Systematic Review of Healthcare Economic Evaluation on Malaysia: An Overview on Cancer-Related Economic Studies

Abstract

Background: In Malaysia, the inclusion of health economic evidence in health technology assessment improves the efficiency of the healthcare spending as it is used to promote the use of value for money in policy making. However, despite the potential of its use in ensuring the value of health technologies, its adoption is constrained by several factors. Limited number of researchers to produce economic evaluation, challenges in local data retrieval and lack of awareness and understanding of value-based concept among decision makers are among the most common limiting factors in Malaysia. Aim: To conduct a systematic review of economic evaluation studies in Malaysia and to explore and describe cancer-related economic evaluation studies in Malaysia. Methods: A comprehensive scientific electronic databases was conducted and the last search was done on 20 March 2017. Additional articles were identified from reviewing the references of retrieved articles and personal communication with the local higher institution representatives. Only full text of full and partial economic evaluations conducted in Malaysia were considered to be eligible for the review. Data extraction was performed by first author and verified by second author. Critical Appraisal Skills Program (CASP) checklist and Quality of Health Economic Studies (QHES) instrument was used as the quality appraisal tools in view of variability of the quality of conduct and reporting of economic evaluation. Results: Based on the evidence search, 1014 titles were retrieved from the scientific electronic databases. After articles selection, 39 full text articles were finally selected to be included in this review. Of these, eight studies (20.5%) are cancer-related economic evaluation. Five cost-utility analyses, two cost-effectiveness analyses and one cost-minimization analysis were conducted in Malaysia up to March 20, 2017. The studies are on HPV vaccination in preventing cervical cancer, early screening of cervical cancer, treatment using monoclonal antibody for colorectal cancer, targeted therapy in HER2+ breast cancer and antiemetic in chemotherapy induced nausea and vomiting. Among the interventions that were highly cost effective were screening strategies and HPV vaccination in prevention of cervical cancer as well as additional of granisetron as antiemetic regimens for chemotherapy-induced emesis. Conclusion: This review provides useful information on the overall scenario of economic evaluation in Malaysia, particularly on cancer which incur high financial impact to the healthcare system. Various type of analysis has been conducted in recent years which provide different findings and information such as the incremental value, local costs data, patient preference and economic burden. These information may be adopted by other researchers in conducting future economic evaluation by facilitating and accelerating the process of producing the evaluation.