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Fulltext Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia

Zafirah SA, Nur AM, Puteh SEW, Aljunid SM

BMC Health Serv Res, 2018 01 25;18(1):38.
PMID: 29370785 DOI: 10.1186/s12913-018-2843-1

BACKGROUND: The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia.

METHODS: Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert.

RESULTS: Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG® code was RM654,303.91.

CONCLUSIONS: The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

Matched MeSH terms: Diagnosis-Related Groups/economics*; Hospitals, Teaching/economics*; Pharmaceutical Services/economics*; Efficiency, Organizational/economics
Fulltext Success stories in genomic medicine from resource-limited countries

Mitropoulos K, Al Jaibeji H, Forero DA, Laissue P, Wonkam A, Lopez-Correa C, et al.

Hum Genomics, 2015 Jun 18;9:11.
PMID: 26081768 DOI: 10.1186/s40246-015-0033-3

In recent years, the translation of genomic discoveries into mainstream medical practice and public health has gained momentum, facilitated by the advent of new technologies. However, there are often major discrepancies in the pace of implementation of genomic medicine between developed and developing/resource-limited countries. The main reason does not only lie in the limitation of resources but also in the slow pace of adoption of the new findings and the poor understanding of the potential that this new discipline offers to rationalize medical diagnosis and treatment. Here, we present and critically discuss examples from the successful implementation of genomic medicine in resource-limited countries, focusing on pharmacogenomics, genome informatics, and public health genomics, emphasizing in the latter case genomic education, stakeholder analysis, and economics in pharmacogenomics. These examples can be considered as model cases and be readily replicated for the wide implementation of pharmacogenomics and genomic medicine in other resource-limited environments.

Matched MeSH terms: Pharmacogenetics/economics; Public Health/economics; Developed Countries/economics; Translational Medical Research/economics
Fulltext Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia

Wong LP, Alias H, Bhoo-Pathy N, Chung I, Chong YC, Kalra S, et al.

J Headache Pain, 2020 Jun 08;21(1):68.
PMID: 32513174 DOI: 10.1186/s10194-020-01144-z

BACKGROUND/OBJECTIVE: Productivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country.
METHODS: A cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire.
RESULTS: Of the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment.
CONCLUSION: The significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.

Matched MeSH terms: Banking, Personal/economics*; Presenteeism/economics*; Migraine Disorders/economics*; Workplace/economics*
Fulltext Identifying Where REDD+ Financially Out-Competes Oil Palm in Floodplain Landscapes Using a Fine-Scale Approach

Abram NK, MacMillan DC, Xofis P, Ancrenaz M, Tzanopoulos J, Ong R, et al.

PLoS One, 2016;11(6):e0156481.
PMID: 27276218 DOI: 10.1371/journal.pone.0156481

Reducing Emissions from Deforestation and forest Degradation (REDD+) aims to avoid forest conversion to alternative land-uses through financial incentives. Oil-palm has high opportunity costs, which according to current literature questions the financial competitiveness of REDD+ in tropical lowlands. To understand this more, we undertook regional fine-scale and coarse-scale analyses (through carbon mapping and economic modelling) to assess the financial viability of REDD+ in safeguarding unprotected forest (30,173 ha) in the Lower Kinabatangan floodplain in Malaysian Borneo. Results estimate 4.7 million metric tons of carbon (MgC) in unprotected forest, with 64% allocated for oil-palm cultivations. Through fine-scale mapping and carbon accounting, we demonstrated that REDD+ can outcompete oil-palm in regions with low suitability, with low carbon prices and low carbon stock. In areas with medium oil-palm suitability, REDD+ could outcompete oil palm in areas with: very high carbon and lower carbon price; medium carbon price and average carbon stock; or, low carbon stock and high carbon price. Areas with high oil palm suitability, REDD+ could only outcompete with higher carbon price and higher carbon stock. In the coarse-scale model, oil-palm outcompeted REDD+ in all cases. For the fine-scale models at the landscape level, low carbon offset prices (US $3 MgCO2e) would enable REDD+ to outcompete oil-palm in 55% of the unprotected forests requiring US $27 million to secure these areas for 25 years. Higher carbon offset price (US $30 MgCO2e) would increase the competitiveness of REDD+ within the landscape but would still only capture between 69%-74% of the unprotected forest, requiring US $380-416 million in carbon financing. REDD+ has been identified as a strategy to mitigate climate change by many countries (including Malaysia). Although REDD+ in certain scenarios cannot outcompete oil palm, this research contributes to the global REDD+ debate by: highlighting REDD+ competitiveness in tropical floodplain landscapes; and, providing a robust approach for identifying and targeting limited REDD+ funds.

Matched MeSH terms: Crop Production/economics*; Conservation of Natural Resources/economics*
Fulltext Annual energy usage reduction and cost savings of a school: end-use energy analysis

Roslizar A, Alghoul MA, Bakhtyar B, Asim N, Sopian K

ScientificWorldJournal, 2014;2014:310539.
PMID: 25485294 DOI: 10.1155/2014/310539

Buildings are among the largest consumers of energy. Part of the energy is wasted due to the habits of users and equipment conditions. A solution to this problem is efficient energy usage. To this end, an energy audit can be conducted to assess the energy efficiency. This study aims to analyze the energy usage of a primary school and identify the potential energy reductions and cost savings. A preliminary audit was conducted, and several energy conservation measures were proposed. The energy conservation measures, with reference to the MS1525:2007 standard, were modelled to identify the potential energy reduction and cost savings. It was found that the school's usage of electricity exceeded its need, incurring an excess expenditure of RM 2947.42. From the lighting system alone, it was found that there is a potential energy reduction of 5489.06 kWh, which gives a cost saving of RM 2282.52 via the improvement of lighting system design and its operating hours. Overall, it was found that there is a potential energy reduction and cost saving of 20.7% when the energy conservation measures are earnestly implemented. The previous energy intensity of the school was found to be 50.6 kWh/m(2)/year, but can theoretically be reduced to 40.19 kWh/mm(2)/year.

Matched MeSH terms: Conservation of Energy Resources/economics*; Schools/economics*
Estimating farmers' willingness to pay for climate change adaptation: the case of the Malaysian agricultural sector

Masud MM, Junsheng H, Akhtar R, Al-Amin AQ, Kari FB

Environ Monit Assess, 2015 Feb;187(2):38.
PMID: 25632900 DOI: 10.1007/s10661-014-4254-z

This paper estimates Malaysian farmers' willingness to pay (WTP) for a planned adaptation programme for addressing climate issues in the Malaysian agricultural sector. We used the contingent valuation method (CVM) for a monetary valuation of farmers' preferences for a planned adaptation programme by ascertaining the value attached to address climatic issues in the Malaysian agricultural sector. Structured questionnaires were distributed among the sampled farmers. The study found that 74 % of respondents were willing to pay for a planned adaptation programme and that several socioeconomic and motivation factors have greater influence on their WTP. This paper clearly specifies the steps needed for all institutional bodies to better address issues in climate change. The outcomes of this paper will support policy makers to better design an efficient adaptation framework for adapting to the adverse impacts of climate change.

Matched MeSH terms: Agriculture/economics; Environmental Policy/economics*
Fulltext Cost-benefit analysis and emission reduction of energy efficient lighting at the Universiti Tenaga Nasional

Ganandran GS, Mahlia TM, Ong HC, Rismanchi B, Chong WT

ScientificWorldJournal, 2014;2014:745894.
PMID: 25133258 DOI: 10.1155/2014/745894

This paper reports the result of an investigation on the potential energy saving of the lighting systems at selected buildings of the Universiti Tenaga Nasional. The scope of this project includes evaluation of the lighting system in the Library, Admin Building, College of Engineering, College of Information Technology, Apartments, and COE Food court of the university. The main objectives of this project are to design the proper retrofit scenario and to calculate the potential electricity saving, the payback period, and the potential environmental benefits. In this survey the policy for retrofitting the old lighting system with the new energy saving LEDs starts with 10% for the first year and continues constantly for 10 years until all the lighting systems have been replaced. The result of the life cycle analysis reveals that after four years, the selected buildings will bring profit for the investment.

Matched MeSH terms: Conservation of Energy Resources/economics*; Lighting/economics*
Fulltext Globalization and economic growth: empirical evidence on the role of complementarities

Samimi P, Jenatabadi HS

PLoS One, 2014;9(4):e87824.
PMID: 24721896 DOI: 10.1371/journal.pone.0087824

This study was carried out to investigate the effect of economic globalization on economic growth in OIC countries. Furthermore, the study examined the effect of complementary policies on the growth effect of globalization. It also investigated whether the growth effect of globalization depends on the income level of countries. Utilizing the generalized method of moments (GMM) estimator within the framework of a dynamic panel data approach, we provide evidence which suggests that economic globalization has statistically significant impact on economic growth in OIC countries. The results indicate that this positive effect is increased in the countries with better-educated workers and well-developed financial systems. Our finding shows that the effect of economic globalization also depends on the country's level of income. High and middle-income countries benefit from globalization whereas low-income countries do not gain from it. In fact, the countries should receive the appropriate income level to be benefited from globalization. Economic globalization not only directly promotes growth but also indirectly does so via complementary reforms.

Matched MeSH terms: Developing Countries/economics; Poverty/economics
Effective hospital waste classification to overcome occupational health issues and reduce waste disposal cost

Bai VR, Vanitha G, Zainal Ariff AR

Infect Control Hosp Epidemiol, 2013 Nov;34(11):1234-5.
PMID: 24113615 DOI: 10.1086/673461
Matched MeSH terms: Medical Waste Disposal/economics*; Recycling/economics
Determination of chest x-ray cost using activity based costing approach at Penang General Hospital, Malaysia

Atif M, Sulaiman SA, Shafie AA, Saleem F, Ahmad N

Pan Afr Med J, 2012;12:40.
PMID: 22891098

Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure.

Matched MeSH terms: Health Resources/economics; Radiography, Thoracic/economics*
Fulltext Challenges in clinical research in Malaysia

Zabidi-Hussin ZA

Med J Malaysia, 2007 Oct;62(4):275-7.
PMID: 18551927 MyJurnal
Matched MeSH terms: Practice Patterns, Physicians'/economics; Research Support as Topic/economics
Catastrophic payments for health care in Asia

van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al.

Health Econ, 2007 Nov;16(11):1159-84.
PMID: 17311356

Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments.

Matched MeSH terms: Catastrophic Illness/economics*; Financing, Personal/economics*
A holistic framework for design of cost-effective minimum water utilization network

Wan Alwi SR, Manan ZA, Samingin MH, Misran N

J Environ Manage, 2008 Jul;88(2):219-52.
PMID: 17449168

Water pinch analysis (WPA) is a well-established tool for the design of a maximum water recovery (MWR) network. MWR, which is primarily concerned with water recovery and regeneration, only partly addresses water minimization problem. Strictly speaking, WPA can only lead to maximum water recovery targets as opposed to the minimum water targets as widely claimed by researchers over the years. The minimum water targets can be achieved when all water minimization options including elimination, reduction, reuse/recycling, outsourcing and regeneration have been holistically applied. Even though WPA has been well established for synthesis of MWR network, research towards holistic water minimization has lagged behind. This paper describes a new holistic framework for designing a cost-effective minimum water network (CEMWN) for industry and urban systems. The framework consists of five key steps, i.e. (1) Specify the limiting water data, (2) Determine MWR targets, (3) Screen process changes using water management hierarchy (WMH), (4) Apply Systematic Hierarchical Approach for Resilient Process Screening (SHARPS) strategy, and (5) Design water network. Three key contributions have emerged from this work. First is a hierarchical approach for systematic screening of process changes guided by the WMH. Second is a set of four new heuristics for implementing process changes that considers the interactions among process changes options as well as among equipment and the implications of applying each process change on utility targets. Third is the SHARPS cost-screening technique to customize process changes and ultimately generate a minimum water utilization network that is cost-effective and affordable. The CEMWN holistic framework has been successfully implemented on semiconductor and mosque case studies and yielded results within the designer payback period criterion.

Matched MeSH terms: Conservation of Natural Resources/economics*; Water Supply/economics*
Implementing cost-effective 3-dimensional ultrasound using visual probe localization

Ali A, Logeswaran R

J Digit Imaging, 2007 Dec;20(4):352-66.
PMID: 17372781

This article proposes a set-up for a 3-dimensional ultrasound system using visual probe localization on the conventional 2-dimensional ultrasound machines readily available in most hospitals. A calibrated digital camera is used for probe-tracking (localization) purposes, whereas ultrasound probe calibration is implemented using a purpose-built phantom. The calibration steps and results are detailed here. The overall system is proven effective in clinical trials through scanning of human organs. Results obtained show successful, accurate 3-dimensional representations using this simple cost-effective set-up.

Matched MeSH terms: Ultrasonography/economics*; Imaging, Three-Dimensional/economics*
Factors and values of willingness to pay for improved construction waste management--a perspective of Malaysian contractors

Begum RA, Siwar C, Pereira JJ, Jaafar AH

Waste Manag, 2007;27(12):1902-9.
PMID: 17110094

Malaysia is facing an increase in the generation of waste and of accompanying problems with the disposal of this waste. In the last two decades, extensive building and infrastructure development projects have led to an increase in the generation of construction waste material. The construction industry has a substantial impact on the environment, and its environmental effects are in direct relation to the quality and quantity of the waste it generates. This paper discusses general characteristics of the construction contractors, the contractors' willingness to pay (WTP) for improved construction waste management, determining factors which affect the amount of their willingness to pay, and suggestions and policy implications in the perspective of construction waste management in Malaysia. The data in this study is based on contractors registered with the construction industry development board (CIDB) of Malaysia. Employing the open ended contingent valuation method, the study assessed the contractors' average maximum WTP for improved construction waste management to be RM69.88 (1US$=3.6 RM) per tonne of waste. The result shows that the average maximum WTP is higher for large contractors than for medium and small contractors. The highest average maximum WTP value is RM88.00 for Group A (large contractors) RM78.25 for Group B (medium-size contractors) and RM55.80 for Group C (small contractors). One of the contributions of this study is to highlight the difference of CIDB registration grade in the WTP for improved construction waste management. It is found that contractors' WTP for improved waste collection and disposal services increases with the increase in contractors' current paid up capital. The identified factors and determinants of the WTP will assist the formulation of appropriate policies in addressing the construction waste problem in Malaysia and indirectly improve the quality of construction in the country.

Matched MeSH terms: Facility Design and Construction/economics*; Waste Management/economics*
Ecology, economics and political will: the vicissitudes of malaria strategies in Asia

Kidson C, Indaratna K

Parassitologia, 1998 Jun;40(1-2):39-46.
PMID: 9653730

The documented history of malaria in parts of Asia goes back more than 2,000 years, during which the disease has been a major player on the socioeconomic stage in many nation states as they waxed and waned in power and prosperity. On a much shorter time scale, the last half century has seen in microcosm a history of large fluctuations in endemicity and impact of malaria across the spectrum of rice fields and rain forests, mountains and plains that reflect the vast ecological diversity inhabited by this majority aggregation of mankind. That period has seen some of the most dramatic changes in social and economic structure, in population size, density and mobility, and in political structure in history: all have played a part in the changing face of malaria in this extensive region of the world. While the majority of global malaria cases currently reside in Africa, greater numbers inhabited Asia earlier this century before malaria programs savored significant success, and now Asia harbors a global threat in the form of the epicenter of multidrug resistant Plasmodium falciparum which is gradually encompassing the tropical world. The latter reflects directly the vicissitudes of economic change over recent decades, particularly the mobility of populations in search of commerce, trade and personal fortunes, or caught in the misfortunes of physical conflicts. The period from the 1950s to the 1990s has witnessed near "eradication" followed by resurgence of malaria in Sri Lanka, control and resurgence in India, the influence of war and postwar instability on drug resistance in Cambodia, increase in severe and cerebral malaria in Myanmar during prolonged political turmoil, the essential disappearance of the disease from all but forested border areas of Thailand where it remains for the moment intractable, the basic elimination of vivax malaria from many provinces of central China. Both positive and negative experiences have lessons to teach in the debate between eradication and control as alternative strategies. China has for years held high the goal of "basic elimination", eradication by another name, in sensible semi-defiance of WHO dictates. The Chinese experience makes it clear that, given community organization, exhaustive attention to case detection, management and focus elimination, plus the political will at all levels of society, it is possible both to eliminate malaria from large areas of an expansive nation and to implement surveillance necessary to maintain something approaching eradication status in those areas. But China has not succeeded in the international border regions of the tropical south where unfettered population movement confounds the program. Thailand, Malaysia and to an extent Vietnam have also reached essential elimination in their rice field plains by vigorous vertical programs but fall short at their forested borders. Economics is central to the history of the rise and fall of nations, and to the history of disease in the people who constitute nations. The current love affair with free market economics as the main driving force for advance of national wealth puts severe limitations on the essential involvement of communities in malaria management. The task of malaria control or elimination needs to be clearly related to the basic macroeconomic process that preoccupies governments, not cloistered away in the health sector Historically malaria has had a severe, measurable, negative impact on the productivity of nations. Economic models need rehoning with political aplomb and integrating with technical and demographic strategies. Recent decades in Chinese malaria history carry some lessons that may be relevant in this context.

Matched MeSH terms: Economics; Malaria/economics
Economic burden of stroke: a systematic review on post-stroke care

Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, et al.

Eur J Health Econ, 2019 Feb;20(1):107-134.
PMID: 29909569 DOI: 10.1007/s10198-018-0984-0

OBJECTIVES: Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps.
METHODS: A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated.
RESULTS: We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors.
CONCLUSION: The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.

Matched MeSH terms: Stroke/economics*; Stroke Rehabilitation/economics*
Low-cost low-tech obstacle pushing/gliding wheelchair accessory

Jalal Abdullah S, Shaikh Mohammed J

Disabil Rehabil Assist Technol, 2019 11;14(8):849-858.
PMID: 30556753 DOI: 10.1080/17483107.2018.1539130

Purpose: Some wheelchair users continue to struggle in maneuvering a wheelchair and navigating through manual doors. Several smart wheelchairs and robotic manipulators were developed to minimize such challenges facing disabled people. Disappointingly, a majority of these high-tech solutions are restricted to laboratories and are not extensively available as commercial products. Previously, a low-tech wheelchair accessory (arc-shaped with many wheels) for pushing doors was modelled and simulated. This work demonstrates the fabrication and testing of the first-generation prototype of the accessory.Materials and methods: The accessory has side portions with a straight arrangement of wheels and a front portion with a straight-arc-straight arrangement of wheels. The accessory was fabricated using conventional manufacturing, off-the-shelf components, and 3D printed ABS fasteners. Stress analysis simulations were done for the fasteners that attach the front accessory to the wheelchair frame. The proof-of-concept of the prototype installed onto a powered wheelchair was tested with a door and an obstacle, each with ∼50 N resistance force.Results: Prototype tests demonstrate the ability of the accessory along with the mechanical robustness of the 3D printed fasteners to push open doors allowing easy navigation through doors and to push/glide against obstacles. The accessory is foldable and detachable.Conclusion: The low-cost of the accessory makes it affordable to many users intending to improve their quality of life. The current study provides an engineering perspective of the accessory, and a clinical perspective is crucial. Other potential applications of the wheelchair accessory include use with scooters, walkers and stretchers.Implications for rehabilitationLow-cost, low-tech accessory is foldable and detachable.Accessory is effective for pushing doors and pushing/gliding against obstacles.Protective nature of the front accessory could prove highly beneficial to some wheelchair users.

Matched MeSH terms: Equipment Design/economics*; Wheelchairs/economics*
Fulltext Follow-up data on patent expiry and atorvastatin price: experiences in Brunei Darussalam, Malaysia, the Philippines and Thailand

Kemp-Casey A, Ceria-Perena J, Guerrero AM, Suchonwanich N, Salleh SM, Roughead EE

WHO South East Asia J Public Health, 2019 09;8(2):115-117.
PMID: 31441448 DOI: 10.4103/2224-3151.264857
Matched MeSH terms: Atorvastatin Calcium/economics*; Costs and Cost Analysis/economics*
Telemedicine Cost-Effectiveness for Diabetes Management: A Systematic Review

Lee JY, Lee SWH

Diabetes Technol Ther, 2018 Jul;20(7):492-500.
PMID: 29812965 DOI: 10.1089/dia.2018.0098

BACKGROUND: Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness.
MATERIALS AND METHODS: A literature search was performed in 10 databases from inception until February 2018. All economic evaluations assessing the economic evaluation of telemedicine in diabetes were eligible for inclusion. We subsequently evaluated the study quality in terms of effectiveness measures, cost measure, economic model, as well as time horizon.
RESULTS: Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers' fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost-effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management.
CONCLUSIONS: Among all telemedicine strategies examined, teleophthalmology was the most cost-effective intervention. Future research is needed to provide evidence on the long-term experience of telemedicine and facilitate resource allocation.

Matched MeSH terms: Diabetes Mellitus/economics*; Telemedicine/economics*

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