Browsing by Author "Hoon Shien Teh"
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- PublicationEconomic Evaluation of Nirmatrelvir/Ritonavir Among Adults Against Hospitalization During the Omicron Dominated Period in Malaysia: A Real-World Evidence Perspective(Springer Link, 2024)
;Ee Vien Low ;Hoon Shien Teh ;Nicholas Yee Liang Hing ;Suresh Kumar Chidambaram ;Mohan Dass Pathmanathan ;Wee Ric Kim ;Wei Jia Lee ;Zhi Wei Teh ;Maheshwara Rao Appannan ;Shahanizan Mohd Zin ;Faizah Muhamad Zin ;Samha Bashirah Mohamed Amin ;Mastura Ismail ;Azah Abdul SamadKalaiarasu M. PeariasamyBackground and objectives: Nirmatrelvir/ritonavir was administered orally to manage mild to moderate symptoms of COVID 19 in adult patients. The objectives of this study were to (i) evaluate the cost-efectiveness of prescribing nirmatrelvir/rito navir within 5 days of a COVID-19 illness in order to avert hospitalization within a 30-day period in the Malaysia setting; (ii) determine how variations in pricing and hospitalization rates will afect the cost-efectiveness of nirmatrelvir/ritonavir. Methods: The 30-day hospitalization related to COVID-19 was determined using 1 to 1 propensity score-matched real-world data in Malaysia from 14 July 2022 to 14 November 2022. To determine the total per-person costs related to COVID-19, we added the cost of drug (nirmatrelvir/ritonavir or control), clinic visits and inpatient care. Incremental cost-efectiveness ratio (ICER) per hospitalization averted was calculated. Results: Our cohort included 31,487 patients. The rate of hospitalization within 30 days was found to be 0.35% for the group treated with nirmatrelvir/ritonavir, and 0.52% for the control group. The nirmatrelvir/ritonavir group cost an additional MYR 1,625.72 (USD 358.88) per patient. This treatment also resulted in a reduction of 0.17% risk for hospitalization, which corresponded to an ICER of MYR 946,801.26 (USD 209,006.90) per hospitalization averted. Conclusion: In Malaysia, where vaccination rates were high, nirmatrelvir/ritonavir has been shown to be benefcial in the outpatient treatment of adults with COVID-19 who have risk factors; however, it was only marginally cost efective against hospitalization for healthy adults during the Omicron period. - PublicationFactors influencing physicians’ decision to conduct cardiovascular risk assessments among cancer patients: A Systematic Review(Research Square, 2023)
;Hoon Shien Teh ;Shridevi Subramaniam ;Muthukkumaran ThiagarajanWen Yea HwongBackground: Improved cancer survivorship has led to untoward effects of developing cardiovascular complications, mainly due to exposure to cardiotoxic cancer therapy. Cardiovascular screening can provide substantial benefits to patient care and outcomes, but successful implementation is challenging. This systematic review consolidates factors from existing literature and explores its relationships to highlight key domains that need to be addressed to implement these risk assessment programs in clinical practice. Methods: We searched PubMed, EMBASE, CINAHL, Web of Science and PsycINFO using search terms focused specifically on factors influencing the implementation of cardiovascular risk assessment among the cancer population. Two reviewers completed independently in study selection, data extraction, and quality assessment. To get meaningful insight of the findings, we thematically matched those factors into the domain of the Tailored Implementation for Chronic Diseases (TICD) framework and inductively identified its relationships. Results: Twelve studies met the inclusion criteria. Identified factors were grouped into six domains, of which the top three included factors related to individual health professionals, which were cited in 83% of studies, incentives and resources (75% of the studies), and professional interactions in 58% of studies. Within the domain of individual health professional, we include factors concerning cognitions and attitudes, knowledge and skills, and professional behaviour. The domain of incentives and resources highlighted the needs for availability of necessary resources, continuing education system, assistance for clinicians and financial related issues. Communication influence, team and referral processes were found to be the main barriers in the domain of professional interaction. Bi-directional associations were evident between these domains, which were categorised into macro and micro levels for better interpretation. Conclusion: This review identified key factors that could be leveraged to improve cardiovascular assessment reach and appeal. Future intervention efforts should first be targeted at the level of healthcare professionals, who are the key drivers of the entire process.