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