Browsing by Author "Mastura Ismail"
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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. - PublicationFive-year LDL-cholesterol trend and its predictors among type 2 diabetes patients in an upper-middle-income country: a retrospective open cohort study(2022)
;Kim Sui Wan ;Noran Naqiah Hairi ;Feisul Mustapha ;Mastura Ismail ;Muhammad Fadhli Mohd YusoffFoong Ming MoyBackground: Patients with diabetes have increased risks of cardiovascular diseases (CVD), and their LDL-cholesterol (LDL-C) has to be treated to target to prevent complications. We aim to determine the LDL-C trend and its predictors among patients with type 2 diabetes (T2D) in Malaysia. Methods: This was a retrospective open cohort study from 2013 to 2017 among T2D patients in public primary health care clinics in Negeri Sembilan state, Malaysia. Linear mixed-effects modelling was conducted to determine the LDL-C trend and its predictors. The LDL-C target for patients without CVD was <2.6 mmol/L, whereas <1.8 mmol/L was targeted for those with CVD. Results: Among 18,312 patients, there were more females (55.9%), adults ≥60 years (49.4%), Malays (64.7%), non-smokers (93.6%), and 45.3% had diabetes for <5 years. The overall LDL-C trend reduced by 6.8% from 2.96 to 2.76 mmol/L. In 2017, 16.8% (95% CI: 13.2–21.0) of patients without CVD and 45.8% (95% CI: 44.8–46.8) of patients with CVD achieved their respective LDL-C targets. The predictors for a higher LDL-C trend were younger adults, Malay and Indian ethnicities, females, dyslipidemia, and diabetes treatment with lifestyle modification and insulin. Longer diabetes duration, obesity, hypertension, retinopathy, statin therapy, achievement of HbA1c target and achievement of BP target were independent predictors for a lower LDL-C trend. Conclusions: The LDL-C trend has improved, but there are still gaps between actual results and clinical targets. Interventions should be planned and targeted at the high-risk populations to control their LDL-C. - PublicationImpact evaluation of guidelines on antibiotic utilisation & appropriateness in Malaysian public primary care: an interrupted time series analysis(Informa UK Limited, trading as Taylor & Francis Group, 2024)
;Audrey Huili Lim ;Norazida Ab Rahman ;Su Miin Ong ;Siti Raidah Mohamad Azman ;Fairus Zana Mohd Rathi ;Mastura Ismail ;Peter Seah Keng Tok ;Bee Kiau HoSheamini SivasampuBackground: The National Antimicrobial Guidelines (NAG) 2014 and NAG2019 in Malaysia targeted rational and judicious use of antimicrobials. In this study, we assessed the change in antibiotic utilisation and appropriateness due to the guidelines that were implemented from 2011 to 2019. Methods: Interrupted time series analyses on rates of antibiotic appropriateness and utilisation were performed using prescription data from public primary care clinics in Malaysia between January 2011 and December 2019. Rates of antibiotic utilisation, reported as Defined Daily Dose (DDD) per 1000 patients per day, were stratified by antibiotic classes. Results: Of the 16,081,492 prescriptions recorded during the study period, 4.98% (n = 800,899) contained antibiotics. NAG2014 resulted in a significant increase in antibiotic utilisation trend by 0.029 (p < 0.0001) while NAG2019 had a substantial impact on antibiotic utilisation, decreasing DDD by 1778 and increasing appropriateness by 54.6% (p < 0.0001). Variation in the number of antibiotic molecules being prescribed also decreased after NAG2019. Conclusion: Our findings indicate that the introduction of NAG2019 led to a substantial improvement in antibiotic appropriateness. At the same time, antibiotic utilisation decreased. Further research is needed to ascertain and ensure the sustainability of these changes and to establish targeted improvement strategies focusing on reducing inappropriate and unnecessary prescribing.