RESUMO
Background: Estimation of the economic burden of heart failure (HF) through a complete evaluation is essential for improved treatment planning in the future. This estimation also helps in reimbursement decisions for newer HF treatments. This study aims to estimate the cost of HF treatment in Malaysia from the Ministry of Health's perspective. Materials and methods: A prevalence-based, bottom-up cost analysis study was conducted in three tertiary hospitals in Malaysia. Chronic HF patients who received treatment between 1 January 2016 and 31 December 2018 were included in the study. The direct cost of HF was estimated from the patients' healthcare resource utilisation throughout a one-year follow-up period extracted from patients' medical records. The total costs consisted of outpatient, hospitalisation, medications, laboratory tests and procedure costs, categorised according to ejection fraction (EF) and the New York Heart Association (NYHA) functional classification. Results: A total of 329 patients were included in the study. The mean ± standard deviation of total cost per HF patient per-year (PPPY) was USD 1,971 ± USD 1,255, of which inpatient cost accounted for 74.7% of the total cost. Medication costs (42.0%) and procedure cost (40.8%) contributed to the largest proportion of outpatient and inpatient costs. HF patients with preserved EF had the highest mean total cost of PPPY, at USD 2,410 ± USD 1,226. The mean cost PPPY of NYHA class II was USD 2,044 ± USD 1,528, the highest among all the functional classes. Patients with underlying coronary artery disease had the highest mean total cost, at USD 2,438 ± USD 1,456, compared to other comorbidities. HF patients receiving angiotensin-receptor neprilysin-inhibitor (ARNi) had significantly higher total cost of HF PPPY in comparison to patients without ARNi consumption (USD 2,439 vs. USD 1,933, p < 0.001). Hospitalisation, percutaneous coronary intervention, coronary angiogram, and comorbidities were the cost predictors of HF. Conclusion: Inpatient cost was the main driver of healthcare cost for HF. Efficient strategies for preventing HF-related hospitalisation and improving HF management may potentially reduce the healthcare cost for HF treatment in Malaysia.
RESUMO
Objective: To identify the predicting factors that contribute to knowledge, attitude and practices relating to Zika virus infection among the general public in Malaysia. Methods: A cross-sectional study was conducted using a validated self-administered questionnaire. Descriptive analysis was done for participants' socio-demographic profile. Contingency table analysis was done to analyse the associations between knowledge, attitudes, and practices (KAP) scores and socio-demographic profile. A Bonferroni-corrected P-value was used to find the significance of the associations and multiple comparisons were performed in a single data set. To determine the linear relationship between each independent variable and the dependent variable, Spearman rank correlation was performed. Cohen's correlation coefficient was evaluated to determine the strength of the effect size. Multiple correlations and regression analyses were performed to identify independent variables that predicts the dependent variable. Results: Multiple correlation analyses were conducted between respondents' KAP score and independent variables (Age >60 years; Female gender; Selangor state; At least 1 pregnant woman per household). The independent variables such as 'Female gender', 'Selangor state' and 'At least 1 pregnant woman per household' were positively and significantly correlated with KAP score whereas, age >60 years was negatively and significantly correlated with the KAP scores. Conclusions: There were associations between four independent factors and the KAP scores, while only three factors contributed to changes in KAP scores among the public. Among these contributing factors, respondents' age group was the strongest predictor.
