The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals with LTBI.
A systematic literature search was performed to assess studies reporting patient-reported outcomes in LTBI management including health-related quality of life (HRQoL), health utilities, disease burden and experience of individuals with LTBI. A pooled analysis was performed to estimate the effect of LTBI on HRQoL.A total of 4464 studies were screened, of which 13 eligible articles describing nine unique studies were included for review. The HRQoL of individuals with LTBI and without tuberculosis (TB) infection were comparable, and better than patients with active TB disease. However, individuals with LTBI reported poorer mental health compared with individuals without TB infection (mean difference −4.16, 95% CI −7.45– −0.87; p=0.01). Qualitative studies suggest the presence of fear, anxiety and stigma in individuals with LTBI.This review highlights potential psychosocial challenges in individuals with LTBI despite the absence of clinical symptoms. While their quality of life was marginally affected, this could be evidence to support LTBI management in preventing TB re-activation and the severe consequences of active TB disease that affect all domains of HRQoL.
In the battle against tuberculosis (TB), plasticity of the
Mycobacterium tuberculosis
genome is believed to contribute to the pathogen’s virulence and drug resistance. Here, we report 10 draft genome sequences of clinical
M. tuberculosis
isolated in Malaysia as the basis for understanding the genome plasticity of the
M. tuberculosis
isolates.
Objective: Malaysian health ministry is currently evaluating the licensing of dengue vaccine Dengvaxia using a set of criteria including safety, efficacy and cost-effectiveness. The purpose of this research is to formulate a model framework to assist transparent decision-making.
Methods:To quantify the cost-effective price of the vaccine, pharmacoeconomic evaluation models are commonly used. We review in this paper dengue economic burdens and pharmacoeconomic models, with particular reference to cost-effectiveness.
Results:A major weakness in current pharmacoeconomic models is the omission of the cost of vaccine production, which is two orders of magnitude lower than the market price. This paper proposes an inclusive model that yields a highly cost-effective threshold price of dengue vaccine at USD 5 per dose for Malaysia.
Conclusion:At USD 5 per dose, Dengue vaccine will be fair, Affordable and sustainable.
Good health and wellbeing (SDG 3) is a fundamental human right for all. The main determinant for good health and wellbeing critically depends on equitable access to good health care (SDG 10) consisting of a combination of strong primary health care (PHC) oriented around community and efficacious public health services (PHS) based upon hospital and professional services. The world including Malaysia has achieved dramatic improvement in the delivery of health services due to advances in socio-economic development. Yet several diseases remain a daunting challenge to sustainable development goals (SDGs). A disease of the poor and the impoverished, tuberculosis (TB) is the leading infectious disease that kills more than a million people each year worldwide. Tuberculosis infection and disease progression are primarily driven by socio-economic and cultural factors such as poor living conditions, poor nutrition and misplaced cultural beliefs. Yet, management of TB has been mainly biomedical, without addressing the socio-economic and cultural drivers, since the 1940s. Given the status of ineffective management, TB will continue to pose a real threat to SDGs, especially among the poor and susceptible populations in many parts of the world, including Malaysia. This paper addresses global issues regarding TB management in the context of SDGs and suggests reorientation of health care towards PHC to accelerate achievement of SDG 3 and other broader SDGs. A detailed case study on Malaysian health care for TB is presented to review the needs for change in TB management strategy. The paper proposes policy and program modification necessary to achieve by 2035 the WHO End TB Strategy goals and UN SDGs. Index Terms-Tuberculosis in Malaysia, primary health care, UN-SDG, WHO End TB strategy.
A365for the FDA, EMA, Health Canada and Australia the Australian Therapeutic Goods Administration. The studies used to make regulatory decisions were then compared to the studies used in the reimbursement decisions of France, Scotland, Canada and Australia. Results: In all 15 cases reviewed the FDA, EMA and Health Canada used at least one of the same studies to come to their decision and in 13 of the cases Australia also used that same study. In 14 cases the FDA approved the drug before the other regulatory authorities; the longest time before another regulatory agency approved a drug was 15 months for rilpivirine. In six cases the FDA commissioned studies that other regulatory bodies and reimbursement agencies used later. All of the studies were interventional studies. Reimbursement agencies always used studies that were previously cited in regulatory documents. These agencies would also use studies intended for the regulatory approval of another drug as a source for information in a review. ConClusions: Reimbursement agencies and other regulatory agencies are influenced by the FDA in the studies they consider, as illustrated by at least six cases in which other agencies used studies commissioned by the FDA after approval. This influence is easier to see in the last five years, but may be older than that due to improvements in published reports.
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