- Title
- Quality use of medicine in Malaysia public health system: the role of pharmacist
- Creator
- Mohd Tahir, Nurul Ain
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The implementation of quality use of medicine (QUM) would be among the effective strategies in managing the challenges in the healthcare system. Fundamentally, the overall aim of this thesis is to evaluate how to implement the evidence- and value-based healthcare decision-making in the lack of robust evidence in the Malaysian public health system. Considering an increased global attentions and commitment towards chronic diseases, we have focused our evaluation in these diseases (using paediatric epilepsy and osteoporosis disease as examples) to fulfil the information gaps and inform policy changes in these populations. We first evaluated the Malaysian health care system, and the challenges for implementing QUM within the current system. Then, we conducted a series of QUM-related studies including drug utilization review, meta-analysis, and cost-effectiveness analysis study in epilepsy and osteoporosis to evaluate the feasibility of implementing these approaches in Malaysia. These are the specific objectives of this thesis. From our meta-analysis and observational studies, we found a trend of potential benefits of newer antiepileptic drugs (AEDs) in controlling seizures in children. However, the cost-effectiveness evaluation showed the newer AEDs to be associated with some health benefits but with significant increase in treatment costs. Comparatively, cost per outcomes of seizure control for newer AED adjunct treatment is eight times more than the standard therapy. The increasing prescription of newer AEDs globally and results from these studies highlight the needs for more randomized controlled trials (RCTs) in children against active treatments to ascertain their long-term effectiveness, particularly in Malaysia. In osteoporosis, cost-effectiveness of bisphosphonates in glucocorticoid-induced osteoporosis (GIOP) was dependent on various factors such as age, previous fracture, rheumatoid arthritis and secondary osteoporosis. Heavy burden of osteoporosis in Asia reinforces the need to implement appropriate anti-osteoporosis treatments in rational and equitable healthcare resources allocation. Additionally, the findings of potential effective traditional, complementary and alternative medicine (TCAM) treatment in irritable bowel syndrome (IBS) patients could provide initial scientific evidence to support their rational use and the application of QUM in this area. In conclusion, to achieve allocative and technical efficiency, therapeutic and economic value of treatments for chronic diseases should underpin recommendations in the selection and reimbursement of drugs in Malaysia. Finally, this thesis highlights the feasibility of implementing QUM approach and this applies also in other developing countries.
- Subject
- pharmacoeconomics; chronic diseases; health economics; meta-analysis; drug utilization review; burden of diseases; traditional medicines; complementary medicines; alternative medicines; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1385419
- Identifier
- uon:32224
- Rights
- Copyright 2018 Nurul Ain Mohd Tahir
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 87 KB | Adobe Acrobat PDF | View Details Download |