Therapeutic drug monitoring service in malaysia: current practice and cost evaluation

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Date
2008
Authors
Ahmed Abdelrahim, Hisham Elhag
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Abstract
Therapeutic drug monitoring {TOM) has been recognized as a useful clinical tool in drug therapy. Although it was started in the 1980s in this country, very few studies had been performed to evaluate the service. Therefore, this study aims to evaluate the practice of the TOM service in Malaysian hospitals and to determine the cost and impact on clinical outcomes of providing this service in hospitalized patients. The study consists of two related parts. The first part determined the current TOM practice among government hospitals in Malaysia using a survey questionnaire. Questionnaires were mailed to 128 hospitals in Malaysia. Data were collected for general characteristics of the hospitals, administrative, clinical, and laboratory activities related to TDM service. Out of 121 hospitals which responded to the survey, 34 hospitals (28.1 %) provided the service using their own TDM laboratories, 44 hospitals (36.4%) provided the service using other hospitals' laboratories and 43 hospitals (35.5%) did not provide the service at all. The second part of this study was conducted to evaluate the cost and clinical outcomes of providing the TDM service in hospitalized patients. This evaluation was carried out in two hospitals using retrospective data collections. Data from all hospitalized adult patients diagnosed with bronchopneumonia and treated with gentamicin between the years 2001 to 2005 were included. Data collected from Hospital Universiti Sains Malaysia (HUSM) were used to determine the cost of providing the TDM service. Data collected from Hospital Kulim was used to compare the cost and outcome between the group which was provided with the TDM service (TOM group) with the group which was not provided with the service (Non-TDM group). All hospitalization costs were calculated in Ringgit Malaysia (RM), which included TDM service, laboratory and clinical investigations, gentamicin doses, ward staff, and hospital stay. Outcome measures included duration of fever, length of hospital stay during gentamicin therapy and nephrotoxicity incidence. Data from HUSM show that the cost of TDM service contributed about 23% toward the total hospitalization costs. Among TOM service costs, the cost of laboratory equipments was the highest (42%) followed by reagents and consumables (39.7%), TDM team (9.6%), and laboratory space (8.6%). Data from Hospital Kulim show that the costs of hospital stay and total hospitalization were significantly higher in the TDM group compared to the NonTOM group. However, there was no significant difference in outcome parameters ··between the two groups. In conclusion, this study has shown that TDM service is offered by the majority of hospitals in the country. Data from HUSM show that providing TDM service to bronchopneumonia patients did not significantly affect the overall hospital cost. Data from Hospital Kulim show that TDM service significantly increased the total cost of hospitalization and had no significant impact on patients' outcome.
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Keywords
Drug monitoring , Cost evaluation
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