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Title:	Economic burden of type ii diabetes mellitus outpatient care and comparing cost-effectiveness of diabetes care in primary health clinics and tertiary diabetic clinics
Authors:	Wan Norlida Ibrahim (P44977)
Supervisor:	Syed Mohamad AlJunid Syed AlJunid, Dato Prof.
Keywords:	Type II Diabetes Outpatient cost INDAMET Dissertations, Academic -- Malaysia Universiti Kebangsaan Malaysia -- Dissertations
Issue Date:	19-Sep-2014
Description:	Type II diabetes mellitus continuous management involves all levels of care and with active participations of individuals and community. Hence the economic burden of diabetes mellitus is huge and affects both the patients and the providers. Evaluation of delivery system is crucial to contain cost and improve efficiency of care processes. The objectives of the study was to estimate the economic burden of delivering outpatient care, assess the quality of life of type II diabetes patients in Malaysia, and determine the cost-effectiveness of delivering outpatient services at different levels of care. The study was divided into two phases. In phase One, cost of illness study was employed to determine the economic burden of outpatient care for type II diabetes in Malaysia. Quality of life of type II diabetes was also assessed using Audit Dependence Diabetes Quality of life (ADDQOL) questionnaire and SF 36. Phase Two involved Markov modeling to determine the cost-effectiveness of treating type II diabetes outpatient care at primary health clinics and tertiary diabetic clinics. Data was collected from five primary health clinics and five tertiary diabetic clinics in five states in Malaysia. The direct cost was amounted to RM764,418,465.00, the indirect cost was RM48,048,261.87 and the total cost was RM836,305,258.27. Diabetes mellitus reduced quality of life of patients, and the greatest impact was on freedom for choice of food, enjoyment of food and freedom for drinking. Sex life and individual's career were least affected by diabetes mellitus. Markov cohort analysis showed primary health clinics was dominant due to lower cost and better outcome than tertiary diabetic clinics with ICER of -27,165.50/QALYs for provider and -20,299.36/QALYs for patients. In conclusion, the primary health clinic was highly cost-effective in delivering outpatient diabetes care services compared to tertiary diabetic clinic.,Rawatan pesakit kencing manis jenis II melibatkan semua peringkat pemjagaan dengan penglibatan individu serta masyarakat. Dengan itu beban ekonomi yang ditanggung adalah besar dan memberi kesan kepada pesakit dan pembekal kesihatan. Penilaian sistem perkhidmatan kesihatan yang diberikan adalah penting untuk mengekang kos dan meningkatkan efisiensi proses penjagaan kesihatan. Kajian ini bertujuan untuk menganggarkan beban ekonomi keatas penjagaan pesakit luar kencing manis jenis II, menillai kualiti hidup pesakit kencing manis jenis II di Malaysia, dan mengkaji keberkesanan kos penjagaan pesakit luar kencing manis di peringkat penjagaan kesihatan yang berlainan. Kajian ini dibahagikan kepada dua fasa. Dalam fasa pertama, kajian kos penyakit dilakukan bagi menganggar bebanan kos pesakit luar kencing manis di klinik kesihatan dan klinik diabetes tertiari di Malaysia. Kualiti hidup pesakit kencing manis juga di nilai menggunakan soal selidik Audit Dependence Quality of Life (ADDQOL) dan SF 36. Fasa kedua melibatkan analisa model Markov untuk menilai keberkesanan kos bagi penjagaan pesakit luar kencing manis jenis II di klinik kesihatan dan klinik diabetes tertiari. Pengumpulan data melibatkan lima klinik kesihatan dan lima klinik diabetes tertiari di lima buah negeri di Malaysia. Keputusan kajian menunjukkan sebanyak RM764,418,465.00 kos langsung dan RM48,048,261.87 kos tidak langsung diperlukan untuk penjagaan pesakit luar setahun dengan jumlah keseluruhan sebanyak RM836,305,258.27. Penyakit kencing manis merendahkan kualiti hidup pesakit, kesan paling teruk dirasai adalah pada keseronokan memilih makanan, diikuti keseronokan menikmati makanan, dan kebebasan menikmati minuman. Kehidupan seksual dan kerjaya individu adalah kesan yang paling kecil dirasai disebabkan penyakit kencing manis. Analisa kohort Markov menunjukkan klinik kesihatan adalah dominan kerana kos nya yang lebih rendah dan keberkesanan yang lebih baik dari klinik diabetes tertiari dengan ICER sebanyak -27,165.50/QALYs untuk pembekal dan -20,299.36/QALYs untuk pesakit. Kesimpulannya, penjagaan peringkat klinik kesihatan adalah lebih kos-efektif dalam memberikan penjagaan pesakit luar kencing manis jenis II berbanding dengan klinik diabetes tertiari.,Ph.D.
Pages:	206
Call Number:	WA20.5.W244e 2014 9HUKM tesis
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Medicine / Fakulti Perubatan

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