obtained in the community setting and have brought with them to thehospital upon admission. When patients bring their previous medications,often these medications are not being used as they are supplied to thepatients by inpatient pharmacy. This leads to wastage on hospital resourcesand patients’ own supply can be used instead. The aim of this study is todetermine the cost of wastage incurred when PODs brought from homewere not used during hospital stay. The classification and quantity of PODsas well as the most costly medication are also determined. Objectives: 1.To calculate the total cost that would have incurred if PODs are not beingused. 2. To identify the quantity and classes of PODs brought in. 3. Todetermine the class of drug that has the highest cost. Methods: This is adescriptive study. A total of 100 patients admitted into both male and femalemedical ward of Hospital Sungai Buloh were recruited during the period ofone month from 15th September to 15th October 2011. Subjects wererecruited via convenient sampling and patients who were admitted duringthe weekends or medications that were changed by doctors during hospitalstay were excluded from this study. The study data was analysed usingMicrosoft Excel software. Results: A total of 45 subjects were analysed.Eight classes of drugs were identified – oral hypoglycaemic agents, anti-hypertensives, lipid-lowering agents, diuretics, cardiovascular agents, anti-platelets, psychiatric agents and others. Total cost for these medicationswas RM 250.30. Out of the eight classes, anti-hypertensive drugs were themost costly with RM 97.91. On average, the cost of medications per patientper day was RM 0.46. Assuming if beds are occupied throughout the yearin both male and female medical ward, the total cost saving if medicationsare taken from patients’ own supply can be approximately RM 9,402.40.Conclusions: In conclusion, medication wastage is evident in the inpatientsetting when patients’ own supply of medications was not used instead.However, a more thorough audit is needed to determine the exact cost andits’ impact of using patients’ own drugs. It provides as a platform toimplement a healthcare policy on patients’ own drugs in the future.

ABSTRACT #29STUDY ON THE CLINICAL OUTCOME OF PHARMACIST-MANAGEDDIABETES PATIENTSSiti AZ1, Hasnur SH1, Chin KC1, Zaili ME1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Glycaemic control is the key to reduce both micro- andmacro-vascular complications associated with type 2 Diabetes Mellitus. InHospital Sungai Buloh, pharmacists play their role in managing diabeticpatients through interventions done in Diabetes Medication TherapyAdherence Clinic (DMTAC) which is in operation since 2008. Objectives: Toevaluate the clinical outcomes in diabetic patients in terms of reduction inHbA1c and fasting blood sugar (FBS) through interventions done inDiabetes Medication Adherence Clinic (DMTAC). Methods: A retrospectiveand observational study among patients enrolled in the DMTAC programwas conducted between February 2012 and July 2013. Data was includedfrom patients with uncontrolled DM having glycosylated haemoglobin(HbA1c) more than 8% and who had visits more than three times with thepharmacists. The descriptive analysis was used to analyse data on patientsdemographic and medication regimens associated with diabetes. Forstatistical analysis, a paired t-test and Wilcoxon Signed-Rank test was usedto evaluate the differences between pre- and post-values of HbA1c andFBG. Results: A total of 65 patients were included in the analysis. Mostpatients in this study aged between 51 to 60 years old (36.9%). Majority ofthe patients were males (60%). Malays dominate the highest ranking(80.3%), followed by Indians (11.8%) and Chinese (7.9%). For macrocomplications, 70.8% patients do not state any macro complication.However, 26.2% of all patients are complicated with angina. The mostcommon micro complication is diabetic nephropathy (21.5%), retinopathy(18.5%) and neuropathy (7.7%). A mean reduction in HbA1c of 1.168%(p<0.001) and mean reduction in FBG of 3.87mmol/l (p=0.004) wereachieved. Conclusions: The pharmacist-managed diabetes patientsprogram resulted in significant improvements in HbA1c and fasting glucoselevels.

ABSTRACT #30USAGE OF IV NAC IN ICU PATIENT WITH RENAL INSUFFICIENCY TOPREVENT CONTRAST-INDUCED NEPHROPATHYHannah MM1, Nur Syazreen AS1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Nephrotoxicity is a major complication that occurs within 3days of administration of iodine contrast medium intravenously. Studieshave shown that combined hydration therapy with oral NAC given a dayprior to and on the day of administration of contrast medium, may preventnephrotoxicity event in chronic renal failure patients. When there is a timeconstraint, IV administration of NAC immediately before the administration



of contrast and additional dose over subsequent 4 hours has been advocatefor preventing contrast-induced nephropathy (CIN). However, theeffectiveness of NAC for this indication is still under investigation.Objectives: The aim of this study is to assess the outcome of using IV NACin preventing CIN in ICU patient with impaired renal function and toinvestigate the correlation between the risk factor and CIN. Methods: Datawere retrospectively collected from eHIS system of ICU patients who hadreceived IV NAC 10,000mg given as 2000mg for the first hour followed500mg/hour for the next 16 hours. Six readings of serum creatinine weretaken i.e. when patient admitted to the hospital, a day before patientundergo CT scan, 12-hours, 24-hours, 48-hours and 72-hours afterreceiving NAC. Results were analysed using Microsoft Office Excel 2007,Paired T-test and Pearson Correlation. Results: Decrement of serumcreatinine at 12-hours post-NAC has been seen in 52% of 57 patients while55% patient shows decrement at 24-hours post-NAC. At 48-hours and 72-hours post NAC, 57% and 65% of patients shows decrement of serumcreatinine respectively. However, the decrement of the serum creatinine isonly statistically significant at post 72 hours of NAC. Correlation study showsa positive correlation that contrast medium caused increased serumcreatinine in the first 48 hours in patient with acute hypotension, sepsis,chronic kidney disease, diabetic and patient who received nephrotoxicdrugs. Conclusions: With regards to serum creatinine level, administrationof IV NAC appears to be an agent that gives protection to renal function forpatient receiving contrast medium.

Abstract #31PREGNANCY OUTCOMES IN INSULIN TREATED GESTATIONALDIABETES MELLITUS PATIENT FROM DIFFERENT ETHNICITY INHOSPITAL SUNGAI BULOHNur Atiqah S1, Lee XY1, Teo Y1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Gestational Diabetes Mellitus (GDM) is associated withsubstantial rates of maternal and perinatal complications such asmacrosomia, preeclampsia, low birth weight, caesarean delivery andneonatal hypoglycaemia. Unquestionably, there are ethnic differences in theprevalence of GDM. Most studies found Asian women are at higher risk ofgetting GDM especially Indian and Chinese ethnicity compared toCaucasian. However, lack of related studies can be found in Malaysia.Objectives: The objective of the study is to determine prevalence of GDMin different ethnicity and to evaluate adverse pregnancy outcomes fromdifferent ethnicity in Insulin treated GDM. Methods: Retrospective study ofall women who delivered at Hospital Sungai Buloh (n=5,957) whichdiagnosed with GDM patient. Adverse pregnancy outcomes including birthweight, gestational age, preeclampsia, delivery method, NICU stay morethan 24 hours were recorded. Kruskal-Wallis analysis for continuousvariables and Pearson's chi-square for categorical variables were used.Results: In our study from January 2013 until June 2013, the prevalence forgestational diabetes mellitus among pregnant women is 11.52%. From5,957 women, only 696 women were diagnosed with GDM. Among of all,156 patients were treated by insulin. Indians contributed in gestationaldiabetes mellitus prevalence the most (25.1%), followed with the Chinese12.4% and Malays 11.1%. As for method of delivery, caesarean delivery wassignificantly higher compared to spontaneous delivery (p<0.05). However,there is no significant difference between different ethnicity for otheroutcomes (p>0.05). Conclusions: The prevalence GDM in this study(11.52%) fall in high risk population. Indians contributed the highestprevalence among others ethnic. In this study, ethnicity was found to have asignificant difference in caesarean method delivery. Further study is neededto study the relationship between pregnancy outcome and ethnicity. Hence,we can intensify the treatment in high risk ethnic.

ABSTRACT #32CORRELATION OF PHENYTOIN LEVEL WITH RHABDOMYLOSIS ANDTHROMBOCYTOPENIA IN CRITICALLY ILL PATIENTS WITHHYPOALBUMINAEMIARahela AK1, Shing Chyi L1, Sinn Yin A1, Norirmawath S1, Hannah MT1, EeLing B1, Wee Leong L1, Shanthi R1

Anaesthesiology Department, Sungai Buloh Hospital1Introduction: Phenytoin is widely used for traumatic brain injury patients inIntensive Care Unit (ICU) of Hospital Sungai Buloh (HSgB). Phenytoin hasbeen reported to induce rhabdomyolysis, where there is breakdown ofmuscle fibres and results in raised Creatine Kinase (CK) level. In addition,phenytoin is known to induce thrombocytopenia, a rare but serioushaematological adverse effect. Objectives: To evaluate the impact of sub-therapeutic or toxic levels of phenytoin towards rhabdomyolysis andthrombocytopenia, and investigate other factors that may affect phenytoinlevel. Methods: Medical records of 70 patients admitted to Intensive CareUnit of HSgB prescribed with phenytoin from October 2011 to May 2012were retrieved. 61 patients with hypoalbuminemia (albumin <35 g/L) wereidentified for inclusion. CK level, platelet level, albumin level and phenytoinlevel were collected and the data was analysed using 2 way chi-square test.Results: The mean age of the 61 patients was 31.8 ± 8.7 years (range 20 to57 years). The subjects had traumatic brain injury, subarachnoid

haemorrhage or epilepsy. Sub-therapeutic (less than 40 µmol/L) and toxiclevel (more than 80 µmol/L) of phenytoin were associated with increased CKlevel compared to normal phenytoin level. However, it was not statisticallysignificant (p>0.05). Toxic level of phenytoin compared to sub-therapeuticand normal level of phenytoin was associated with significantthrombocytopenia (platelet less than 100 x 109/L; p<0.05). Very low albuminlevel (less than 20 g/l) was associated with significant phenytoin toxicity(p<0.05). Conclusions: Rhabdomyolysis is easily affected by other factors,thus Creatine Kinase (CK) is not a strong indicator to predict phenytoin level.Thrombocytopenia and very low albumin level may play a role in predictingphenytoin toxicity.

ABSTRACT #33TENOFOVIR-INDUCED RENAL IMPAIRMENT IN HIV-INFECTEDPATIENTSPreethi R1, Aiman M1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Tenofovirdisoprovilfumarate (TDF) was the preferrednucleoside reverse transcriptase inhibitor (NRTI) when starting therapy forHIV patient with exception in pregnant women. Tenofovir is mainlyeliminated through kidneys hence its use was associated with reduced renalfunction. TDF was considered safe drug, well tolerated and recommendedas a first line in the triple agent combination therapy. Upon practice use, itwas found out that there was not uncommon number of patients developrenal impairment. Objectives: To estimate the prevalence of Tenofovir-induced renal impairment in HIV-infected patients and to determine whethermedian eGFR after Tenofovir was started differ from median eGFR beforeTenofovir was started. Methods: A retrospective cross sectional study wasconducted among outpatient department (OPD) patient (n=73) receivingTDF in Hospital Sungai Buloh from January 2012 till January 2013 withduration of eGFR ranging from 2 weeks to 5 years. Patients withcomorbidities, pre-existing renal impairment, does not take serum creatininebaseline level prior to TDF treatment, does not follow up and discharged toother hospital was excluded from the study. A definition from National KidneyFoundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) wasused to defined the renal impairment which was GFR less than 60mL/min/1.73m2. Results: The result was one patient (1.37%) having hiseGFR value fall below 60 mL/min/1.73m2. There was a significant difference(p<0.05) in median eGFR before and after TDF was initiated. Conclusions:In conclusion, prevalence of renal impairment in patient taking TDF was 14in 1,000 patients and renal function was significantly reduce after TDF wasinitiated, hence it was advisable for all patient receiving TDF to be counselon the possible side effect of renal impairment and close monitoring of renalfunction is warranted among patients with risk factors.

ABSTRACT #34PENDING AUTHORIZATION IN OUTPATIENT PHARMACY OFHOSPITAL SUNGAI BULOHSivakumar N1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: In Outpatient Pharmacy of Hospital Sungai Buloh, pendingauthorization has been identified as one of the factors that may increasepatients waiting time as well as increase pharmacists workload. Objectives:Objectives of the study are to determine the time taken for authorization ofpending prescriptions and to identify the department that has the highestunauthorized prescriptions. Methods: The study was carried out as a crosssectional study over a period of 1 month starting from 1st October 2013 until30th October 2013 in Outpatient Pharmacy of Hospital Sungai Buloh. A formwas used to record details of unauthorized prescriptions, while total numberof patients, prescriptions and time of prescriptions prescribed andauthorized were generated from eHis. Results: In October 2013, a totalnumber of 13,067 patients visited OPD of Hospital Sungai Buloh with a totalnumber of 17,344 prescriptions received. Out of these, a total of 698prescriptions with pending authorization were obtained from data collection.It counts for about 4% of the total prescription received in October.Conclusions: Department with the highest unauthorized prescriptions isidentified as ENT clinic (38%). Whereas, PSY clinic took the longest time(57.2hours/prescriptions) to authorize prescriptions and department with thehighest percentage of prescriptions left unauthorized is Orthopaedic clinic(89.6%). A future study could be conducted to further identify factors whichcould possibly lead to high number of unauthorized prescriptions that maycause an increase in waiting time of Outpatient Pharmacy.

ABSTRACT #35COST ANALYSIS OF THE EXTEMPORANEOUS PREPARATION OFFOLIC ACID 1MG/ML SYRUP IN SUNGAI BULOH HOSPITAL OUTPATIENT PHARMACY DEPARTMENT WITH THE USE OF EITHERSIMPLE SYRUP OR X-TEMP SUSPENSION AS A SUSPENSIONVEHICLE.Md. Sani R1, Hing YL1, Lee CC1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Folic Acid syrup is most commonly prepared by utilizing



simple syrup (RM 16.50/3.6L) as suspending vehicle but with short shelf life(14 days). There another suspending vehicle exists which is X-TEMPsuspension (RM 50/L) with longer shelf life (60 days). Shorter shelf life ofsuspending vehicle will lead to frequent refills, increasing workload, andincreasing consumption of consumables thereby causing increases inoverall cost of preparations. Thus, a cost analysis study conducted todetermine which suspending vehicle would offer the lowest overall cost.Objectives: To determine the direct cost and indirect cost associated withthe use of simple syrup and X-temp as a suspension vehicle to prepare FAsyrup, which will both be factored in to estimate the overall cost of a bottleof dispensed FA syrup. Methods: It is cross-sectional cost analysis study bydoing cost calculations based on direct cost (prices of various paraphernaliaand personnel labour costs) and indirect cost (lost opportunity cost andtransportation cost). The price of paraphernalia was obtained fromPharmacy Inventory Management and personnel labour cost to prepare anddispense Folic Acid syrup were calculated based on a time recording form.However, a set of questionnaire was distributed to patients who have beenstarted on Folic Acid syrup using simple syrup then continued with X-TEMPfor the next visits in order to obtain indirect costs. Results: The frequencyof refill is 2 times per month for simple syrup but 1 times per month for X-TEMP. So, the overall cost of making Folic Acid syrup with simple syrup assuspending vehicle is RM 675.12/patient/year which would beapproximately 2 times higher than that of X-TEMP which costs RM358.92/patient/year. Conclusions: Folic Acid syrup made by using X-TEMPas suspending agent is more cost saving than simple syrup.

ABSTRACT #36EVALUATION OF CONTINUOUS INFUSION VANCOMYCIN INHOSPITAL SUNGAI BULOH: RETROSPECTIVE OBSERVATIONAL,SINGLE-CENTRED COHORT STUDYKoh HM1, Ang SY1, Mageespary R1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Continuous infusion of vancomycin (CIV) is increasinglypreferred as an alternative to intermittent infusion vancomycin (IIV) inSungai Buloh Hospital. Continuous infusion has been proven to providemore predictable and constant serum concentrations, where the targetserum concentration 15-25mg/L was acquired faster. In addition, this modeof infusion also found to have lower risk of nephrotoxicity. Objectives: Thisstudy was designed to evaluate the effectiveness and safety of continuousinfusion vancomycin in Sungai Buloh Hospital. Methods: This was aretrospective observational, single-centred cohort study, where patientspreviously given vancomycin continuous infusion were followed throughtheir duration of treatment. Period of study was from October 2010 untilOctober 2013. Proportion of patients attaining desired vancomycin level (15-25mg/L) and average time taken to reach desired level were obtained.Results: A total of 10 patients (3 females & 7 males) with age group between14-53 years were studied and 80% of them achieved target vancomycinlevels of 20-25mg/L. 10% of patients attained therapeutic level within 24-48hours. Average time to reach therapeutic level was 6 days. 1 out of 10patients (10%) developed nephrotoxicity during continuous infusionvancomycin which could also be attributed to concomitant polymyxin use.Conclusions: CIV practice is still not well established in Sungai BulohHospital, since only 10 patients administered for the period of 3 years.However, it has shown to be a reliable alternative method for patients withsevere MRSA infections who were unable to reach therapeutic levels withIIV. CIV dosing regimens especially those for neurological-related infectionsneed to be improved to achieve target levels faster.

ABSTRACT #37STUDY ON THE USE OF THE INTRAVENOUS FISH OIL LIPIDEMULSION IN PREMATURE NEONATES REQUIRING PARENTERALNUTRITIONAida MS1, Lee VJ1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Premature infants possess limited energy and fat reservoir asthey have missed the important period of nutrient accretion and storage. Thenutritional needs are usually dependent on parenteral nutrition (PN).Intravenous lipid emulsion (ILE) is an essential part of PN regimen inneonates Although PN is lifesaving; it has been associated with PN-associated liver disease (PNALD) when used for prolonged duration.Objectives: To compare the incidence of parenteral nutrition associatedliver disease (PNALD) in premature neonates receiving either SMOFlipid orIntralipid. Methods: Retrospective study from January 2009 to October2013 in 59 premature neonates receiving at least 7 days of PN containingeither Intralipid (n=28) or SMOFLipid (n=31). Liver parameters includingdirect bilirubin, total bilirubin, ALT and ALP were recorded at baseline (beforestarting PN) and on day 14 were recorded. Results: 3 out of 28 neonates inIntralipid group developed PNALD while receiving parenteral nutrition.Whereas, in the SMOFlipid group no incidence of PNALD was reported.Total bilirubin on day 14 vs. baseline was slightly reduced in neonatesreceiving SMOFLipid group while a significant increase was seen in theIntralipid group. An increase in ALT level on day 14 vs. baseline was seen inboth groups. However, the increment was only significant in Intralipid group

(p<0.05) but not in the SMOFlipid group (p>0.05). Conclusions: Fish oil-based lipid emulsion (SMOFLipid) was potentially beneficial in protecting theliver. A lower incidence of parenteral nutrition associated liver diseases(PNALD) was seen in premature neonates receiving SMOFLipid comparedto those receiving Intralipid. Reduction of total bilirubin also indicatespromising effect of SMOFLipid in protecting the liver.

ABSTRACT #38PRESCRIBING PATTERN OF BROAD-SPECTRUM ANTIBIOTICS IN THEMEDICAL WARDS OF HOSPITAL SUNGAI BULOHNadiah AB1, Yeap JSS1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Hospital-acquired infections (HAI) made up 13.9% of totalhospital admissions in Malaysia in 2010. Appropriate antimicrobial therapyis necessary to reduce morbidity and mortality. Traditionally, guidelines fromwestern countries recommend the use of broad-spectrum penicillin as firstline regime for HAI based on pathogens in their settings. However, themicrobial ecology may not be similar in our setting. There is a need todetermine if our empirical antimicrobial prescription adequately covers ourmost frequent pathogen(s). Objectives: This study attempted to observethe prescribing pattern of broad-spectrum antibiotics (BSAb), identify themost prevalent pathogen of HAI, identify the most commonly used broad-spectrum antibiotic, and evaluate appropriateness of empiricalantimicrobials prescribed according to microbiological cultures. Methods:The prospective observational study took place in the medical wards atHospital Sungai Buloh. Data was collected from April to June 2012. Allpatients started on BSAb, namely Cefepime, Tazocin and Carbapenems,were included within the study period. However, patients whose antibiotic(s)were started in other hospitals, or were transferred to other hospitals, wereexcluded. Results: There were 105 patients started on BSAb for HAI; 98patients were started empirically. 49.5% were empirically started oncefepime and 29.5% on tazocin, while 20% were prescribed carbapenemsbased on definitive cultures (n=105). 8% of patients did not have their bloodcultures taken within 24 hours of receiving antibiotics. 53% (n=98) ofpatients receiving empirical antibiotics did not have any growth frommicrobiological cultures sent. ESBL Klebsiella was the most commonpathogen (10.2%); however, the predominant choice of empiricalantimicrobial was cefepime (49.5%). 58% of antibiotics were stopped afterresults showed no growth. De-escalation or stopping of antimicrobialtherapy was done in almost all the patients, except those for which therewas reason to continue or escalate the choice of antibiotic. Conclusions:The most commonly prescribed BSAb for HAI was cefepime, followed bytazocin. More than 90% of the patients on empirical BSAb had bloodcultures taken within 24 hours of starting antibiotics. However, since themost common pathogen was ESBL Klebsiella, it is worth consideringertapenem as first line choice for empirical antimicrobial in HAI.

ABSTRACT #39A STUDY ON THE AWARENESS AND COMPLIANCE TOWARDS THEAFTER OFFICE HOUR VALUE ADDED SERVICE IN HOSPITAL SUNGAIBULOHDarshini S1, Aqilah AR1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: The After Office Hour Service (AOH) is one of the valueadded services provided in Hospital Sungai Buloh, outpatient pharmacy forpatients who have balance medication collection to make. Patients will haveto call the outpatient pharmacy 2 days prior to collection, to make an order;collections will be made in the emergency pharmacy anytime between5.30pm to 11.30pm, Monday to Friday. However, many patients showedunawareness to the existence of this program and the existing patientsshowed high non-compliance in making orders every month for collection.This study aims to discover the factors co-relating to this problem and toidentify where further improvements can be done within the program, inorder to perfect the service so that it proves to be beneficial to both,pharmacy and patient. Objectives: The objective of this study is to ascertaingeneral patient awareness on this AOH service and assess the complianceof patients who have registered in this program. It aims to identify factorswithin the service itself which contribute to existing patient non-compliancetowards the AOH program. Methods: A quantitative, descriptive, cross-sectional study was carried out via questionnaires and interviews for aperiod of 1 month in the outpatient pharmacy. 2 groups were targeted; firstwere from the general patient population that visited the outpatientpharmacy, who have not signed up for any value added services, secondgroup was all registered active patients within the AOH program itself whomade orders consistently for 3 months or more; The former investigated theawareness component and the later the compliance component. Data wasanalysed using Microsoft Excel. Results: 68% of the respondents wereunaware of the service. Lack of publicity and promotion, no interest, longwaiting time in clinics, lack of information available on how to sign up, lackof confidence in the service, low credibility and popularity of the programwere the main factors that contributed to the low awareness. More than 78%were non-compliant due to timing inconvenience, day-to-day personalmatters, rigid rules and non-flexibility of the program. 8% of respondents



claimed that the pharmacy occasionally forget to process their prescriptions.Conclusions: Majority of patients visiting the outpatient pharmacy wasunaware of this AOH program. The high non-compliance was due to manyfactors contributed by both the pharmacy department and patient’sthemselves. It was noted that many areas within the program itself could beimproved to increase patient’s compliance to the program once registered toit.

ABSTRACT #40A SURVEY ON KNOWLEDGE OF ORAL EXTEMPORANEOUSPREPARATIONS AMONGST PHARMACIST AND PHARMACIST’SASSISTANTS IN HOSPITAL SUNGAI BULOHDarshini S1, Hon MY1, Nordiyana S1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Oral extemporaneous preparation is widely used in allhospitals in Malaysia to fulfil patients’ needs. Lack of commercially availableoral liquid preparations in the market poses a challenge in providingmedications to patients. Pharmacists and pharmacist’s assistant are oftenrequired to prepare extemporaneous preparation to meet the needs of thesepatients however, pharmaceutical profile such as stability, efficacy, expiry,taste and many more should be take into consideration before thepreparation is carried out. The question then arises if the majority ofpharmacy staffs have sufficient knowledge and skills needed in preparingextemporaneous as they are the one who will be responsible in preparing itwith accurate concentration and dosages. Objectives: The purpose of thisstudy was to measure the current level of knowledge on oralextemporaneous preparation amongst pharmacists and assistantpharmacists in Hospital Sungai Buloh and to identify the common problemsthat are frequently encountered when preparing extemporaneouspreparations. Methods: The data comprise of 92 respondents; 40pharmacists, 19 provisionally registered pharmacists and 33 assistantpharmacists. The questionnaire was divided into several sections:demography, awareness, extemporaneous knowledge and experience inpreparing extemporaneous preparation. 6 questions on generalextemporaneous knowledge were used to measure the level of knowledge.The data was analysed using Likert Scale. Results: The data analysisshowed the current level of knowledge amongst personnel was good,accounting for 36% from total respondents. Majority of pharmacists hadvery good level of knowledge; assistant pharmacist had good level ofknowledge while provisionally registered pharmacists had fair level ofknowledge. The common problem encountered when preparingextemporaneous preparations was, they did not know what diluent to usewhen preparing the preparations. Conclusions: Continuous professionaleducation would be beneficial, especially to the provisionally registeredpharmacists in improving their knowledge and skills in oral extemporaneouspreparations. This would also shorten the time needed to process andprepare the extemporaneous solutions.

ABSTRACT #41THE EFFECTS OF PHARMACIST PATIENT EDUCATION ON THEOCCURRENCE OF RETURN MEDICATIONS IN AN INPATIENTSETTINGChong PF1, Ang ASY1, Balakrisnan N1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Majority of elderly patients take 4-5 types of prescriptiondrugs and 2 over-the-counter medications. Medication Return Campaigndone in Hospital USM (2009) has helped reduce poly-pharmacy andadverse drug reactions amongst elderly patients. Objectives: Theobjectives of the study were to identify the reasons for return medications,to identify the prevalence of poly-pharmacy in medical ward patients, toassess patient’s compliance to their home medications and to estimate thecost of savings achieved through returned medications. Methods: This is aprospective convenience sampling method. Data is collected using themodified CP1 form that was validated via pilot studies which were carriedout. The types and the amount of medication returned were recorded. Thiswas done after the patient was admitted and educated about the returnedmedication system being practices at Hospital Sungai Buloh. Results: Atotal of 60.7% (p= 0.304) patients had returned their medications aftercounselled to do so by the pharmacist. However, 39.3% of patients did notreturn their medications due to several reasons such as, family member wasunable to bring the medication on time before the patient was discharged orthe patient did not remember to bring in their medications during admissionin spite of being informed to do so. The pharmacist’s education about thereturn medication movement was effective as it increased the occurrence ofreturned medication to 15.7%. 62.7% (p= 0.334) of patients involved in thisintervention was found to be compliant to their medication. Most of thepatients were not compliant due to multiple medications prescribed andbeing forgetful. There are no occurrences of poly-pharmacy becausepatients were well informed of their medications as they had good socialsupport. The average cost of medications returned was RM 22.41 with astandard deviation of RM 34.89. The total cost of medications returned wasRM 3338.54. Conclusions: The occurrence of returned medicationsincreased after the pharmacist educates the patient or family member.

ABSTRACT #42A SURVEY ON THE PERFORMANCE OF CLINICAL PHARMACISTS BYMEDICAL PROVIDERS IN HOSPITAL SUNGAI BULOHChong PF1, Ramalingam M1, Yeo BH1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Clinical pharmacists are able to offer information on drugmanagement to both patients and the medical team as they are speciallytrained in therapeutics. This study was done to evaluate the satisfactionamong medical staff on the performance of the clinical pharmacist in HSB.Objectives: This study is done to evaluate the participation and contributionof clinical pharmacists with the healthcare providers in HSB, to assess theinvolvement of clinical pharmacists in providing relevant pharmacy-relatedservices to discharged patients/ patients’ caretaker/ patients’ family and toassess the personal skills of clinical pharmacists at a working environment.Methods: In this cross-sectional questionnaire-based survey, a pilot studywas done. 130 questionnaires were distributed in August 2013, and 101were collected from the HSB medical staffs serving in wards that have aclinical pharmacist, including medical officers, specialists, consultants,nurses and sisters. Participants were randomly selected from the wards,according to the ratio of professions in each ward. Sample size wasdetermined using Altman plotting. For each question, the respondentsindicated their degree of satisfaction on a 4-point Likert Scale; verysatisfying, moderate satisfactory, not satisfactory, and poor. SPSS softwarewas utilized for descriptive analysis. Results: For participation andcontribution of clinical pharmacists, 67.5% are moderately satisfied, 27.1%are very satisfied while only 5.4% are not satisfied. For the provision ofservices to patients, 65.3% are moderately satisfied, 29.2% are verysatisfied, leaving only 1.5% of dissatisfaction. 99.5% of the respondents areat least moderately satisfied with the personal skills. For the overallperformance, all respondents were at least moderately satisfied.Conclusions: The clinical pharmacists shall provide more CME to medicalstaffs as there is still space for improvement. Since majority of therespondents were satisfied, the services of clinical pharmacists shall becontinued and expanded to other wards as well.

ABSTRACT #43REVIEW OF OFF LABEL PRESCRIBING IN PAEDIATRIC PATIENTS INHOSPITAL SUNGAI BULOH: A PROSPECTIVE STUDYHon MY1, Yew SF1, Shamala B1, Nurul F1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Off label prescribing of medication is defined as theunauthorized use of a drug for a purpose other than that approved by theauthorized organization. Unavailability of suitable registered medicine andlack of clinical trials in paediatrics result in high percentage of off labelprescribing in paediatrics. This prospective study is to determine theproportion of off label prescribing in paediatrics in Hospital Sungai Buloh(HSB). Objectives: The objectives of this study are to identify the classesof medication associated with off label prescribing among paediatricpatients; to identify the most common medications frequently prescribed asoff label medication and to document the common types of off labelprescribing. Methods: Data was collected from all paediatric patientsadmitted into paediatric wards of HSB for over 4 weeks. Paediatric patientsunder Dental observation or in intermediate and conva of Neonatal IntensiveCare Unit were not included. Data collected included patient identificationnumber, age, gender, race, diagnosis and details of all drugs administered.All data obtained was analysed using Microsoft Office Excel 2007. Results:333 paediatrics were admitted during data collection period with a total of1,427 medicines prescribed. 81% of medicines prescribed were listed inMinistry of Health (MOH) Formulary and 19% were used off label (17% listedin MOH Formulary for other indications, dose, frequency or permissible agewhile 2% were not listed in MOH Formulary). Off label dosing (28%), age(27%), and extemporaneous preparations (18%) accounted for the mostcommon types of off label prescribing. Antibiotics (such asamoxicillin+clavulanate and benzylpenicillin) prescribing were the main drugclass that were prescribed off label. Conclusions: Out of 1,427prescriptions, 19% prescribed medicines in the paediatric wards were offlabelled. Safety and efficacy data should be obtained for children todetermine whether these medicines used as off-label are warranted or safe.

ABSTRACT #44KNOWLEDGE, ATTITUDES AND PRACTICE TOWARD DRG SYSTEMAMONG TURKISH HEALTH CARE PROVIDERSSaad Ahmed AJ1, 2,Aljunid SM1, 2, Dastan I3, Dilmac E4,Nur Sulku S5, KahveciR6, Tutuncu T6, Gulcu E6

United Nations University-International Institute of Global Health (UNU-IIGH), UKM Medical Centre1; International Centre for Case-Mix and ClinicalCoding (ITCC), UKM Medical Centre, Kuala Lumpur, Malaysia2; Departmentof Economics, Izmir University of Economics, Izmir, Turkey3; HealthResearch General Directory, Ministry of Health of Turkey, Ankara, Turkey4;Department of Econometrics, Economics and Management SciencesFaculty, Gazi University, Ankara, Turkey5; Health Technology AssessmentUnit (ANHTA), Ankara Numune Training and Research Hospital, Ankara,Turkey6



Objective: Diagnosis-related group (DRG) system is patient classificationsystem designed to produce limited number of classes which are relativelysimilar in terms of resource consumption and clinical characteristics. Theaim of this study was to assess the level of knowledge, attitude and practice(KAP) of Turkish health care providers toward DRG system implemented inTurkey. Methods: A total of 302 healthcare providers were convenientlyselected from five public hospitals in Turkey. A self-administered modifiedquestionnaire on KAP regarding various aspects of DRG system wasrecruited to collect data. Results: Two third of healthcare providers showedpoor knowledge (66.6%) and poor practice (61.3%) about DRG system, but63.6% of them showed good attitude based on chi-square and multiplelogistic regression results. There was significant difference between age,gender, occupation groups and whether the respondents have attended aworkshop for DRG system in terms of KAP (p>0.05). Conclusions: Theseresults indicated the need for further actions to implement DRG system interms of creation of suitable environment and increasing awareness amonghealthcare providers, especially male, elderly, and those who have neverattended a workshop, in addition to regular review to ensure the programwould reach its targets.

ABSTRACT #45PRESCRIPTIONS STUDY TO ASSESS DRUG UTILIZATION PATTERNAND ESTIMATE DIRECT DRUG COST: A REVIEW OF EXISTINGLITERATURELee SW1, 2, Aljunid SM1, 2, Ahmed Z1

International Training Centre for Casemix and Clinical Coding (ITCC) 1;National University Malaysia, United Nations University-InternationalInstitute for Global Health2

Objectives: To review the current literature on the usage of prescriptions toassess drug utilization pattern and estimate the direct cost of drugs.Methods: Literature search was undertaken on Scientific databases(Science Direct, Emeralds, Wiley Online Library), Google scholar usingkeywords including drug prescription study, drug cost, drug utilizationpattern, prescription pattern, prescription drug use. The articles were thenanalysed for the usage of prescriptions in determine the utilization of thedrugs and direct drug cost. Literatures using other methods thanprescriptions such as patient interviews, questionnaire, review of medicalrecords and laboratory data were excluded. Results: Prescription studieswere quite commonly used in drug utilization and estimate of direct drugcost. 10 articles were reviewed. Most of the studies were done in developingcountries like India, Saudi Arabia, Pakistan, China, Hong Kong andMalaysia. 8 studies were done in outpatient setting, 1 in inpatient setting and1 in both inpatient and outpatient setting. 8 studies were done in singlehospital and 2 studies were done in a few health facilities. In single hospital,the longest duration of study is 4 years with 12,000 prescriptions collectedand the shortest duration of study is 1 month with 1,206 prescriptionscollected. In multiple healthcare facilities, a study with total of 2,382prescriptions collected at 10 facilities in 1 day and a study with total 3,769prescriptions collected at 5 facilities in 3 months. The average number ofdrugs per prescription is 1.9 at outpatient setting and 7.2 at inpatient setting.The direct drug cost is calculated from the unit cost obtained from HospitalDrug Formulary and unit price charged by dispensing chemist in hospital.Conclusions: Prescriptions studies are more commonly used at outpatientsetting due to the monitoring of drug utilization in chronic condition likediabetes and hypertension. It is also used in specialist clinics to monitor thespecific drug use in specific group of patients like paediatric and pregnantwomen. Prescription studies were mostly done in developing countries dueto the availability of the prescription data. The direct drug cost is normallycalculated from the unit cost by respective hospital procurement.

ABSTRACT #46THE EPIDEMIOLOGIC AND ECONOMIC IMPACT OF AQUADRIVALENT HUMAN PAPILLOMAVIRUS VACCINE (6/11/16/18) INMALAYSIA'S GENDER NEUTRAL SETTINGWan Puteh SE1, Kulkarni AS2, Shcheprov A3, Surinder Singh BSG4, Hsu TY5,Woo YL6

Department of Community Health, Faculty of Medicine, UKM MedicalCentre, Malaysia1; Global Health Outcomes, Merck & Co., Inc., WhitehouseStation, New Jersey, USA2; Reveille Technologies, Inc., Winston-Salem,North Carolina, USA3; Global Medical Affairs, Merck Sharp &Dohme(Malaysia) Sdn. Bhd., Selangor, Malaysia4; Global Medical Affairs, MSDPharma (Singapore) Pte. Ltd., Singapore5; Department of Obstetrics andGynaecology, Faculty of Medicine, UM Medical Centre, Malaysia6

Objectives: Evaluate the public health and economic impact associatedwith the introduction of routine vaccination of a Quadrivalent HumanPapillomavirus Vaccine (6/11/16/18) in Malaysia. Methods: A validateddynamic transmission model was adapted to the Malaysian setting. Themodel used an age-structured Malaysian population stratified by gender andsexual activity group to simulate heterosexual HPV transmission and theoccurrence of HPV-related diseases. The model captured both direct andindirect (herd immunity) benefits. Model inputs were obtained from literature,unpublished data and expert opinion. The vaccination strategy assessedwas of combining current screening and treatment practices with routine

vaccination of 13-14 year old females and males (coverage of 89.62%).Results & Conclusions: Routine vaccination would prevent 107,056cases of cervical cancer, 28,872 deaths from cervical cancer, 282,800 casesof HPV 16/18 related CIN1, 659,3545 cases of CIN2/3, 128,625 cases ofHPV 6/11 related CIN1 and 2,480,823 cases of HPV 6/11 related genitalwarts among women and men over a 100-year period. Vaccination of 13-14years females and males with a Quadrivalent HPV vaccine demonstrated agreater reduction in HPV related disease incidences and cost as comparedto the current scenario of screening and treatment only. The ICER per QALYin a gender neutral vaccination was 13,477 MYR/Years (In 2012, Malaysia'sthreshold for cost effectiveness was 55,207 MYR), which indicates that theQuadrivalent HPV vaccination is a highly cost effective strategy in Malaysia.

ABSTRACT #47FORMULARY LIST REVIEW OF SULPHONYLUREAS USINGMEDICINES SCORING SYSTEM (MEDSS): ANY COST SAVINGSOFFERED?Ramli A1, 3, Aljunid SM1, 2, Sulong S2, Md Yusof FA3

United Nations University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia1; International Centre for Casemix andClinical Coding (ITCC), UKM Medical Centre, Kuala Lumpur, Malaysia2;Pharmaceutical Services Division, Ministry of Health, Petaling Jaya,Malaysia3

Objectives: Sulphonylureas are widely used for the management diabetes.In Malaysia available sulphonylureas include glibenclamide, gliclazide,glimepiride and glipizide providing varying degree of benefits and risks. Inthis study we review and compare overall utility values of sulphonylureasusing medicines scoring system (MedSS). Potential cost savings resultingfrom recommended medicine utilization ratio was calculated. Methods:MedSS, a previously developed scoring framework based on multicriteriadecision analysis that systematizes evaluation of the various drug attributeswas used. An expert panel of 3 endocrinologists, 1 family physician and 5pharmacists were formed. A group of medicine reviewers assisted inevidences search and reviews. In a series of meetings, attributes identifiedand selected for analysis were efficacy (clinical efficacy, clinical endpoints),safety (interactions, serious side effects, hypoglycaemia, documentation,cardiovascular effects, combination with insulin, frequent side-effects anduse in special population), patients’ acceptability (formulation, dosefrequency, weight change), and cost. The average weights assigned bypanel members for efficacy, safety, patients acceptability and cost were23.89%, 43.89%, 20.33%, and 11.89%, respectively. Based on evidences,attribute scores were allocated and added up to provide the total utility score(TUS). Results: The five sulphonylureas were successfully scored andranked using MedSS. Gliclazide (both forms) scored consistently high forboth efficacy and safety attributes resulting in total utility score (TUS) of 68.5and 67.4 for gliclazide modified release and gliclazide respectively.Glibenclamide scored high for both efficacy and cost however safetyconcerns lowered its TUS to 56.8. In addition to more patients benefitingfrom the use of better drug gliclazide, over RM 3 million per year potentialmedicine cost savings were predicted when the use of glibenclamide (drugwith lowest TUS) is reduced to 5%. Conclusions: MedSS successfullyorganize the attributes and utilities of the medicines compared. Benefits ofclinicians’ involvement can be twofold: better acceptance of any changesplanned for the formulary list leads to improved prescribing pattern andbetter management of medicine expenditures.

ABSTRACT #48OUTCOME STATUS AND DURATION OF DUAL ANTIPLATELET USEAMONG POST-PCI PATIENTS.Azmi S1, Abdul Aziz SH1, Wan Azman WA2, Sim KH3

Azmi Burhani Consulting1; Department of Medicine, Universiti MalayaMedical Centre2; National Heart Association Malaysia3

Objective: To compare patient outcomes based on duration of dualantiplatelet use following percutaneous coronary intervention (PCI).Methods: The National Heart Association Malaysia collects and reportsdata on patients undergoing PCIs in the NCVD-PCI registry. The NCVD-PCIregistry database was analysed to assess the outcomes of interest. Patientswith PCI procedures performed between 2010-2012 and received dualantiplatelet therapy (DAPT) at time of discharge were selected. DAPT wasdefined as combination of aspirin and clopidogrel or ticlopidine. We thenidentified patients’ dual antiplatelet use at 30-days, 6-months and 1-yearfollow-up. Descriptive analysis was performed using STATA version 11.2.Results: Between 2010-2012, a total of 11,567 patients received DAPT atdischarge following PCI procedure. More than half of patients were male(82.6%). Majority of patients had dyslipidaemia (71.6%) or hypertension(73.1%), while almost half had a diagnosis of diabetes mellitus (45.9%).About half of patients only received DAPT at discharge (51.5%) whereas14.8%, 11.0% and 18.9% received DAPT up to 30-days, 6 months and 1-year. Patient outcome after 1-year follow up was different among the DAPTusage duration. The proportion of patients who had died were highest foramong those who received the DAPT up to 30-days (3.5%), followed by upto 6-months (2.7%), only at discharge (1.1%) and up to 1-year (0.2%).Conclusions: Approximately half of post PCI patients who were given



DAPT, received DAPT only at discharge, while approximately 20% were onDAPT up to one year. Results showed that patients who received themedication up to 1-year may have better outcome.

ABSTRACT #49LENGTH OF STAY AND PROGNOSTIC FACTORS FOR 30-DAYREADMISSION FOR POST-PCI PATIENTS WITH DYSLIPIDAEMIA,HYPERTENSION AND DIABETESAzmi S1, Abdul Aziz SH1, Wan Azman WA1, Sim KH3Azmi Burhani Consulting1; Department of Medicine, Universiti MalayaMedical Centre2; National Heart Association Malaysia3Objectives: To describe the differences in length of stay (LOS) andprognostic factors for 30-day readmission for patients undergoing PCI whohave dyslipidaemia, hypertension or diabetes mellitus. Methods: TheNational Heart Association Malaysia collects and reports data on patientsundergoing percutaneous coronary intervention (PCI) in the NCVD-PCIregistry. We utilized registry data of patients who underwent PCI between2010-2012 who also had a diagnosis of dyslipidaemia, hypertension ordiabetes mellitus and compared their LOS and 30-day readmission rates.Descriptive and regression analyses were performed using STATA version11.2. Results: In the registry, among patients who had undergone PCIbetween 2010-2012, there were 9,560 (71.7%) patients with a diagnosis ofdyslipidaemia, 9,791 (73.5%) with hypertension and 6,076 (45.6%) withdiabetes. The percentage of dyslipidaemic, hypertensive and diabeticpatients having 30-day readmission was 3.6%, 3.3% and 3.8%, respectively.Meanwhile, LOS was similar for all three conditions, at an average ofapproximately 5 days. However, different factors influenced the 30-dayreadmission between these comorbidities. For dyslipidaemic patients, thefactors were Killip Class 2 (HR=1.43, p-value=0.019) and intra-aortic balloonpump use (HR=2.93, p-value=0.004). For hypertensive patients, thereadmission rate was only affected by Killip Class 2 (HR=1.52, p-value=0.009). For diabetic patients, the prognostic factor was the PCI statusof acute myocardial infarction (HR=2.11, p-value=0.010). Conclusions: TheLOS for these three comorbidities was similar at 5 days. However, differentfactors were found to influence 30-day readmission rate.

ABSTRACT #50RELATIONSHIP BETWEEN BELIEFS, ADHERENCE AND QUALITY OFLIFE (QOL) AMONG CHRONIC KIDNEY DISEASE (CKD) PATIENTS ONHAEMODIALYSIS IN PENANG GENERAL HOSPITALSaid SH1, Shafie AA2

Department of Pharmacy, Tumpat Hospital1; School of PharmaceuticalSciences, Universiti Sains Malaysia2

Objectives: The objectives of this study are to assess the relationshipbetween patient’s specific beliefs about medications (necessity andconcerns), their adherence level and QOL. Methods: This study was across-sectional study among CKD patients on regular haemodialysis inPenang General Hospital. Validated self-administered BMQ specific, MMASand EQ-5D questionnaires were used in 50 patients. Results: The resultfrom BMQ-specific shows the mean necessity scale (19.6, SD=4.1)outweighs the concerns scale (15.6, SD=4.2) with positive necessity-concerns differential (Means =4.6, SD=5.0). Majority of the participant (82%)had a necessity outweighs the concerns scale. Even though reportedmedications adherence level was low (mean 5.5 ± 1.84), the findingssupport that patient’s necessity towards their prescribed medications washaving significant relationship in influencing the adherence rate withstatistically significant positive correlation (r=0.368, p<0.05). There is nosignificant relationship between beliefs or adherence in QOL though theyreported moderate to severe problems especially involving pain/discomfort.Conclusions: Educational intervention and medication counselling toemphasize the necessity of their medication may be useful to influencepatient’s medications adherence.

ABSTRACT #51VALIDATION OF EQ-5D-5L IN THE GENERAL POPULATION OFMALAYSIAShafie AA1, Chan CY1


Purpose: The EQ-5D-5L is an expanded version of EQ-5D-3L tocompensate its lack of descriptive richness and high ceiling effect. Our aimwas to determine the validity of EQ-5D-5L in the general population ofMalaysia. Methods: A cross-sectional study was conducted amongMalaysian adults in six states of Malaysia using random cluster technique.Selected sample were provided with interviewer assisted EQ-5D-3L, EQ-5D-5L and EQ-VAS questionnaire to determine their health state.Redistribution response, ceiling effect, discriminatory power, andconvergent validity of EQ-5D-5L were evaluated. Results: A total of 421participants (mean age 22.7 years; male 28.0%) were enrolled. Theproportion of inconsistent response was 1.3%. Redistribution from EQ-5D-3L to EQ-5D-5L using VAS was validated except 3L2-5L level for usualactivity. The ceiling effect of EQ-5D-5L (45.4%) was lower compared to EQ-5D-3L (52.3%). The absolute discriminatory power was improved for the

EQ-5D-5L than EQ-5D-3L by an average of 24.5%, but there was anaverage 11.7% loss for relative discriminatory power. Convergence of EQ-5D-3L and EQ-5D-5L with VAS improved slightly with 5L versus 3L exceptfor usual activities. Conclusions: Greater absolute informativity and lowerceiling effect were noted in EQ-5D-5L compared to EQ-5D-3L. EQ-5D-5Lbetter describes various health states and has acceptable convergentvalidity EQ-VAS.

ABSTRACT #52COST EFFECTIVENESS STUDY OF PANTOPRAZOLE ANDESOMEPRAZOLE IN THE TREATMENT OF UPPERGASTROINTESTINAL BLEEDING AT HOSPITAL TAIPINGJiun CS1, Shafie AA2, Pei SP1, Shah Jehan RD1, Megat Fauzi SH1, Wan-Omar WA1, Yi BX1, Umasangar R3

Department of Pharmacy, Taiping Hospital1; School of PharmaceuticalSciences, Universiti Sains Malaysia2; Surgical Department, Taiping Hospital3Objectives: Upper gastrointestinal bleeding is a life threatening emergencywhich requires urgent assessment and pharmacological management. Theclinical practice guideline recommends proton pump inhibitors as themainstay therapy for upper gastrointestinal bleeding. However, there are nopublished head-to-head cost effectiveness comparison betweenpantoprazole and esomeprazole. This study aimed to evaluate the clinicaleffectiveness and cost effectiveness of pantoprazole and esomeprazole inthe treatment of upper gastrointestinal bleeding, from the healthcare payerperspective. Methods: A total of 31 patients were recruited and randomlyassigned into pantoprazole (n=17) and esomeprazole (n=14) group. Clinicaleffectiveness was determined by the duration of treatment until bleedingstops and the occurrence of re-bleeding event. The cost includedmedications, hospitalization, outpatient, medical procedures, imaging andlaboratory investigation. The primary outcomes were cost effectiveness ratioand incremental cost effectiveness ratio for one bleeding-free day and re-bleeding event averted between pantoprazole and esomeprazole. Results:The direct cost per patient for pantoprazole and esomeprazole regimen wasRM 4,817.60 and RM 4,745.74. Esomeprazole achieved earlier bleeding-free day (2.07 days vs. 2.3 days), and averted more re-bleeding event(100% vs. 82.35%) than pantoprazole. Esomeprazole dominate overpantoprazole for additional one bleeding free-day re-bleeding event. Thesensitivity analysis showed that the cost effectiveness values were mostsensitive to shorter duration to achieve bleeding-free day as well as thereduction of blood transfusion cost. Conclusions: Esomeprazole is morecost effective compared to pantoprazole in the treatment of uppergastrointestinal bleeding.

ABSTRACT #53EXPLORING THE WILLINGNESS TO PAY FOR VOLUNTARYCOMMUNITY-BASED HEALTH INSURANCE IN MALAYSIAShafie AA1, Hassali MA1, Chan CY1

Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia1

Introduction: Healthcare in Malaysia is funded primarily through taxation(98%) but is no longer sustainable. One funding option is community-basedhealth insurance (CVHI). The purpose of this study is to assess the factorsaffecting of Malaysian willingness to pay (WTP) for voluntary CVHI.Methods: A cross sectional study was carried out in the Penang betweenAugust and September 2009 on 472 randomly selected respondents. Therespondents were asked to select their preferred health financing schemeamong three (totally private funding, compulsory health insurance andCVHI). The extent of the participants’ WTP for the described CVHI schemewas assessed using contingent valuation (CV) method. Results: 54% of theparticipants were female with mean age of 34 years (SD=11.9). A majorityhad a monthly income of MYR 2,001-4,000. 63.1% of the respondentsindicated their willingness to join and contributed an average of MYR 196.12per month toward VHI. The odds of those married to choose VCHI ratherthan total out-of-pocket is 2.95 times greater than those who are notmarried, adjusting for health insurance, and education level. WTP ispositively influenced by ethnicity, education level, household monthlyincomes, types of chronic disease and insurance coverage (p<0.05).Conclusions: Most Malaysians are willing join the CVHI and WTP anaverage of MYR 191.12 (USD 56) per month for the scheme. Their choiceof financing scheme is associated with their marriage status, current healthinsurance and education level. The amount that they are willing to pay forCVCHI is influenced by income, ethnicity and marriage status.

ABSTRACT #54THE STATE OF HEALTH ECONOMICS RESEARCH IN MALAYSIALim KK1, Lim M2

Clinical Research Centre, Malaysia1; Medtronic2

Objectives: Economic evaluation has immense potential to contributetowards cost-effective delivery of health care services and technology inMalaysia. However, little is known about the state of economic evaluationstudies in the country. The aim of the study is to evaluate the characteristicshealth economics researches in Malaysia. Methods: A literature search wasconducted in January 2014 using PubMed, Medline and EconLit databases



to identify economic evaluation (including cost analysis) studies related toMalaysia published between 01/01/1990 to 01/01/2014. Only originalstudies published in English peer-reviewed journals addressing a health-related topic in Malaysia were included. Results: Only 30 articles met theinclusion criteria. These studies covered 11 disease areas, most of whichwere cost analyses (n=17) rather than economic evaluation studies (n=13),involved an average of 6 authors per publication, led by local researchers(first authors) (n=20), mostly published after 2010 (n=18). Conclusions:There are only limited conducts of health economics studies in Malaysia. Itis imperative to evaluate the quality of these studies and to ensure more andbetter quality health economics studies in Malaysia to advise evidence-based allocation of resources for health care.

ABSTRACT #55A STUDY ON DRUG INFORMATION UTILIZATION AND ACCESSIBILITYAT KAJANG HOSPITALSarah Diyana S1, Zaiton K1, Nur Adlina S1, Haizun Athirah I1, Nur Farah A1Department of Pharmacy, Kajang Hospital1Introduction: Despite the importance of drug information resources, thereis little knowledge about which are actually used in practice by prescribers.Objectives: To determine the accessibility and utilization of drug informationresources among prescribers in Kajang Hospital (HKJ). Methods: Aquestionnaire survey used consists of 2 sections: 1) Prescribers wereneeded to indicate drug information resources used from the 23 list of druginformation resources 2) Questions pertaining to awareness, utilization, andquality of services provided by Drug Information Service (DIS) PharmacyDepartment, HKJ. A check list form was used to audit the availability of druginformation resources in all wards and clinics in HKJ. Results: Among 114prescribers, the top 3 type of drug information resources used were druginformation provided by pharmacist (78.9%), formularies (73.7%), and MOHClinical Practice Guidelines (CPG) (63.2%). The least use type of resourceswas journal articles. Findings from survey were essentially similar to findingsfrom audits. Audits results showed that drug information resources mostfrequently available/readily accessible in wards and clinics were CPG(72.2%), MIMS (66.7%), and Hospital Drug Formulary (55.5%). Assessmenton quality of DIS findings showed that majority of the prescribers (94.8%)indicated that drug information provided by the DIS to be useful and helpsthem during prescribing process. Conclusions: Although prescribersfrequently obtain drug information from tertiary resources they often consultpharmacists for drug information resources. There is a need for trainingawareness for healthcare professionals on utilization of drug informationresources as the current focus is on evidence-based medicine to ensuresafe and effective medical therapy. Since the choice of drug informationresources depends on one’s place of employment and its availability thereis a need for pharmacists role to monitor and ensure readily accessible, upto date and quality drug information resources in all wards and units.

ABSTRACT #56ANALYSIS OF MEDICATION RETURNED TO HOSPITAL OUTPATIENTPHARMACY: A QUALITATIVE FOCUS GROUP STUDYPing LS1, Syarifah Naemah SH1, Vigayakumaran JR1, Haniza MA1, SarahDiyana S1, Zaiton K1, Yee LW1

Department of Pharmacy, Kajang Hospital1Introduction: Studies on medication return are vital to curb spiralling coststo ascertain wastage in prescribing and usage. To augment the findings ofthe quantitative research on returned medications, in-depth qualitativeresearch is needed to explore reasons, perceptions and experiences ofmedicines excess being return. Objectives: To delve further into the reasonsand perceptions behind returned medications among patients fromhealthcare personnel group. Methods: Purposive sampling was used torecruit patients from healthcare personnel group who have returnedmedications to Outpatient Pharmacy Kajang Hospital. Two focus groupdiscussion (FGD) sessions were held consisted of 6 participants in eachsession. Audio recording, transcription and textual analysis were conductedfor FGD. Audio recording, transcription and textual analysis were conductedfor FGD. Results: Most of participants stated reasons for excessmedications returned was due to treatment changes accounted bymedication being stopped and changed in dose/medication prescribed.Some of the participants pointed out reasons was due to discontinuation ofown medication attributed by personal beliefs that medications wereunnecessary, ineffective and harmful. Other reasons for excess medicationsreturned stated were discrepancy between duration of drugs prescribed andthe subsequent prescribers’ appointment with patients and patients beingprescribed for same disease indication by more than one prescribers atdifferent health institutions follow ups, patients’ experienced of unpleasantside effects, medications that are prescribed as a needed/PRN basis andmedications which had expired. All of the participants agreed that returnmedication program helped them to manage their excess medication and isa practical method to avoid wastage and reduces government expenses. Allwere adamant that sharing excess medications should not be a practice.Conclusions: Reasons for excess medications returned ranging fromdeliberate choices on the part of patients through involuntary personal andsystem related variables. Various interventions should therefore be

identified i.e. improving the quality of medicines related informationprovision to patients and promoting greater efficiency at every stage of therepeat prescribing and dispensing process.

ABSTRACT #57HEALTH RELATED-QUALITY OF LIFE (HRQOL) IN TYPE 2 DIABETESMELLITUS: A STUDY IN SELANGOR DISTRICT HOSPITALSAinur Fadlina MN1, Nurliana AL1, Zati Iwani I1, Ang LC1, Intan Nor HafizahMJ2, Khairatun Hisan MN1, Jeyasridevi S1, Piriya Dharshini T1, Teh WY3

Department of Pharmacy, Kuala Kubu Bharu Hospital1; Department ofPharmacy, Tanjung Karang Hospital2; Department of Pharmacy, TengkuAmpuan Jemaah Hospital3Introduction: Diabetic patients need to adhere to severe dietary restrictionsand daily self-administration of oral medications or insulin. These mayadversely affect diabetic patient’s quality of life. Due to this, it is crucial toassess health-related quality of life (HRQoL) of diabetic patients so thatinterventions can be designed and implemented that will further enhancepatient’s compliance and lifestyle. Objectives: To compare quality of life(QOL) between age groups and to compare QOL between patients on oralanti-diabetic agent (OAD) with insulin treated patient with or without OAD.Methods: This cross sectional study use convenient sampling method toassess HRQoL among diabetic patients from three district hospitals inSelangor; Hospital Kuala Kubu Bharu, Hospital Tanjung Karang andHospital Tengku Ampuan Jemaah. Face to face interviews were conductedamong 150 respondents from Out-patient Pharmacy and Diabetic Clinic byusing validated World Health Organization Quality of Life Questionnaire(WHOQOL-BREF). It is divided into four domains; domain 1 (physicalhealth), domain 2 (psychological health), domain 3 (social health) anddomain 4 (environmental health). It were calculated in score from 0 - 100.The higher the mean score is, the higher the QOL. Results: Age “40 – 49years old” group has the highest mean score in domain 2 and 4 which was64.48 and 61.48 respectively. Nevertheless, group “50 - 59 years old” recordhighest mean score in domain 1 and 3 (61.76 and 66.94). Respondents whowere treated with tablet(s) only have higher mean scores in domain 1 and 2when compared with the subjects who treated with insulin (p<0.05).Conclusions: No significance difference shown between age group.However, patients who were treated with tablets only are significantly havinga good quality of life in term of physical and psychological health thanpatients who are treated with insulin with or without OAD.

ABSTRACT #58INCIDENCE OF HYPERSENSITIVITY REACTION IN HIV-INFECTEDPATIENT STARTING NNRTI-CONTAINING REGIME: A CROSSSECTIONAL STUDY ON HTAR PATIENTSOon HY1, Amir Hamzah SA1, Abdul Latip WSS1, Wong WW1, Wan MohdAzam WI1


Objectives: This study aimed to determine and compare the incidence ofhypersensitivity reactions in HAART-naïve HIV patient taking EFV or NVPbased regimens, to assess risk factors associated with the hypersensitivityreactions and to study the prescribing trend of NNRTI regimen in HTAR.Methodology: This retrospective study included antiretroviral drug-na˚vepatients initiated with either EFV or NVP-based HAART that undergonefollow up at the Medication Therapy Adherence Clinic (MTAC), HospitalTengku Ampuan Rahimah, Klang from January 2006 until March 2013. Theincidence of HSR is extracted from patients’ medication record using a self-structured, piloted data collection form. Results: A total of 112 patients wereincluded in the study, 47 in NVP-based group and 65 in the EFV-basedgroup. Hypersensitivity developed in 11 patients (9.8%) in the NVP-basedgroup and 2 patients (1.8%) in EFV-based group with a significant p valueof 0.001. No significant risk factor could be assessed. Prescribing rate ofEFV is higher than NVP in HTAR. Conclusions: Incidence ofhypersensitivity in patient initiated with NVP is higher than EFV. Nosignificant risk factor associated with risk of developing hypersensitivitytowards NNRTI could be concluded due to limited power of the research.Prescribing rate of EFV is higher than NVP.

ABSTRACT #59COMPARING THE TREATMENT OUTCOME FOR ANTHRAL GASTRITISAND NON ULCER DYSPEPSIA USING PANTOPRAZOLE VERSUSESOMEPRAZOLE IN AN OUTPATIENT SETTING IN HOSPITALTENGKU AMPUAN RAHIMAH (HTAR)Chevena A1, Khoo CC1, Yong SY1, Sarmilah A1


Objectives: To compare the treatment outcome between Esomeprazoleversus Pantoprazole in the outpatient surgical department at HTAR.Methods: A cross sectional study was carried among non-ulcer/functionalrelated dyspepsia and anthral gastritis patients aged from 18 to 80 years oldwho are prescribed with either Pantoprazole or Esomeprazole in theOutpatient Surgical Clinic. A total of 47 patients were recruited from Marchto August 2013 using research assisted questionnaires which was preparedin both English and Malay and were then cross validated amongst the



pharmacists in HTAR. The result was tabulated using Chi-square Test.Results: This study showed that after 1 month of the therapy, there is nosignificant difference between Esomeprazole and Pantoprazole in overallsymptoms improvement (p>0.05). Esomeprazole has greater improvementcompared to Pantoprazole to reduce the abdominal ache or pain beforemeals or when hungry or right after meals or at night (p<0.05). This studyalso shows that there is no significant difference between Esomeprazoleand Pantoprazole in the reduction of the frequency of dyspeptic symptoms(p>0.05). Conclusions: The difference in symptoms improvement betweenthe two treatment arms is statistically insignificant. However, Esomeprazoleexhibited greater improvement in reducing pre-meal abdominal ache orabdominal pain during hunger, post meal or nocturnal abdominal ache.

ABSTRACT #60THE OUTCOME OF HOME MEDICATION REVIEW PROGRAMME INEMPOWERING PSYCHIATRIC PATIENTS AT HTAR KLANGAnusuya K1, Larry LLS1, Parimala VI1


Objectives: To investigate the effect of pharmacist’s involvement underHMR programme in CPU on the rate of patient’s readmission to psychiatryward within three months of the last discharge. Methods: 510 patient’srecords from 2009 to 2012 were reviewed. Prior to 2011, there was nopharmacist’s involvement in CPU. From 2011 onwards, pharmacist hasbeen actively participating in patient’s care under HMR programme.Results: There were 60 readmissions from 79 patients in 2009 whichresulted in 6.3% of readmission rate. In 2010, there were 52 readmissionsfrom the total patient of 120, this contributed to 3.6% of readmission rate.There were 141 patients in 2011 and total readmission was 8 which resultedin 0.47% of readmission rate. In 2012, there were 13 readmissions from170patients resulting in 0.63% of readmission rate. It was found that there weresignificant reduction in the rate of readmission into psychiatry ward withinthree months of the last discharge after pharmacist’s involvement in CPUpatient care under HMR programme, from 6.3% (2009) and 3.6% (2010) to0.47% (2011) and 0.63% (2012). Conclusions: This study shows thatpharmacist’s involvement in CPU under HMR programme does help tooptimise patient’s healthcare and thus reducing the rate of patientreadmission into psychiatry ward.

ABSTRACT #61MEDICATION RECONCILIATION IN HOSPITAL BANTING MEDICALWARDS: IDENTIFYING THE TYPES AND FACTORS CONTRIBUTING TOMEDICATION DISCREPANCIESCheong WK1, Mohd Khalimi NZ1, Mohd. Fathir N1

Department of Pharmacy, Banting Hospital1Introduction: Medication reconciliation is a formal process for creating themost complete and accurate list possible of a patient’s current medicationsand comparing the list to those in the patient record or medication orders.While medication discrepancies are defined as unexplained differencesamong documented regimens across different sites of care. This aspect hasbecome one of the factor in which attention is required to improve the qualityand safety of healthcare. Objectives: To conduct medication reconciliationin patients who admitted to medical wards and to identify types ofmedication discrepancies and factors contributing to medicationdiscrepancies. Methods: An observational study on medicationdiscrepancies amongst patients that are admitted to medical wards ofHospital Banting. Results: The percentage of medication discrepanciesobtained in this study of 60 samples are 14.29%, and the types ofmedication discrepancies commonly occurring in the Medical Wards ofHospital Banting are (1) omission of drug; (2) change in the dose; (3)change in frequency; (4) change of drug; (5) addition of new drug; all inorder of the most common to the least common. Conclusions: This studyidentified the factors that lead to medication discrepancies that commonlyoccur are either the Patient factor or the System factor. The common factorsresulting discrepancies are; non-adherence, unable to tolerate side effects,unneeded prescription, conflicting information and unrecognized cognitiveimpairment. Medications commonly associated with medicationdiscrepancies are antihypertensives, antihyperglycaemic, antidyslipidaemia,antiasthmatics, and cardiovascular (in order or most common to the leastcommon).

ABSTRACT #62CLINICAL OUTCOMES OF PREMATURE INFANTS RECEIVING TOTALPARENTERAL NUTRITION (TPN) SOLUTION WITH AMINO ACIDCONCENTRATION OF 2.5%W/V VERSUS 2.8%W/V IN NICU, HOSPITALSELAYANGLeon IGW1, Lim PL1, Ruffehe NS1, Ismail NS1, Lau SY1, Tan YH1

Department of Pharmacy, Selayang Hospital1Objectives: To compare the clinical outcomes of premature infantsreceiving TPN solution with different amino acid concentrations (2.5%w/vversus 2.8%w/v) in Neonatal Intensive Care Unit (NICU), Hospital Selayang.Design: Retrospective study Setting: Hospital Selayang neonatal intensivecare unit. Methods: A total of 151 premature infants were hospitalized but40 were excluded (28 of them had birth weight more than 1.25kg, 8 of them

passed away, 2 of them were transferred out before the end of the studyperiod and 2 of them had disrupted total parental nutrition regimen). A totalof 111 premature infants were eligible for the study. Electronic medicalrecords were reviewed to obtain the following parameters: gestational age,birth weight, date of commencement and date of ending of total parentalnutrition, length of mechanical ventilation, length of stay in neonatalintensive care unit, time taken to achieve birth weight (in days), presence ofTPN-associated cholestasis and renal impairment. Results: There is nosignificant difference (p>0.05) in the mean of birth weight and gestationalage between the two groups of infants. No significant difference wasobserved for time taken to achieve birth weight (in days), length ofmechanical ventilation, length of hospital stay, number of episodes of TPN-associated cholestasis and renal impairment between infants who receivedTPN with 2.5%w/v amino acid concentration and 2.8%w/v amino acidconcentration. However, the duration of parenteral nutrition was shorter andthere were less episodes of sepsis in premature infants receiving TPN withamino acid concentration of 2.8%w/v (p-value<0.05). Conclusions: Thesmall difference of amino acid concentration between the two groups(2.5%w/v versus 2.8%w/v) could be insufficient to cause significantdifference in the aforementioned outcomes. However, TPN containinghigher amino acid concentration (2.8%w/v) seems to be a better choice ofnutrition in premature infants and a further study with a bigger sample sizeand larger difference in amino acid concentrations should be conducted.

ABSTRACT #63AN AUDIT OF THE DIABETES MEDICATION THERAPY ADHERENCECLINIC (DMTAC) IN SERDANG HOSPITALKhaw MJ1, Rasyidah CS1

Department of Pharmacy, Serdang Hospital1Introduction: An increase in prevalence of diabetes has made it a nationalhealthcare concern. Poor glycaemic control leads to diabetic-relatedcomplications as well as increases healthcare cost. To date, there is adearth of evidence regarding the role of pharmacist in managing the diseasein Malaysia. The impact of the pharmacist-run DMTAC in Hospital Serdangremains unknown. Objectives: To evaluate the standard of care of patientsin the DMTAC programme in Serdang Hospital by assessing the currentpractice against the protocol outlined by the Ministry of Health and to provideevidence on the quality of care of patients. Methods: This is a retrospectivestudy, where a total of 208 patients involved in the MTAC programme atSerdang Hospital from the year 2008 to 2013. Only 89 patients wereincluded in the study as the rest does not meet the criteria (completed atleast 4 visits). Three categories of data were collected from Feb to Jun 2013,(i) Structure (based on DMTAC policy and patients record); (ii) Process; and(iii) Outcome. As for (ii) and (iii), data were collected from patients whocompleted a minimum of 4 visits. Results: In terms of adequacy of thestructure of care in DMTAC, documentation was found to be inadequate. Asfor process care indicators, medication knowledge was lacking, while theother six indicators fulfilled the minimum requirement (more than 70%). Foroutcome care indicators, compliance was found to have no significantimprovement after 4 visits (p=0.467). Contrary, by using different length oftime between visits, there is a significant decrease in HbA1c (p=0.003) aftereach visit with 47.5% of patients achieving a mean reduction of 1.24%. Thenumber of drug-related problems encountered as well as interventionsdecreased, 35% and 32%, respectively. Conclusions: The criteriaassessed met the target standards except for documentation (understructure) and DFIT (under process). MTAC also found to be effective inimproving patient’s glycaemic control after 4 visits. However the outcome ofimproving adherence was not met after 4 visits. It is suggested thatadherence should be analysed after the completion of 8 visits.

ABSTRACT #64A SURVEY TO EVALUATE THE TECHNIQUES OF MEDICATIONADMINISTRATION THROUGH ENTERAL FEEDING CATHETERS (EFC)FOR ADULT PATIENTS IN NURSING PRACTICE IN SERDANGHOSPITALOh PY1, Lai WM1

Department of Pharmacy, Serdang Hospital1Introduction: Medication administration through EFC in adult patients canbe difficult to administer and when administered wrongly, can causecomplications including patient fatality. Objectives: The objectives of thisstudy were to compare and contrast the techniques of medicationadministration through EFC in nursing practice throughout 5 disciplines inSerdang Hospital, to identify common drugs contributing towards catheterobstruction, to determine the frequency of medication causing EFCobstruction, to identify common complications other than catheterobstruction and to determine nurses’ satisfaction on their current skills andperception for more training on this area of practice. Methods: Medical,Surgical, Acute Intensive Care, Cardiology and Cardiothoracic disciplineswere chosen and using formula with finite population correction in samplesize calculator for prevalence studies, 122 nurses were needed for thisstudy. 160 surveys were distributed out. Nurses were selected viarandomized, proportionate sampling according to discipline and approachedto self-administer the validated questionnaire on EFC techniques. Results:



144 surveys were returned. All respondents regardless of specialty wereroutinely crushing enteric coated medications (94.2%) while 97% werecrushing sustained-release medications. When medications are due at thesame time, respondents will administer medications together through EFC,with the highest number of respondents from Surgical (100%), followed byCardiology (94.2%), Cardiothoracic (88.9%), Medical (66.7%) and AIC(61.5%) and there is a significant differences among the disciplines (p-value=0.018).Common drugs thought to contribute to catheter obstructionare calcium polystyrene sulfonate powder (54.3%) and potassium chloride(13.6%). Of total catheters encountered per week, catheter obstruction dueto medication occurs about 50% of the time. Common complications otherthan catheter obstruction are aspiration from enteral feeding (26.4%) andtube dislodgement (20.4%). Majority of respondents think they have learnedthe proper technique (92.8%) and feel confident with their current skills(92.9%). However, 80.4% still prefer more training in this area of practice.Conclusions: 86.1% of the total respondents have three or moreinappropriate techniques. International guidelines on medicationadministration through EFC should be adapted and tailored as reference forlocal setting.

ABSTRACT #65A STUDY OF PATIENT’S SATISFACTION & ADHERENCE TO MINISTRYOF HEALTH MALAYSIA (MOH) GUIDELINES ON DISPENSINGMETHADONE IN AGENSI ANTIDADAH KEBANGSAAN (AADK) HULULANGAT, SELANGORNg SY1, Siti Maryam AR1

Department of Pharmacy, Serdang Hospital1Introduction: Methadone is used as a substitution therapy for opioiddependence patient who abuses heroine and morphine. In October 2005,MOH introduced methadone maintenance therapy programme. Retention inthe programme showed a better client’s satisfaction. MOH has producedtwo guidelines on dispensing and counselling of methadone. Auditingservice helps identify areas of clinical care and service delivery that requirechanges and improvement. Therefore, this study is done to assess thequality of methadone dispensing in our centre. Objectives: To assesspatient’s satisfaction, to determine whether the dispensing of methadone inour centre adhere to MOH guidelines and to determine the side effects ofmethadone. Methods: Part I: A cross sectional study was carried out viaquestionnaire adapted from Client Satisfaction Questionaire-8 items (CSQ-8) from March to May 2013. Two additional questions were added whereone of the questions was open ended. The sample population is all patientsin enrolled in the programme except dropouts (missed attendance morethan two weeks) during the data collection period. Part II: An audit has beencarried out using a review form via face to face interview. The data obtainedwas evaluated against the “Garis Panduan Pendispensan Methadone” and“Garis Panduan Kaunseling Methadone” as outlined by the MOH. Results:Part I: Out of 60 patients, only 55 patients completed the questionnaire.Majority (96.4%) were satisfied whereas the others (3.6%) were verysatisfied. In the voluntary open-ended question, 63.6% commented, mostlyon the opening hours and take away policy. Part II: A total of 40 subjectswere interviewed with their medical records reviewed. The results showedthat the dispensing of methadone practiced in our centre was in accordanceto MOH’s guidelines. All subjects experienced the side effects of methadonecommonly drowsiness, constipation and excessive sweating. Conclusions:In conclusion, our patients were satisfied with the programme and it is inaccordance to the MOH’s guidelines.

ABSTRACT #66POTENTIAL DRUG-DRUG INTERACTION AMONG ELDERLYADMITTED TO MEDICAL WARDS OF SERDANG HOSPITAL: APROSPECTIVE STUDYNurul Khalilah K1, Nurul Huda Y1, Tan SY1

Department of Pharmacy, Serdang Hospital1Introduction: Medication therapy in elderly patients is difficult to manageand has the potential of being hazardous especially in elderly with multipleco-morbid diseases. Objectives: The objectives of the study were to assesspolypharmacy incidence among elderly, to evaluate the frequency of drug-drug interaction of an elderly hospitalised population admitted to medicalward of Serdang Hospital and to identify the most common medicationinvolved. Methods: The prescriptions of a total of 206 elderly in-patientswere collected prospectively using convenient sampling from March untilJune 2012. All prescriptions were checked for potential drug-druginteractions using a computerized detection program frommimsgateway.com. The inclusion criteria included hospitalized elderlypatients who were admitted in medical ward and was prescribed with at least4 in-ward medications. Results: It was found that 96% of elderly patientsadmitted to medical wards have polypharmacy. Out of this, 36.1% patientshad received more than 10 drugs. Among 155 study population, 81.3% wasdiscovered to have potential drug-drug interaction (pDDI). From this 81.3%,it was found that 50.8% elderly patients having major pDDI, 39% moderatewhile only 10.3% falls under minor category. The common drugs involved inDDIs were Salicylates (10.2%), Diuretic (6.8%), Statins (7.6%) and ACEinhibitors (5.1%). Conclusions: This study showed majority of elderly

patients who were admitted to medical ward have moderate severity ofpotential drug-drug interactions and such interactions have significantassociation with increased number of drugs prescribed. Future studies ondrug-drug interaction may focus on evaluation of physician’s awareness onpotentially harmful drug interactions as well as assessment on clinicalpharmacist intervention in order to improve inappropriate prescribing inelderly inpatients as well as outpatients with polypharmacy.

ABSTRACT #67A STUDY TO EVALUATE PATIENT’S KNOWLEDGE AND SATISFACTIONTO THE TOPICAL TREATMENT IN CHRONIC SKIN DISEASELow PY1, Low NW1

Department of Pharmacy, Serdang Hospital1Introduction: Patients with chronic skin diseases rely on topicalmedications to control their skin problems. One of the reasons of treatmentfailure is the lack of knowledge or understanding on the appropriate use oftopical medications. Poor knowledge may affect the patient’s adherence andthus lead to poor treatment outcome. When this happens, it may affect thepatient’s satisfaction level. Objectives: To evaluate the patient’s knowledgelevel on the proper use of topical medications; and the satisfaction level tothe topical treatment and service provided by the Hospital Serdangpharmacy. To study the association between the level of knowledge topatients’ age, education level, duration of skin disease, number of topicalmedications prescribed and the satisfaction level. Methods: Patients whofulfil the study criteria were interviewed to assess their knowledge andsatisfaction level using a validated questionnaire. For the knowledge part,patients were asked regarding the name, site, frequency, duration and howto apply the topical medications; whereas for the satisfaction part, patientswere asked about the pharmacy services and treatment satisfaction.Results: Most patients were ‘satisfied’ for the monthly supply (42.7%),packing (66.7%) and treatment given (60.0%); whereas for the knowledgepart, most patients answered wrongly for the name of topical medications(36.0%), followed by the site of application (28.0%), how to apply (22.7%),frequency (18.7%) and duration of use (1.3%). Only 36.0% of patientsunderstood the different strength of corticosteroids. There was no significantassociation between the level of knowledge with patient’s age (p=0.856),education level (p=0.570) and duration of disease (p=0.899). However,there was a significant negative relationship between level of knowledgeand number of topical medications prescribed (p=0.008); and a positiverelationship between level of satisfaction and knowledge (p=0.001).Conclusions: Knowledge was poorer as the number of topical medicationsincreased. Result also demonstrated a positive relationship between level ofsatisfaction and knowledge.

ABSTRACT #68GENTAMICIN PHARMACOKINETICS IN NEONATES: IDENTIFICATIONOF FACTORS AND PREDICTORS FOR LOCAL PHARMACOKINETICEQUATIONS OF HTAR, KLANG.Rusli RA1, Cheng LP1, Ahmad Fuad FI1, Woo SJ1


Introduction: Concerns of individualised pharmacotherapy inaminoglycoside antibiotic led to this study of gentamicin in neonatalpopulation. Previous literatures have established pharmacokineticequations of aminoglycoside antibiotics; however, the populationparameters that are used for estimation of pharmacokinetic profiles inneonates are mainly taken from adult population parameters with limitedreferences on local neonatal population. Objectives: To determine localpopulation pharmacokinetic parameters; clearance rate, volume ofdistribution (Vd) and half-life of gentamicin and factors that influence thepharmacokinetic parameters. Methods: Data were collected on 143neonates receiving gentamicin from February to June 2013. Out of this, 90neonates were included for analysis. Data on serum concentration ofgentamicin were retrieved from TDM request form whereas other data i.e.patient’s medical and drug history was gathered from the patients’ bed headticket and medication chart. Variables such as patients’ gestational andpostnatal age, birth weight (BW) and creatinine clearance were analysed.Maximum and minimum concentrations, Vd, clearance and half-life werecalculated for each case. Results: About one-third of the subjects were bornprematurely with mean gestational age of36.7 weeks (±3.03). The meanvalues for creatinine clearance, elimination rate constant (Ke), Vd and half-life of gentamicin are 37.0ml/min (±19.31), 0.112hr-1 (±0.06), 0.78L/kg(±0.36) and 7.35 hours (±3.12) respectively. The clearance rate is increasedwith increasing postnatal age and birth weight among patients weighing lessthan 2.5kg (p<0.05). Birth weight is a good predictive variable of Ke(p=0.002). There is a significant linear relationship between half-life ofgentamicin and patients’ gestational age (p<0.001). However, volume ofdistribution was not influenced by any of the above variables (BW,gestational and postnatal age). Furthermore, the mean creatinine clearanceof premature neonates is significantly lower than full term neonates(p=0.007, 95% CI -19.12, -3.12). Conclusions: The mean Vd differssignificantly from international data but comparable to the local ones. Inter-patient variability is an important aspect to consider in determining optimaldosing regimen.



ABSTRACT #69A SURVEY ON SELF-MEDICATION BY CAREGIVERS/PARENTS OFPAEDIATRIC PATIENTS IN HOSPITAL TENGKU AMPUAN RAHIMAH Lee JL1, Tahir B1, Lim FP1


Introduction: Self-medication is defined as obtaining and consuming drugswithout the advice of physician/pharmacist either for diagnosis, prescriptionor treatment. Tendency to treat children by parents/ care givers by means ofself-medication has been quantified in several studies from other countries.However, the incidence of this practice in Malaysia has not been reported.Objectives: To determine the extent of family self-medication amongchildren admitted to paediatric medical ward in Hospital Tengku AmpuanRahimah (HTAR). Methods: A cross sectional study was conducted usingstructured questionnaires which were distributed to parents or caregivers ofchild admitted to 4 paediatric medical wards in HTAR, between March toJune 2013. Results: A total of 390 questionnaires were distributed and allresponded. 63.8% have practice self-medication on their children. Commonillnesses that prompted self-medication were cough (29.7%), cold or flu(20.9%) and fever (18.5%). 28.7% of respondents were confident in self-medicating their child. Majority of the surveyed parents viewed thatpharmacists has high level of professionalism on medication (81.8%) andthey agreed that pharmacists should provide advice on medication (89%).Race, age of child, education level and income of caregivers do not predictthe practice of self-medication in children by care givers. Conclusions:Self-medication is common among the care givers of paediatric patients inHTAR, which largely involved management of minor ailments.

ABSTRACT #70MEASURING CHILDHOOD OBESITY BASED ON THREE DIFFERENTAPPROACHES: WHO, CDC AND IOTF CRITERIADastan I1, Delice ME1

Izmir University of Economics, Turkey1

Objectives: This study compares body mass index (BMI) and childhoodobesity ratios by using three different cut-points based on growth curvesgenerated by World Health Organization (WHO), International Obesity TaskForce (IOTF), and the US Centers for Disease Control (CDC). Methods:Prevalence estimates are calculated by using these three BMI cut-points.Estimates are based on a data from 1,271 school children (659 females and612 males) that are between 8 and 17 years old from different schools in cityof Izmir, Turkey. Heights, weights, socio-economic and demographicinformation of children are also measured. Results: Prevalence estimate ofchildhood obesity is much higher with WHO criteria (8.8%) than with CDC(4.7%) or with IOTF (1.8%). Prevalence estimates of childhoodoverweight/obesity are similar based on CDC (15.6%) and IOTF (15.3%),but higher when based on WHO criteria (21.1%). Conclusions: Prevalenceestimates of childhood obesity and other BMI categories changeconsiderably when different cut-points are employed. This may result invariations in prevalence of childhood obesity estimates in the literature, thusit is necessary to establish a generally accepted standardization in cut-points to determine BMI categories.

ABSTRACT #71TO EVALUATE THE EFFECTIVENESS OF MEDICATION THERAPYADHERENCE CLINIC (MTAC) IN PSORIASIS PATIENTS IN SELAYANGHOSPITALNg HW1, Khairul Syazwani1, Chee YY1, Teo KW1, Nik Nur Shairah1, ZukifliNH1, Low EH1

Department of Pharmacy, Selayang Hospital1Introduction: Psoriasis is a chronic skin disorder which affectsapproximately 3% of Malaysians which i.e. 400,000. Psoriasis has aprofound negative impact on patients’ quality of life. Medication TherapyAdherence Clinic (MTAC) psoriasis is an intervention where the pharmacistprovides education and information about psoriasis symptoms, causes, risk,triggering factors and treatment options in addition to standard care oftreatment. Objectives: The objective of this study is to measure theeffectiveness and impact of MTAC based on severity of disease, quality oflife and patient’s compliance in psoriasis patients. Methods: We recruited42 subjects using convenient sampling from Dermatology Clinic SelayangHospital from May until September 2013. The clinical outcome wasmeasured by doctors and pharmacists using Psoriasis Area and SeverityIndex (PASI) to access on the disease severity, Dermatology Life QualityLife (DLQI) to evaluate on patient’s quality of life, Modified Morisky Score(MMS) to evaluate on patient’s compliance. Subjects were givenappointment monthly and undergo a three-month MTAC programme. Theclinical outcome was measured during pre and post-three-month MTACprogramme. Results: Out of 42 subjects, 30 subjects have completed the3-months MTAC programme. The results shown that disease severity,quality of life, and patient’s compliance significantly improved for psoriasispatients after completing MTAC programme. The result shows statisticallysignificant improvement at post-MTAC compared to pre-MTAC usingWilcoxon Signed-Rank Test. The median (IQR) of pre PASI and post PASIwere 10.5 (14.43) and 7.7 (10.8), which elicit a statistically significant

difference of pre and post PASI after MTAC (Z=-4.238, p<0.000). Thedifferences of DLQI score during pre 10.5 (15.25) and post MTAC 8.5 (12)shown a significant improvement with Z=-3.703, p<0.000. The differences ofMMS between pre 5 (3) and post MTAC 6 (2.25) was shown to bestatistically significant with Z=-3.066, p<0.002. Conclusions: MedicationAdherence Therapy Clinic (MTAC) psoriasis has shown to improve psoriasispatients in addition to the standard therapy given.

ABSTRACT #72STRUCTURED INTERVENTION FOR ACUTE LOW BACK PAIN INPRIMARY CARE: A RANDOMISED CONTROL TRIAL STUDYAziz NA1, Syahnaz MH1, Muhammad Irfan YAU2, Shamsul AS3

Department of Family Medicine, Faculty of Medicine, UKM Medical Centre1;Family Medicine Specialist, Klinik Kesihatan Semporna, Sabah2;Department of Community Medicine, Faculty of Medicine, UKM MedicalCentre3

Background: Acute low back pain is a common complaint, imposing a hugecost in medical care. Back exercise program which was also known as“Back School” program was developed since 1969 for treatment of low backpain. Objectives: To assess the effectiveness of structured back exerciseprogram as a treatment for acute low back pain, in comparison with thestandard care alone in terms of pain improvement and changes in functionalstatus in primary care setting. Methods: This was open-labelled randomizedclinical trial conducted at a primary care clinic. A total of 90 patients who metthe study criteria were randomized into two groups. 45 patients in theintervention group received both standard care of treatment followed with astructured back exercise program. The remaining 45 patients in the controlgroup received standard care of treatment alone which were analgesics andadvice on back pain. The patients were followed until eight weeks.Outcomes: The main outcomes were the mean pain score using VisualAnalogue Score (VAS) and functional status by using Oswestry DisabilityIndex Questionnaire (ODQ) between intervention and the control group atbaseline and after eight weeks. Results: Using per protocol analysis, in bothgroups, Visual Analogue Score (VAS) and Oswestry Disability IndexQuestionnaire (ODQ) were significantly reduced after eight weeks duration(p<0.05), but the difference between the control and intervention group poststudy was not significant. Conclusions: The addition of structured backexercise program in intervention group in patient with acute non-specific lowback pain do not show significant improvement in pain score and functionalstatus compared to standard care of treatment alone. Keywords: BackSchool program, back exercise program, acute low back pain, OswestryDisability Index

ABSTRACT #73A RETROSPECTIVE ANALYSIS OF MEDICATION POSSESSION RATIOIN PREDICTING VIROLOGIC OUTCOMES AMONG HIV INFECTEDADULTS ON SECOND LINE ANTIRETROVIRAL THERAPY IN SUNGAIBULOH HOSPITAL (HSB)Raghavan P1, Kok KL1, Mak WY1

Department of Pharmacy, Sungai Buloh Hospital1Introduction: Adherence to ART is a predictor of virologic suppression,emergence of HIV drug resistance, disease progression and death.Monitoring of adherence is often necessary to identify patients at risk of poorclinical outcomes. One of the widely used measures to assess medicationadherence is medication possession ratio (MPR). Objectives: The aim ofthis study is to determine whether MPR can be a predictor of viral loadoutcome among patients who had failed first line ART. Methods: Weconducted a cross sectional study by collecting data from Sungai BulohHospital (HSB) computer prescribing system (eHIS) dated from 2008-2013.MPR was defined as the days of medications dispensed divided by thenumber of days between the first and last prescription refill. Associationbetween MPR and viral load outcome was then determined by crosstabulation of results. Results: MPR was determined for a total of 76patients. Mean duration of prescription days was 155 days. Median andmean MPR was 85.81% and 74.40% respectively. Viral load of all 76patients were not suppressed. Results showed that more than half of them(69.8%) had poor and suboptimal MPR. This implied that most of thepatients who had failed first line therapy had poor or suboptimal MPR.Conclusions: This study proved that MPR can be one of the predictors ofvirologic outcome in patients on ART. Hence it can be a supporting tool toidentify patients at risk of suboptimal adherence. Although not definite, it canbe incorporated as one of the measures to determine HIV patients’medication adherence in HSB.



PROFILE OF SPEAKERS


ADRIAN GOH

Adrian has over a decade of experience in healtheconomics and outcomes research and is

currently a health economist at Azmi BurhaniConsulting. He has previously worked as aresearcher for the Clinical Research Centre of theMinistry of Health, Malaysia and has consulted forthe World Health Organisation and the Ministry ofHealth, where he was appointed to the technicalcommittee to develop the Malaysian pharmacoeconomicguidelines. He studied economics at MacquarieUniversity, Australia and the National University ofMalaysia. He has published scientific papers in theareas of cost-effectiveness analysis, health registrydata, and estimation of health utility tariffs usingmodelling approaches. His recent work has centredon building cost-effectiveness decision models andthe adaptation of global cost effectiveness models tolocal and regional settings.

DR AMRIZAL MUHAMMAD NUR

Dr Amrizal Muhammad Nur is a Research Fellow,United Nation University- International Institute forGlobal Health (UNU-IIGH). He obtained his MD fromFaculty of Medicine Andalas University of Indonesiain 1993, and continuing Master Program (MSc) inMedical Science (Health Care Service Management)at School of Medicine Universiti Sains Malaysia in2002 and PhD in Public Health (CasemixManagement & Health Economics) from NationalUniversity of Malaysia Kuala Lumpur in 2007. Hestarted his housemanship at Mohammad JamilHospital (Provincial & Teaching GovernmentHospital), Padang (West Sumatera), and later asDeputy Director of Muara Labuh Hospital (DistrictGovernment Hospital) in West Sumatera Indonesia(1994-1997). He has worked as a CasemixCoordinator in Casemix Unit Hospital UniversityKebangsaan Malaysia for 9 years (2002-2010). Healso appointed as a Medical Lecturer and CasemixConsultant in International Centre for Casemix andClinical Coding (ITCC) National University ofMalaysia from April 2008 till November 2010. From1st December 2010 until now, he has beenappointed as a Research Fellow at UNU-IIGH KualaLumpur to conduct research & capacity building onAccessibility, Efficiency and Quality of Care in HealthSystem (especially in casemix management) tosupport casemix implementation in developingcountry. His main interest is to assist developingcountries in casemix management implementation(especially in patient data analysis, costing dataanalysis) and cost analysis in Health Care Systemthrough research and development in healtheconomics and financing. He is currently involves insupporting a number of developing countries todevelop and implement casemix management, ahealth management and information tool to enhancequality and efficiency of healthcare services providedunder Social Health Insurance programmes. Heworks together with Prof Syed Mohamed Aljunid oncasemix system in UNU-IIGH covers research andcapacity building programmes in Malaysia,Indonesia, Philippines, Uruguay, Yemen, Kenya,

United Arab Emirates, Vietnam and Ghana. He is theone of the Co-Developer and owner of the patents forcasemix groupers United Nation Case Based Groups(UNU-CBGs), Malaysian DRGs (MY-DRGs) , andClinical Costing Modelling Software (CCM) forpatient level costing

Currently he appointed as the Casemix Consultant toPhilippine Health Insurance to develop PhillipineDRG Tariff for Philhealth Reimbursement,Consortium of Private Hospital (FEMI) Uruguay todevelop Uruguay DRG Tariff for reimbursement andCentre of Financing and Social Health Security MOHIndonesia (Jamkesmas) to develop INA-CBGs Tarifffor Jamkesmas Reimbursement. He has publishedand co-author several articles in journals andpresented in conferences in areas of healtheconomics and public health in general

ANIS TALIB

Puan Anis is the Deputy Director of Formulary andPharmacoeconomics Branch in Pharmaceutical

Services Division. She has 31 years of workingexperience in various departments within the Ministryof Health (MOH). She plays a key role in theimplementation of evidence-based evaluation ondrugs to be listed in the MOH drug formulary(FUKKM). Under her leadership, the branch is nowbuilding capacity to have their own HealthTechnology Assessment (HTA) unit with a specialfocus on drugs. This is especially important as theunit will provide crucial inputs on safety, efficacy andcost-effectiveness of pharmacotherapy for thedevelopment of National Health Policy. Pn Anis isalso directly involved in the publication ofPharmacoeconomics Guidelines which serves asreference for researchers who would like to conductPharmacoeconomics study in Malaysia. Her effortshave led to the development of Centre ofPharmacoeconomics, a pilot project underPharmaceutical Services Division together with theother key stake holders such as the academics,Medical Development Division (National Institutes ofHealth and Casemix Unit) and Agensi InovasiMalaysia (AIM). Besides that, she has headed theteam in initiating drug scoring system to classifydrugs within the same class according to theirefficacy, safety and economic profiles. This activityinvolves multi-disciplinary experts in order to ensurethat it is comprehensive and has a high standard. Sofar, the branch has succeeded in scoring the drugswithin the statin and sulfonylurea groups. On top ofthat, she took another initiative to improve the currentdrug listing system with the New SubmissionGuideline underway. To date, there are 8 formulariesunder her care that are used nationwide namely, theNational Drug Formulary, the National EssentialMedicines List, MOH Drug Formulary (FUKKM),Hospital Drug Formulary, Health Clinics Formulary,1Malaysia Mobile Clinics Formulary, 1MalaysiaClinics Formulary, Rural Clinics Formulary.



ASSOCIATE PROFESSOR ASRULAKMAL SHAFIE

Asrul A Shafie is a registered pharmacist in Malaysiasince 2001 and completed his PhD degree inpharmacoeconomic in Cardiff University, UK in 2007.His research interests are in the application ofeconomic evaluation in pharmaceutical services andproduct, and pharmacy practice. He is now leadingand co-investigating a number of researches inpharmacy practice, PRO instrument validation andvaluation, and health technology assessment wherehe has published more than 200 peer reviewedjournal articles/abstracts in various internationaljournals including Value in Health, Social Science &Medicine, Quality of Life Research, BMC PublicHealth and Pharmacoeconomics, and sixbooks/monographs. He regularly reviewedmanuscripts for international and local publicationsincluding British Medical Journal, Bulletin WHO andValue in Health. He was invited to speak in more thanfifty international and domestic scientific events inUK, US, South Korea, Indonesia, Japan, China,Thailand and Singapore. He is also an appointedexpert member for the UK National Institute forHealth Research Committee, Malaysia HealthTechonology Assessment Agency (MaHTAS),Malaysia Pharmacoeconomic GuidelinesDevelopment Committee, Malaysia NationalMedicine Policy Steering Committee, Ministry ofHealth’s Quality Use of Medicine Committee,Malaysia Health Promotion Board, Institute of HealthService Research, Malaysia Pharmacy AdvisoryBoard and Malaysia Pharmacoeconomic TechnicalCommittee. He plays an active and vital role inprofessional societies and served as the Chair-Electfor ISPOR Good Outcomes Research Practices &Publications Committee, Co-editor for ISPOR NewsAcross Asia, Board Member for HTAsiaLink Networkand former Chairman for Malaysian PharmaceuticalSociety (Penang Branch). In 2010, he was awardedthe prestigious International Fellowship forInternational Society of Pharmacoeconomics andOutcomes Research. At present, Dr Asrul is anAssociate Professor and Chairman in social andadministrative pharmacy in Universiti SainsMalaysia, where he teaches pharmacoeconomic,statistic and epidemiology to both undergraduatesand postgraduates in the university and four otherlocal institutions.

DR CAROL BAO

Carol Bao is a Director of Global Health Economicsand Outcomes Research at AbbVie in the greaterChicago area in the U.S., leading the internationalteam for immunology supporting HUMIRA allindications. She joined Abbott, now AbbVie, in April2008 as a manager and in the last 6 years, shechanged her roles from dermatology lead, to the leadin Cross Indication Strategic Initiatives and later tothe global lead for HUMIRA rheumatology, before hercurrent role. Aside from industry experience, Carolspent one year in the greater Boston area as a seniorscientist with Abt Associates, Inc., now part of theUnited Biosource Corporation. She has workedextensively on projects spanning across clinical trialdata and administrative claims data base analyses,cost-effectiveness and budget impact models,patient/physician surveys, retrospective chart reviewstudies and value dossiers. Carol holds her doctoraland master degree in Economics from the Universityof Illinois at Chicago and has a bachelor degree inEconomics from Fudan University in Shanghai,China. She was born and raised in Shanghai, Chinaand now lives in the greater Chicago area with herhusband and two daughters.

PROFESSOR CHAIYAKUNAPRUK

Professor Chaiyakunapruk joined Monash Universityas a Professor of Health Economics. He earned hisbachelor in Pharmaceutical Sciences fromChulalongkorn Univesity and Doctor of Pharmacy(Pharm.D.) from the University of Wisconsin-Madison. He completed his Ph.D. in PharmaceuticalOutcomes Research and Policy Program from theUniversity of Washington in Seattle, USA. He is bestknown for his research expertise in systematicreview and meta-analysis, health economics, andpharmacoepidemiology/outcomes research. He hasmore than 50 international publications. He hasapplied his expertise in a wide range of researchtopics in pharmacy, medicine, and public health.Dr.Chaiyakunapruk has been very active at bothnational and international levels. He was a co-founder of the ISPOR Asia Consortium (InternationalSociety of Pharmacoeconomics and OutcomesResearch), ISPOR Thailand Chapter, and AsiaPacific Evidence-based Medicine Network. Hecurrently serves as an education chair of ISPOR Asiaconsortium and an executive member and a scientificcommittee member for ISPOR Asia-Pacific meetings.He is also a member of Health economic board ofNational Essential Drug List Selection Committee,Signal Detection Committee of Thai FDA, PharmacyNetwork in Tobacco Control Committee, andadvisory board of Research and DevelopmentInstitute, Governmental Pharmaceutical Organization.He is also a co-author of Thai Health TechnologyAssessment Guideline. He has also been working asa consultant for WHO in vaccine-related healtheconomics, malaria control, and pharmaceuticaleconomics. He has also published numerous articlesin peer-reviewed medical, public health, pharmacy,and economics journals including Annals of InternalMedicine, Chest, Clinical Infectious Disease, JAMADermatology, Journal of Thrombosis andHaemostasis, Drug Safety, Tobacco Control, value inhealth, and Pharmacoepidemiology and Drug Safety.Dr Chaiyakunapruk also serves as a co-editorofValue in Health Regional Issue, a member of aneditorial board of Journal of Medical Economics anda reviewer for several prestigious internationaljournals such as the British Medical Journal, JAMA,Annals of Internal Medicine, Vaccine, Value inHealth, International Journal of Pharmacy Practice,and Pharmacotherapy. As part of the recognition, hehas received several research awards. They includeWilliam Rutala Award for his antiseptic research workin year 2001, Nagai Research Award in year 2006,2009, 2011, Distinguished Research Award ofNaresuan University in year 2007, 2008, 2009, 2011Distinguished Routine to Research Award in year2008, Best research in community pharmacy awardin year 2011, best presentation at Society of MedicalDecision Making –Asia Pacific conference in 2014

CHRISTOPH GLAETZER

ì More than 18 years global experience in thedevelopment and implementation ofpharmaceutical market access strategies

ì Responsible for various commercial and marketaccess related functions in Europe, US and AsiaPacific

ì International thought leader and speaker onPharmaceutical Market Access aspects

ì Representative of Janssen/J&J at variousinternational forum and initiatives (e.g. PhRMA,Gates Foundation, GHC, ISPOR, HTAi )

ì Currently Vice President Market Access AsiaPacific responsible for access and pricingstrategies for all pharmaceutical products

ì Last position before moving to AP in 2011 Headof Global Pricing

ì Co-designer of the Janssen Access Frameworkì Champion of the Janssen Equity Based Tiered

Pricing Strategy ì Educational background: Economist, Trained

Health Economist and Black Belt Negotiator



DR FEISUL IDZWAN MUSTAPHA

Dr. Feisul Idzwan Mustapha graduated with anMBBS degree from the University of Newcastle-upon-Tyne, United Kingdom in 1997. Hesubsequently obtained an MPH in Epidemiology andBiostatistics from the National University of Malaysiain 2006. He was inducted as a member of theAcademy of Medicine, Malaysia, in 2008. He joinedthe Disease Control Division (Non-CommunicableDiseases Sector), Ministry of Health, Putrajaya as aPublic Health Specialist in 2006, where he iscurrently engaged in the practice of public health inthe prevention and control of non-communicablediseases (NCD), with special focus on diabetes andobesity. He led the development of the “NationalStrategic Plan for Non-Communicable Diseases”(NSP-NCD), which was launched in December 2010.NSP-NCD now provides the framework forMalaysia’s response to the increasing burden ofNCD in the country. Specifically for improving thequality of care of diabetes at the primary care level,he led the development of the National DiabetesRegistry (or NDR), a web-based application, whichwent live on 1 January 2011. In addition to being adisease registry, NDR supports the implementationof the “Diabetes Clinical Audit” and the new DiabetesQuality Assurance (QA) Programme for MOH HealthClinics entitled “Quality of Diabetes Care at MOHHealthcare Facilities: Glycaemic Control”, both ofwhich were implemented nationally in 2009. Herepresents Malaysia at various internationalmeetings, conferences and workshops relating to theprevention and control of NCD, and has also beeninvited by the World Health Organisation as atemporary advisor for their technical meetings. Inaddition, he is currently involved in several studiesrelating to diabetes and obesity in Malaysia,providing expertise in epidemiology and biostatistics.He was chair of the Technical Working Group forNCD risk factors in the recent 2011 National Healthand Morbidity Survey (NHMS).

DR GOH BAK LEONG

Dr Goh Bak Leong is the Head and SeniorConsultant Nephrologist in Serdang Hospital. Hebecame a member of the Royal College ofPhysicians in United Kingdom MRCP (UK) in 1996.He obtained his further training as Renal Fellow atMonash Medical School, Alfred Hospital. He wasawarded the Fellowship of Royal College ofPhysicians and Surgeons of Glasgow in 2002. DrGoh has published numerous original articles in theinternational peer review journals in the field ofgeneral nephrology, dialysis and transplantation. Hehas special interest in CAPD. He has published greatquantity of PD access related articles in Seminars inDialysis and Peritoneal Dialysis International. He haspresented great number of scientific papers ininternational meetings and congresses. He is amember of many Registries, and Clinical PracticeGuidelines. He also sits in many panel / committee /advisory boards as well as professional societies atboth national and international level.

DR JASMINE RAOH-FANG PWU

Dr. Pwu obtained her PhD from College of PublicHealth, National Taiwan University: and the subjectof her dissertation was the application of cost-effective analysis using examples from vaccine andanti-viral treatments. Trained as an epidemiologist,Dr. Pwu has been an expert in both observationalresearch and large database analysis. She laterbecame interested in economic evaluations,especially modelling studies. In this area, she hasnearly 20 years of research experience. Dr. Pwu iscurrently Director of the Health TechnologyAssessment Division for the Center for Drug

Evaluation in Taiwan. Her division (CDE/HTA) worksclosely with the Bureau of National Health Insurancefor reimbursement and pricing decisions. Herexperiences has led to her participation in severalresearch projects designed to aid health policydecision-making in areas such as anti-HBVtreatment, cervical cancer screening and HPVvaccination. Prior to CDE, she worked as aconsultant, for both government and industry,conducting economic evaluation studies. Dr. Pwu isalso an adjunct Assistant Professor at the TaipeiMedical University.

PROFESSOR DATUK DR JEYAINDRAN SINNADURAI

Datuk Dr. Jeya graduated from the NationalUniversity of Malaysia (UKM ) in 1981 and initiallyworked at the Kuala Lumpur General Hospital and helater worked at the Klang General Hospital .Over theyears, he has had extensive working experience andpostgraduate training at major hospitals in New York,Singapore, London and Dublin. Datuk Dr. Jeya hasearned great distinction for research in the fields ofCritical Care with an emphasis in both Pulmonologyand Cardiology, both of which he has a stronginterest In 1990, in recognition of his contributions tothe field of Respiratory Medicine, Datuk Dr. Jeya wasawarded the "British High Commissioner's-Chevening Award" to pursue a postgraduate coursein Thoracic Medicine at the Royal Brompton NationalHeart and Lung Institute London. He completed hiscourse in 1991 and became the first Asian to beawarded a distinction in that field by the University ofLondon. He has presented more than 150 scientificpapers in cardiology, pneumonias and asthma. Hehas also published papers both in local andInternational medical journals covering these topics.Recognised as international expert and opinionleader in these fields, he has been invited to chairlocal and international meeting both locally andoverseas. Datuk Dr. Jeya also serves as a memberof several committees of the Ministry of Health. He isalso a member of the committee which wasresponsible for the development and implementationof Clinical Practices and has an interest in bettermanagement of patients. In this respect he is astrong advocate of Clinical Governance and Patientsafety. Datuk Dr. Jeya is currently a SeniorConsultant Pulmonary and Critical Care Physicianand with effect from 1st March 2013 was appointedas the Deputy Director General of Health (Medical) ofthe Ministry of Health, Malaysia. Datuk Dr. Jeya isalso a Fellow of the American College of ChestPhysicians, Fellow of the Royal Academy ofMedicine Ireland, Fellow of the Royal College ofPhysicians of Ireland, Fellow of the Faculty ofOccupational Medicine, Ireland. He also part of theteaching faculty of the Universiti KebangasanMalaysia, Univeristi Putra Malaysia and MAHSA. Heserves The Royal College of Physicians of Ireland asThe Dean of Examinations –Malaysia, Examiner –Clinical Examinations, The Regional advisor to theRoyal College of Physicians of Ireland and TheAmerican College of Chest Physicians. He is also aMember of the Global Initiative in Asthma (GINA)advisory council which advises the WHO on thecurrent treatment and management of asthma,Member of the WHO Consultation Panel for theDevelopment of a Comprehensive Approach for theGlobal Prevention and Control of ChronicRespiratory Diseases and Member of the WHOworking group on Dengue.



PROFESSOR KENNETH KC LEE

Kenneth Lee is Professor of Pharmacy and Head ofPharmacy Discipline, Monash University, Malaysia.Before he moved to Malaysia, he was Professor andAssociate Director (External Affairs) of the ChineseUniversity of Hong Kong (CUHK) School ofPharmacy where he was one of the foundingmembers and had subsequently worked for 18 years.He was appointed as a Justice of the Peace by thegovernment of Hong Kong in 2003 for his services tothe community. Prof Lee received his pharmacyundergraduate training from the University ofWashington in Seattle. His subsequent higherqualifications were from the CUHK and the Universityof Oxford, UK. He is widely recognised as one of thepioneers in pharmacoeconomics and outcomesresearch in Asia focusing on comparativeeffectiveness research, health technologyassessment and healthcare policy development. Hehas published extensively in peer-reviewedinternational journals and has been author/editor ofseveral textbook chapters. He has been the Editor-in-chief of the Journal of Medical Economics since2006 and is serving on the editorial board of anumber of international journals including Value inHealth. He served as Adjunct Professor of School ofPharmacy, the CUHK, and Honorary Professor ofSchool of Public Health, the University of Hong Kongfrom 2010-13. From 2008-11, he was also appointedas visiting Professor of University of London Schoolof Pharmacy. He has been recently appointed as theChairman of the Scientific Advisory Committee of theMalaysian Medicinal and Aromatic Plants (MyMAP)project, a collaborative project between MonashUniversity and the Prime Minister’s Office ofMalaysia. Prof Lee has served in a number ofpositions in the International Society forPharmacoeconomics and Outcomes Research(ISPOR). He was the major driving force and later afounding member of the first ISPOR regionalconsortium - ISPOR Asia Consortium which wasestablished in 2004. He served as president of theConsortium from 2006-8. Before this, he alsospearheaded and became the founding chair of thefirst ISPOR local chapter in Asia – ISPOR HongKong Chapter in 1999. He had been a member of theorganizing committee of several ISPOR Asia PacificConferences from 2004-11. He had also taught in anumber of ISPOR short courses. Currently he is oneof the co-editors of Value in Health Regional Issue,an official publication of ISPOR. In May 2012, he waselected as a member of the ISPOR Board ofDirectors for 2012-4.

.DR MD KHADZIR BIN SHEIKH HJ AHMAD

Dr. Md Khadzir is a certified Occupational HealthPhysician and received MD degree from NationalUniversity of Malaysia, Master degree inOccupational Medicine from National University ofSingapore and PhD degree in Occupational Healthfrom The University of Birmingham, UK. He had beendrafting Health Laws; Medical Ethics andinstrumental in initiating the Traditional andComplementary Medicine Services in the pioneerHospital Kepala Batas, Hospital Putrajaya andHospital Sultan Ismail. The program includesregistration of Traditional and Complementarymedicine practitioner in Malaysia. Currently sincelate 2008, he is heading the development andoperation of electronic Health Information andManagement System and the development of HealthInformatics Standards for Malaysia. He is nowleading the development of Malaysian Health DataWarehouse Project, Acquiring and development ofPOC of SNOMED CT for implementation in Ministryof Health Hospitals; Development of MalaysianHealth Data Dictionary; and development and rollingout of Web Based version of Medical CareInformation System that collect granular data for

discharges of inpatient and those attending Day CareServices. He is also involved in the implementationof Hospital Information System and Malaysia HealthInformation Exchange.

MENDEL GROBLER

Mendel Grobler is the Director, Access and PublicAffairs at Pfizer Australia (Pty Ltd) and is responsiblefor reimbursement strategy and public affairs for thecompany’s products in Australia and New Zealand,as well as advising Pfizer Inc. on regional and globalapproaches to Health Technology Assessment. Hehas been working in the field of health care fundingand financing for more than twenty years and alsohas extensive experience across the pharmaceuticalindustry including manufacture, productdevelopment, registration, distribution andcommunity/hospital pharmacy. He has previouslyrepresented the industry on the Economic Sub-Committee of the Pharmaceutical Benefits AdvisoryCommittee (PBAC) and also served as advisor to theAustralian Department of Veterans’ Affairs. Over thepast few years he has accepted invitations tocontribute to various government- industrydiscussions about equitable funding policy in Korea,China and Taiwan. He has published a number ofresearch papers in peer-reviewed and other journals,and delivered presentations at international medicaland health economic conferences. He is a memberof the Australian Health Economics Society, theInternational Health Economics Association andHealth Technology Association International. Mendelwas recently awarded the 2012 Pat Clear Award,Medicines Australia's most prestigious honour. Theaward is presented annually to recognise anoutstanding level of commitment by an individual,group or team for the benefit of the Australianmedicines industry.

NOORMAH MOHD DARUS

Noormah Mohd Darus is currently the SeniorPrincipal Assistant Director working at the MalaysianHealth Technology Assessment Section, MedicalDevelopment Division, and Ministry of HealthMalaysia (MOH). She has 32 years of experience inmany areas such as health technology assessment,evidence-based medicine, evidence-basedhealthcare, public health research, pharmacyservices and health outcomes research. Currentlyher work is focused on systematic reviews and she isinvolved in producing HTA reports, technologyassessment reviews for the Ministry of Health andtraining of MOH personal / University post graduatestudents on evidence based medicine. Prior to thisposition, she had vast experiences as a pharmacistand researcher at several MOH institutions such asSungai Buloh Hospital, National PharmaceuticalBureau, Kuala Lumpur Hospital, Clinical ResearchCentre, and Institute for Medical Research. She isalso actively involved in creating awareness amongstthe healthcare professionals on evidence-basedmedicine and health technology assessment. Sheholds a degree on Bachelor of PharmaceuticalSciences (medical doctor) from MansourahUniversity (Egypt)and Masters of Science in ClinicalEpidemiology from Erasmus University, Rotterdam,Netherlands (Holland).



DR RAMLI ZAINAL

Dr Ramli Zainal is currently the Head of HealthcareFinancing and Economic Research Division at theInstitute for Health Systems Research (IHSR). Hegraduated from Universiti Sains Malaysia (USM) inPharmacy and completed a Masters degree fromUniversity of Bradford. He then returned to USM andwas awarded a PhD degree in Pharmacoeconomics.As a researcher, Dr Ramli Zainal is the principleinvestigator for projects funded by UNDP and theNational Institute of Health. He also collaborates invarious projects and currently actively involved inconducting trainings in the field of economicsevaluation in healthcare. He is an expert member tothe Ministry of Health Malaysia, PharmacoeconomicsTechnical Working Group, Health TechnologyAssessment group and is an appointed member ofthe Pharmacy Board Malaysia. He has served theWorld Health Organisation (WHO) as a consultant forthe Training of Trainer in QA/QI in Papua NewGuinea and the Pacific Islands. He is also involved inthe training for QA/QI at national level and forcountries within the WHO Western Pacific RegionalOffice. Prior to joining IHSR, he had served and heldvarious positions in the National PharmaceuticalControl Bureau as a GMP Auditor, Head of CosmeticUnit, Head of Secretariat Unit and Head ofOrganisational Development & IT Division. He hasalso worked as a Drug Enforcement Officer inPenang and as a Hospital Pharmacist in Gerik andSeremban. He is currently the Secretary to theMalaysian Society for PharmacoEconomics andOutcomes Research (MySPOR) and a member ofthe Malaysian Pharmaceutical Society (MPS).

DR. SALMAH BAHRI

Dr. Salmah Binti Bahri graduated with a B.Sc inPharmacy from the University of Baghdad, Republicof Iraq in 1981. She continued her advanced degreestudies in 2001 and received her M.Sc (Pharmacy)and Ph.D in Drug Policy and Management from theUniversiti Sains Malaysia in 2002 and 2007respectively. Her areas of expertise includeMedicines Policy and Management, Quality Use ofMedicines, Medicines Pricing and Good Governancein Medicines. She is currently the Director ofPharmacy Practice & Development, PharmaceuticalServices Division, Ministry of Health Malaysia(MOH). She leads the strategic planning,implementation and the development of thepharmacy practice activities in Malaysia. She is theadvisor the National Pharmacy Research &Development Committee, MOH and chairman ofvarious committees such as, ImplementationCommittee for Comprehensive National Project onthe Quality Use of Medicines by Consumers,Implementation Committee for Good Governance inMedicines, Advisory Group for the Medicine PriceMonitoring Program in Malaysia, and TechnicalCommittee for Implementation of National DrugPolicy. In addition, she is a member of the MalaysianBoard of Pharmacy, Malaysian Drug ControlAuthority and Panel of the MOH Drug Formulary.Internationally, she is a member of the ASEANWorking Group on Pharmaceutical Development andWHO panel member for the development of theWHO Guideline on Pharmaceutical Pricing Policies.Dr Salmah Bahri is also an active researcher inMOH. Among her important national researchprojects are the Drug Utilization in the Treatment ofDiabetes Mellitus in the Ministry of Health Facilitiesand National Survey on the Use of Medicines byMalaysian Consumers (2007) and (2012). She hasalso published some international peer reviewedarticles, mostly in collaboration with USM, andvarious proceedings, compendiums, researchreports, articles, bulletins and newsletters for theMOH. She has also co-authored a few book chaptersand was recently the main author of a book entitledNational Medicine Policy-A Malaysian Perspective(2012).

PROFESSOR DR SAMSINAH HAJIHUSSAIN

Dr. Samsinah Haji Hussain was conferred a degreein Bachelor of Pharmacy (Hons) from UniversitiSains Malaysia (USM) Penang in 1984 and wasawarded a PhD degree in 1987 from LeedsUniversity, United Kingdom in the field ofneuroendocrinology under the USM fellowship. In2005 she completed her Graduate Certificate inPharmaco-economics specialty training at MonashUniversity, Australia and was promoted to Professorof Pharmacy in 2008. Dr. Samsinah is an appointedmember to the National Professor Council under thePharmacy and Applied Science Cluster (2011 –now), appointed member of the Malaysian DrugControl Authority (DCA) from 2001 until 2013 andalso an expert member for the Ministry of HealthMalaysia Pharmacoeconomics Technical WorkingGroup. She actively conducts training workshopspertaining to pharmacoeconomics evaluation inhealthcare on invitation for the Pharmacy ServicesDivision and Health Technology Assessment Section(MaHTAS) Medical Development Division under theMalaysia Ministry of Health, Ministry of DefenceMalaysia, multinational pharmaceutical companiesand the Malaysian Pharmaceutical Society and isoften invited to be the external examiner andreviewer for universities and international journals.She is also a member of several professionalsocieties and non-government organizations. She iscurrently the vice-president of the Malaysia Societyfor Pharmacoeconomics and Outcome Research(MySPOR) and also the Head of the StudentEmpowerment & Research Unit (SERU) underUniversity of Malaya Student Affairs Division. Dr.Samsinah research interests include economicevaluation and outcome research in the areas ofhealthcare resource utilization, drug formularymanagement, paediatric asthma and obstructivesleep apnea syndrome, diabetes and metabolicdisorders. In addition her research interests alsoinclude areas relating to student empowerment andholistic student development.

ASSOCIATE PROFESSOR DR.SHARIFA EZAT WAN PUTEH

Dr. Sharifa Ezat Wan Puteh is a trained MedicalDoctor from UKM. She obtained her Masters inPublic Health (Hospital and Health Management)and PhD in Public Health-Health economics from theUnited Nations University-International Institute forGlobal Health (UNU-IIGH). Her main interests are inareas of health inequality and health economics. Sheis also a coding and casemix consultant (with UNU-IIGH and International Training Centre and ClinicalCoding UKM Medical Centre) with developingcountries and ITCC. She is also a UKM memberconsultant on Cost benefit analysis on industries andoccupational diseases in the country. From 1stDecember 2010 until now, she has been appointedas a casemix consultant (with UNU-IIGH and ITCCUKM) Kuala Lumpur to conduct research & capacitybuilding on Accessibility, Efficiency and Quality ofCare in Health System (especially in casemixmanagement) to support casemix implementation indeveloping country. She is currently the assistanteditor for the Malaysian Journal of Public Health (anScopus indexed journal) and reviewer of a fewjournals locally and abroad. She has publishednumerous papers locally and abroad and book oncost effectiveness of vaccination against cervicalcancer. She has presented many papers andproceedings locally and abroad and is a a memberon HTA reviews on cost effectiveness, a member ofthe Health Economics Association Malaysia, theMalaysian Public Health Physicians Association,MySPOR (Malaysian Pharmacoeconomics andOutcome Research Group) and One Health with theGlobal Health Institute. She also is an activemember in NGO activities and CSR, having



participated in "Doctor Turun Ke Desa" and Program"Kami Prihatin" with local companies and organisations.

PROFESSOR SHU CHUEN LI

Professor Shu Chuen Li is Chair Professor andHead, Discipline of Pharmacy & ExperimentalPharmacology, School of Biomedical Sciences,University of Newcastle. Prior to this, Professor Lihas worked as an academic at the NationalUniversity of Singapore (NUS) and as Acting Director& Deputy Director, Pharmaceutical EvaluationSection (PES) of Pharmaceutical Benefits Branch,Australian Commonwealth Department of Health &Ageing. During his period in Singapore, Professor Lialso served as the Visiting Specialist /Consultant tothe Health Sciences Authority (HSA), and has beeninstrumental in developing the Pharmacoeconomicsand Drug Utilization Unit at the Centre for DrugAdministration. In his capacity as Acting Director &Deputy Director of PES in Australia, Professor Li wasamong the few pioneers that put the principles ofpharmacoeconomic evaluation into practice forregulatory affairs, and has been involved inimplementing the 1st version of the AustralianPharmacoeconomics Guidelines and developing the2nd version of the same Guidelines. Professor Liwas a Director of ISPOPR from 2006 -2008, and afounding member of the ISPOR Asia Consortium.Additionally, Professor Li have held many otherconsultative positions in Australia and in variousAsian countries both for the pharmaceutical industryas well as for governments. Besides his expertise inhealth technology assessment and pharmaceuticalpolicy, Professor Li is a very active researcher in healthservice research and pharmacoepidemiology. Hehas published more than 350 scientific manuscriptsand conference abstracts and has been invited topresent in numerous international conferences.

DR. SORAYA AZMI

Having trained as a physician at the University ofAdelaide, Australia, and obtained a Masters in PublicHealth at Harvard, Soraya is founder and ManagingDirector of Azmi Burhani Consulting, a healthresearch services company, and Veras Research, aclinical research organization. Her career in clinicalresearch has spanned more than a decade. Shebegan her career in the Malaysian Ministry of Health,Malaysia, first as a physician then a researcher.Health economics and outcomes research is one ofher main areas of interest. After earning her Mastersdegree, she worked in the United States for theUnited Nations Population Fund and PfizerPharmaceuticals (New York headquarters) as well asthe consulting arm of NDCHealth in Arizona (nowpart of Wolters Kluwer). Soraya is a currentcommittee member of the Malaysian NationalCommittee for Clinical Research (NCCR) chaired bythe Director-General of Health, committee memberfor the Malaysian Society of Pharmacoeconomicsand Outcomes Research (MySPOR) and is theorganizing committee chair for the 2014Pharmacoeconomics and Outcomes ResearchConference organized by MySPOR. Soraya alsoserves on the management board of Asia CRO Alliance,a network of clinical trial partners across Asia.

DR. SUNITA BAVANANDAN

Dr. Sunita Bavanandan is a Consultant Nephrologistat the Department of Nephrology, Hospital KualaLumpur. She graduated from the University ofQueensland Australia in December, 1991 andobtained her qualifications as a Member of the RoyalCollege of Physicians United Kingdom in 1997 andas a Fellow of the Royal College of PhysiciansEdinburgh in 2007. Her special interests are inChronic Kidney Disease, Hypertension, DiabeticKidney Disease and Peritoneal Dialysis.

PROFESSOR DATO’ DR SYEDMOHAMED ALJUNID

Dr Syed Aljunid is a Professor of Health Economicsand Interim Director of United Nations University-International Institute for Global Health. Prior to thishe served as a Senior Consultant in Public HealthMedicine and Head of Department of CommunityHealth, Faculty of Medicine, National University ofMalaysia (UKM). He obtained his MD from UniversitiKebangsaan Malaysia, Master of Science in PublicHealth from National University of Singapore andPhD in Health Economics and FinancingProgramme, London School of Hygiene and TropicalMedicine. He is now the head of International Centrefor Casemix and Clinical Coding of UKM. He iscurrently involves in supporting a number ofdeveloping countries to develop and implementcasemix system under Social Health Insuranceprogrammes. His work on casemix system in UNU-IIGH covers research and capacity buildingprogrammes in Malaysia, Indonesia, Philippines,Mongolia, Vietnam, China, Saudi Arabia, United ArabEmirates, Sudan, Nepal, Uruguay, Iran, Chile, Kenyaand Ghana. He is the developer of internationalcasemix grouper UNU-CBGs as well as Clinical CostModelling Software (CCM Version 2.0). Currently, heserves as the co-chair of Morbidity TechnicalAdvisory Group of ICD-11 Revision of World HealthOrganisation-Family of International Classification.He is actively involves in teaching public healthmedicine, health economics and health managementcourses in MPH, MBA and PhD programmes jointlyrun by UNU-IIGH and its partner universities inMalaysia, Nepal, Yemen, United Arab Emirates andSudan. He served as consultant and adviser to anumber of international agencies includingInternational Atomic Energy Agency, World HealthOrganisations, GTZ, AUSAID, UN-AIDS, UNDP,UNICEF, GAVI, Asian Development Bank and theWorld Bank in various international projects. He isthe Past-President of the Public Health MedicineSpecialists’ Association of Malaysia and FoundingPresident of Malaysian Health EconomicsAssociation (MY-HEA) and Malaysian Society ofPharmacoeconomics and Outcome Research (MY-ISPOR).

YEW WEI TARNG

Presently the Managing Director of Eisai (Malaysia)Sdn. Bhd, Yew Wei Tarng is also the President of thePharmaceutical Association of Malaysia (PhAMA).Mr Yew began his journey within PhAMA as theChairman of the Human Resource Committee from2006 - 2008. He then went on to become theChairman of Regulatory Affairs Committee with theassociation and continues to hold this position todate. ln 2006, Mr Yew became Vice President ofPhAMA, a position he has held until he became thePresident of the association in September 2012.Besides PhAMA, Mr Yew has also been active inother associations such as the ASEANPharmaceutical Research lndustry Association(APRIA), where he was chairman of the associationfor a year. APRIA is a regional associationrepresenting the research-based pharmaceuticalcompanies in ASEAN, committed to ensuring optimalregulatory environment for the continueddevelopment of the pharmaceutical industry tofurther improve the health and well-being of ASEANpatients. Mr Yew holds a Bachelor of Pharmacy witha minor in Management from Universiti SainsMalaysia followed by a traineeship at the NationalPharmaceutical Control Bureau and the KualaLumpur Hospital. He then went on to participate inthe Duke Program for Manager Development atDuke University in North Carolina and he studied aswell at the Kellogg School of Management inChicago.



DR. ZAFAR AHMED

Dr. Ahmed is a Senior Lecturer at the InternationalCenter for Casemix and Clinical Coding Faculty ofMedicine Kebangsan Malaysia. He is a ConsultantHealth Economist and Casemix Consultant. He wasinvolved as a Consultant in the development andimplementation of Casemix System in Mongolia,Indonesia, Philippines, Uruguay and Vietnam. Hisconsultancy in those countries involved thedevelopment of Benefit Package for thereimbursement on Case base Tariffs developed onDRG system. He is also one of the Consultants whodeveloped first Case-Mix Online project for Casemixtraining online. Among his involvement in Casemixproject are ongoing Casemix implementation inVietnam, the recently concluded implementation ofCasemix in all kemkes (Ministry of Health Indonesia)hospitals in Indonesia, 25 hospitals in Uruguay,development of national tariff in the context ofCasemix for the social health insurance in thePhilippines, and Casemix system implementation inUruguay, Mongolia and Vietnam. Dr Zafar Ahmed isactively involved in graduate level teaching both atUKM (Universiti Kebangsaan Malaysia), and UTM

(Universiti Teknologi Malaysia). His research interestincludes Disease burden and economic burden ofdisease, economic evaluation of health interventions,and disease and economic modeling. Apart from hisconsultancy work with UNU-IIGH, he is a ClinicalCoordinator/Consultant of Casemix Unit in HospitalUniversity Kebangsaan Malaysia. This is theDepartment in the university which pioneered thedevelopment of DRG base solution for hospital inUKM. Furthermore, he is a consultant for COHORTMalaysia, first ever COHORT in Malaysia and part ofAsian COHORT Consortium. Malaysian COHORT isto study 100,000 sample in Malaysia for studying thechronic disease in Malaysia. Beside this he hasextensive experience in evaluating the HospitalInformation System (HIS) in Malaysian hospitals. Hehas special interest in developing the DecisionSupport Systems (DSS) in the clinical environment,especially in the pharmacy environment, for that hehas worked with various hospitals, both in public andprivate sector, to develop Drug decision supportsystem using existing drug knowledge bases.Majority of his publications and research papers areEconomic Evaluation in healthcare, Casemiximplementation and Health Care System.

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