Malaysian STATISTICS ON MEDICINE 2005 Edited by: Sameerah S.A.R Sarojini S. With contributions from Goh A, Faridah A, Rosminah MD, Radzi H, Azuana R, Letchuman R, Muruga V, Zanariah H, Oiyammal C, Sim KH, Fong AYY, Tamil Selvan M, Basariah N, Hooi LS, Zaki Morad, Fadilah O, Lim V.K.E., Tan KK, Biswal BM, Lim YS, Lim GCC, Mohammad Anwar H.A, Ahmad Sabri O, Mary SC, Marzida M, Benjamin Chan TM, Suarn Singh, Zoriah A, Noor Ratna N , Abdul Razak M, Norzila Z, Shamsinah H A publication of the Pharmaceutical Services Division and the Clinical Research Centre Ministry of Health Malaysia Malaysian Statistics On Medicine 22005005 Edited by: Sameerah S.A.R Sarojini S. With contributions from Goh A, Faridah A, Rosminah MD, Radzi H, Azuana R, Letchuman R, Muruga V, Zanariah H, Oiyammal C, Sim KH, Fong AYY, Tamil Selvan M, Basariah N, Hooi LS, Zaki Morad, Fadilah O, Lim V.K.E., Tan KK, Biswal BM, Lim YS, Lim GCC, Mohammad Anwar H.A, Ahmad Sabri O, Mary SC, Marzida M, Benjamin Chan TM, Suarn Singh, Zoriah A, Noor Ratna N , Abdul Razak M, Norzila Z, Shamsinah H A publication of the Pharmaceutical Services Division and the Clinical Research Centre Ministry of Health Malaysia Malaysian Statistics On Medicine 2005 April 2007 © Ministry of Health Malaysia Published by: The National Medicines Use Survey Pharmaceutical Services Division Lot 36, Jalan Universiti 46350 Petaling Jaya Selangor, Malaysia Tel. : (603) 4043 9300 Fax : (603) 4043 9400 e-mail : [email protected] Web site : http://www.crc.gov.my/nmus This report is copyrighted. However it may be freely reproduced without the permission of the National Medicines Use Survey. Acknowledgement would be appreciated. Suggested citation is Sameerah S.A.R, Sarojini S. (Eds). Malaysian Statistics on Medicine 2005. Kuala Lumpur 2007 This report is also published electronically on the website of The National Medicines Use Survey at: http://www.crc.gov.my/nmus Funding: The National Medicines Use Survey is funded by a grant from the Ministry of Health Malaysia (MRG-2004-14) PREFACE Ensuring access to quality and affordable medicines is one important objective of Malaysia’s National Medicines Policy. The National Medicines Use Survey (NMUS) was conducted with the intent to continuously and systematically collect data on medicines in the hope to further improve its use as well as providing a tool for better decision making in the allocation of healthcare resources for the Malaysian population. NMUS is into its third year and we are glad to announce the successful publication of its second report, the Malaysian Statistics on Medicine (MSOM) 2005. It is worthwhile to note that the fi rst report MSOM2004 presented results largely from pilot surveys and using test methods basically to demonstrate that such a project was feasible in a healthcare system such as Malaysia that has many players. In 2005, we have not only scaled up the survey with larger sample size and wider distribution, but also refi ned data processing and statistical methods. The statistical estimates in MSOM2005 are derived using highly elaborate data processing and complex statistical methods as explained in the Methods section of this publication. Hence results in MSOM2005, in our opinion are more reliable, more representative and more robust. Three additional chapters namely Use of Drugs for Acid Related Disorders, Use of Systemic Corticosteroids and Immunosuppressive Agents and Use of Opioid Analgesics were included in MSOM2005. We are optimistic that more chapters will be reported in future publications of MSOM. We hope that this MSOM2005 report will be useful to relevant healthcare professionals serving as a source of reference and baseline for embark in future research or clinical audits towards improving rational prescribing. We would like to thank all staff who had worked very hard in ensuring the success of the survey, all agencies and institutions that had helped in providing data, all expert panel members for their enthusiasm and contributions in completing the chapter reports and each and everyone who have in one way or another contributed to the success of NMUS and this publication. Pharmaceutical Services Division Clinical Research Centre Ministry of Health Malaysia i ACKNOWLEDGEMENTS The National Medicines Use Survey would like to thank the following: • All the medical doctors, pharmacists and pharmacy assistants who participated in NMUS surveys • The Association of Private Hospitals Malaysia, Malaysian Organisation of Pharmaceutical Industries and Pharmaceutical Association of Malaysia for encouraging their members to contribute data to the NMUS • Participating private hospitals for allowing access to their medicines procurement data • Pharmaniaga Sdn Bhd for assistance in downloading MOH procurement data • The National Pharmaceutical Control Bureau, Family Health Development Division, Procurement Division, all of the MOH, for their valuable assistance • The Malaysian Royal Custom Service for permission to download pharmaceutical import data • The Malaysian Medical Council, Malaysian Medical Association, The Academy of Family Physicians, Primary Care Doctors Association Malaysia, Malaysian Dental Association, Malaysian Private Dental Practitioner’s Association, Malaysian Pharmaceutical Society, University Malaya Medical Centre, Hospital University Kebangsaan and Hospital Universiti Sains Malaysia and Lumut Armed Forces Hospital for supporting this project AND • All who have in one way or another supported and/or contributed to the success of the NMUS and this report Mr. Lai Lim Swee Chairman Dr Lim Teck Onn Co-Chairman National Medicines Use Survey Ministry of Health Malaysia iii ABOUT THE NATIONAL MEDICINES USE SURVEY The National Medicines Survey (NMUS) is a service initiated and supported by the Ministry of Health (MOH) to collect information on the supply, procurement, prescription, dispensing and use of drugs in Malaysia. The NMUS is designed to support the implementation of our proposed National Medicines Policy (NMP). The objectives of NMP are to ensure only safe, effi cacious and good quality medicines are available for use in Malaysia, as well as to promote equitable access to, rational and cost-effective use of these medicines, ultimately leading to improved health for all Malaysians. In supporting this, the NMUS provides the functional capacity for the collection, analysis, reporting and dissemination of data on drug utilisation in Malaysia Sponsors and Governance of the NMUS The NMUS is jointly sponsored by Pharmaceutical Services Division and the Clinical Research Centre, Ministry of Health Malaysia. A Governance Board is established to oversee the operations of the NMUS. Governance via a Board is necessary to ensure that the NMUS meets the needs and expectations of all interested parties, and thereby to assure the continuing relevance and justifi cation of the NMUS. All major groups involved in pharmaceutical issues in Malaysia such as the MOH, Universities, professional bodies, private healthcare providers and the pharmaceutical industry are represented on this board. The board also works as a consultative forum and provide advice on issues pertaining to the NMUS and other aspects of the quality use of medicines. Purpose of the NMUS The availability of high quality, reliable and timely information on medicines use is crucial for any discussion on improving the use of medicines in Malaysia. The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilisation at various level of our health care system, whether national, regional, local or institutional. Routinely compiled statistics on medicines utilisation have many uses, such as to: 1. Estimate the number of medicine users overall, by age, sex and geography and over time 2. Estimate on the basis of known disease epidemiology to what extent medicines are under or over-used. 3. Describe pattern of medicines use through assessing which alternative drugs are being used for particular conditions and to what extent. 4. Relate the number of adverse drug reactions reported to our pharmacovigilance system to the number of people exposed to the drug in order to assess the magnitude of the problem, or to estimate the degree of under- reporting of adverse events 5. Provide a crude estimate of disease prevalence based on its prescription rate. 6. Estimate expenditure on pharmaceuticals, which constitutes a signifi cant proportion of our healthcare expenditure. 7. Monitor and evaluate the effects of interventions to improve the use of medicines. These interventions may be educational effort, promotional campaign, formulary restriction, medicines reimbursement scheme or regulatory measures. iv NMUS GOVERNANCE BOARD CHAIRMAN: Mr Lai Lim Swee CO- CHAIRMAN: Dr Lim Teck Onn MEMBERS Medical Services, MOH Dato’ Dr. Zaki Morad b. Mohd. Zaher Pharmaceutical Services, MOH Mr Lai Lim Swee National Pharmaceutical Control Bureau Ms Eishah bt Abd Rahman Clinical Research Centre Dr Lim Teck Onn Family Health and Development Division Ms Sahidah Said Procurement Division Mr Abdullah Abdul Rahman Malaysian Medical Council Prof Dr Raymond Ali Malaysian Pharmaceutical Society Ms Usha Rajasingam The Academy of Family Physicians of Malaysia Dr Mohd Husni B Jamal Primary Care Doctors Organisation Malaysia Dr Molly Cheah Malaysian Medical Association Dr M. Ponnusamy A/L Muthaya Malaysian Dental Association Dr Shubon Sinha Roy Malaysian Private Dental Practitioner’s Association Dr Haja Badrudeen Association of Private Hospitals Malaysia Dr T. Mahadevan Malaysian