REGIONAL HEALTH-RELATED QUALITY OF LIFE DISPARITIES IN MALAYSIA: A SUBGROUP COST-EFFECTIVENESS AND EQUITY ANALYSIS OF THALASSAEMIA-RELATED NEUROPATHY SCREENING...
Author(s)
Ai Ch'i Liew, MSc1, Asrul Akmal Shafie, PhD2, LAY KHOON LOO, Consultant Specialist3, Irene Looi, Consultant Specialist4.
1PhD candidate, Universiti Sains Malaysia, BUKIT MERTAJAM, Malaysia, 2Universiti Sains Malaysia, Minden, Penang, Malaysia, 3Penang Sunway Medical Centre, Seberang Jaya, Penang, Malaysia, 4Hospital Seberang Jaya, Seberang Jaya, Penang, Malaysia.
1PhD candidate, Universiti Sains Malaysia, BUKIT MERTAJAM, Malaysia, 2Universiti Sains Malaysia, Minden, Penang, Malaysia, 3Penang Sunway Medical Centre, Seberang Jaya, Penang, Malaysia, 4Hospital Seberang Jaya, Seberang Jaya, Penang, Malaysia.
OBJECTIVES: This study evaluates the national cost-effectiveness of a Thalassaemia-related peripheral neuropathy (ThalPN) screening programme through a regional subgroup analysis comparing Sabah and Penang to ensure health equity in national resource allocation.
METHODS: A hybrid Decision Tree-Markov model was developed across three age cohorts (20-29, 30-39, and ≥40), with national patient populations derived from the Malaysia Thalassaemia Registry (MTR) 2023. To address regional data gaps, utility multipliers associated with ThalPN were extrapolated from the Penang screening cohort and mapped onto Sabah-specific baseline HRQOL. This region-aware approach accounted for the starting-point penalty of lower baseline health in East Malaysia when calculating Incremental Cost-Effectiveness Ratios (ICERs) per quality-adjusted life year (QALY) gained.
RESULTS: A significant interregional HRQOL disparity was identified: Sabah patients reported lower baseline utility than Penang (0.849 ± 0.186 vs. 0.964 ± 0.074, p < 0.001), with utility loss manifesting within the subclinical phase (0.928 ± 0.097) prior to objective clinical signs (0.925 ± 0.126, p < 0.015). Screening was cost-effective nationally and regionally across all cohorts (< willing-to-pay threshold: MYR 50,000/QALY; USD 11,161), with the ≥40 cohort yielding the lowest ICERs of MYR 9,925 (national), MYR 9,081 (Penang), and MYR 10,312 (Sabah). Probabilistic sensitivity analysis certainty for the 18-29,30-39, and ≥40 cohort group was 57%, 51%, and 71% (national);61%, 52%, and 71% (Penang); and 59%, 52%, and 69% (Sabah).
CONCLUSIONS: National ThalPN screening is a high-value economic strategy. While the 'starting-point penalty' of lower baseline health utility results in a marginally higher ICER for the Sabah subgroup, the superior PSA certainty for these patients underscores the intervention’s resilience in disadvantaged regions. By integrating MTR data with regional utility multipliers, this study provides a framework for equity-weighted resource allocation, positioning screening as a vital instrument for narrowing the East-West health divide and ensuring health equity.
METHODS: A hybrid Decision Tree-Markov model was developed across three age cohorts (20-29, 30-39, and ≥40), with national patient populations derived from the Malaysia Thalassaemia Registry (MTR) 2023. To address regional data gaps, utility multipliers associated with ThalPN were extrapolated from the Penang screening cohort and mapped onto Sabah-specific baseline HRQOL. This region-aware approach accounted for the starting-point penalty of lower baseline health in East Malaysia when calculating Incremental Cost-Effectiveness Ratios (ICERs) per quality-adjusted life year (QALY) gained.
RESULTS: A significant interregional HRQOL disparity was identified: Sabah patients reported lower baseline utility than Penang (0.849 ± 0.186 vs. 0.964 ± 0.074, p < 0.001), with utility loss manifesting within the subclinical phase (0.928 ± 0.097) prior to objective clinical signs (0.925 ± 0.126, p < 0.015). Screening was cost-effective nationally and regionally across all cohorts (< willing-to-pay threshold: MYR 50,000/QALY; USD 11,161), with the ≥40 cohort yielding the lowest ICERs of MYR 9,925 (national), MYR 9,081 (Penang), and MYR 10,312 (Sabah). Probabilistic sensitivity analysis certainty for the 18-29,30-39, and ≥40 cohort group was 57%, 51%, and 71% (national);61%, 52%, and 71% (Penang); and 59%, 52%, and 69% (Sabah).
CONCLUSIONS: National ThalPN screening is a high-value economic strategy. While the 'starting-point penalty' of lower baseline health utility results in a marginally higher ICER for the Sabah subgroup, the superior PSA certainty for these patients underscores the intervention’s resilience in disadvantaged regions. By integrating MTR data with regional utility multipliers, this study provides a framework for equity-weighted resource allocation, positioning screening as a vital instrument for narrowing the East-West health divide and ensuring health equity.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE65
Topic
Economic Evaluation
Disease
SDC: Rare & Orphan Diseases