Introduction: In respond to the World Health Assembly global NCD target of 30% reduction in the prevalence of adult tobacco use by 2025, Malaysian government called for lowering its smoking prevalence to 15% by 2025. In addition, moving towards the endgame target of less than 5% smoking prevalence in 2045. Methods: Malaysia Abridged SimSmoke model, a simulation model uses specific policy parameters, the most recent smoking prevalence, and population size for Malaysia is developed to estimates and access the impact of MPOWER policies in achieving the targets. Results: The 15% prevalence rate in 2025 can be achieved if the Malaysian government increase tobacco excise tax to 72% of the retail price, implement and enforce comprehensive smoke-free air policies, ban all forms of advertising/promotions and run intensive mass media campaigns. Such approach would reduce the number of smokers by about 2.6 million, averting almost 1.3 million premature deaths in the long term. The tobacco endgame target of less than 5% smoking prevalence by 2045 is achievable if the excise tax is further increased to 86.5% of the retail price while all other tobacco control policies are kept at the enhanced level. Conclusions: Both the targeted smoking prevalence are a realistic proposition if the proposed measures are fully implemented. It requires a whole government approach with the MOH as a leading agency driving the process. It is important to monitor both the compliance with the new measures and smoking prevalence to make sure that Malaysia is on track in achieving its targets.
Tobacco

The overweight and obese population may affect the population health which can lead to economic stability and development of the countries to be compromised. Thus, this study estimates the burden of disease attributable to overweight and obesity in Malaysia for adults aged 20-59 years old. Population attribution fraction (PAF) and disability-adjusted life year (DALY) have been used to quantify years of life lost from premature death and number of years lost due to disability resulting from obesity and overweight. The burden of disease attributable to overweight was 1582 and 1146 PYs per 1000 persons for male and female, respectively. Meanwhile, the burden of disease attributable to obesity was 2951 PYs per 1000 persons with women in the lead at 1657 PYs per 1000 persons. The burden of overweight and obesity among Malaysian adults is substantial. The outcome of this study is crucial as it gives a comprehensive information on the burden of overweight and obesity in Malaysia. The information from this study also enables the authorities to develop activities and programs to combat obesity and tomaintain healthy lifestyle among Malaysian.
obesity ; relative risk ; disability-adjusted life year (DALY) ; population attributable fraction (PAF)

he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.
dementia ; Provider Cost ; CCM ; Step-down costing

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.

The Malaysian government implemented an excise tax of MYR 0.40 per L on sugar-sweetened beverages in July 2019. Excise tax is imposed on sweetened drinks containing more than 5 g of sugar per 100 ml, flavoured Ultra High Temperature milk-based drinks, and fruit juices with more than 7 g and 12 g of sugar per 100 ml, respectively. We analysed the impact of excise tax on the consumption of SSBs by developing a demand model for SSBs to estimate the elasticity of demand using a two-way fixed-effect model. The tax increased the price of 1 L SSBs by 8.33%, and we estimated it to decrease the consumption of SSBs by 9.25%. The estimated own-price elasticity of demand for SSBs was −1.11 (95% CI: −1.97 to −0.25). Price of SSB is a determinant for SSB demand, but income or the price of milk are not. The estimated excise revenue calculated was MYR 357.61 million. However, industry responses via product reformulation and pass-through rates could reduce revenue and enhance or reduce health impacts.