MALAYSIAN - pharmacy · Pharmaceutical Services Programme Ministry of Health Malaysia . iv ......

MALAYSIAN STATISTICS ON MEDICINES

2015-2016

Edited by

Mary Chok Chiew Fong, Azzy Iyzati Ahmad Shanizza

A publication of the

Pharmaceutical Services Programme

Ministry of Health Malaysia

ii

February 2020


Published by Pharmaceutical Services Programme


Lot 36, Jalan Universiti,

46200 Petaling Jaya,

Selangor, Malaysia.

Telephone (603) 7841 3200

Fax (603) 7968 2222

Website www.pharmacy.gov.my

This report is copyrighted. Reproduction and dissemination of this report in part or in whole for research,

educational or other non-commercial purposes are authorised without any prior written permission from

the copyright holders provided the source is fully acknowledged.

Suggested citation: Malaysian Statistics on Medicines 2015-2016; Pharmaceutical Services Programme,

Ministry of Health Malaysia: Kuala Lumpur, 2020.

Funding : The study on medicines utilisation and publication of Malaysian Statistics on Medicines were

funded by Pharmaceutical Services Programme, Ministry of Health Malaysia.

iii

PREFACE

Enhance the accessibility of affordable and equitable medicines, and promote rational use of safe and

effective medicines in Malaysia are integral of the implementation of Malaysian National Medicines Policy

(NMP). Govern by the policy, it is therefore essential to deliver pharmaceutical services of high quality

and efficiency to the nation as a single entity by all stakeholders, irrespective of either in public or private

sector to improve health status and quality of life of Malaysian population. Thus, Pharmaceutical Services

Programme has been the pioneer in conducting several initiatives to achieve the ultimate goals of NMP.

National medicines utilisation study and publication of Malaysian Statistics on Medicines (MSOM) are

example of these initiatives to support NMP. Most current, up-to-date findings in MSOM may serve as

valuable resources for better decision making in areas of higher priority or unmet needs and financial

concerns in healthcare system.

Since the release of MSOM 2011-2014 in 2018, considerable effort has been taken in improving the

methodology of medicines utilisation study in the subsequent years of study. This including the formation

of a technical advisory committee, a platform designated for discussion and sharing of information and

experiences. In addition, methods on data collection and processing has been revised and improved

further to acquire high quality data. This is crucial for the publication of current, accurate and reliable

statistics on time for use by health professionals. In this report, the tabulation of findings was further refined

by including groups of medicines which was not previously included in MSOM 2011-2014. For the purpose

of enabling meaningful comparison with statistics published in the past, same analysis method was

applied.

We sincerely hope that MSOM 2015-2016 would provide valuable information to all fields of healthcare

professionals, and could serve as a source of reference and baseline for embarking in future research or

clinical audits towards promoting rational prescribing and effective medicines use.

We are grateful to all colleagues and collaborators who had worked very hard in ensuring the success of

this report. These including all agencies, institutions, expert panel members and all individuals who had

contributed invaluable input. In the spirit of true cooperation and partnership in research and

development, the value of rational use of medicines and attaining high quality healthcare status of the

nation can be uphold.

Pharmaceutical Services Programme


iv

ACKNOWLEDGEMENTS

Team members of national medicines utilisation study would like to express highest gratitude to all the

individuals involved, directly or indirectly in making the study on medicines utilisation and publication of

MSOM 2015-2016 a success. This gratitude would go to

Senior Director of Pharmaceutical Services Programme, Ministry of Health Malaysia for the

invaluable support in conducting research,

Director of Pharmacy Policy and Strategic Planning Division, Ministry of Health Malaysia for the

support in providing resources and advice on implementing medicines utilisation study and

publication of this report,

Deputy Director and pharmacists at Medicines Pricing Branch, Pharmacy Practice and

Development Division, Ministry of Health Malaysia, of their generosity in data sharing required for

this project,

Deputy Director and pharmacists at Pharmacy Logistics Branch, Pharmacy Practice and

Development Division, Ministry of Health Malaysia, of the precious,

Personnel at Pharmaniaga Logistics Sdn Bhd, who had contributed diligently to the study,

IQVIA Solution Malaysia Sdn Bhd, for the valuable inputs,

All the members of the expert panel who had contributed to the review and writing of this report,

All participating pharmacist personnel at Pharmacy Departments in Ministry of Health Malaysia,

and at three university hospitals in the Ministry of Education Malaysia,

Reviewers and members of Technical Advisory Committee for their extensive review and valuable

comments on the project and report,

All individuals who had in one way or another contributed enthusiastically to the success of this

project.

Lastly, the team would like to thank the Director General of Health Malaysia for the permission to publish

this report.

v

Project Team of National Medicines Utilisation Study

Leader Dr. Azuana Ramli

Deputy Director

Pharmacy Policy and Strategic Planning Division


Coordinator Mr. Tineshwaran Velvanathan

Pharmacist



Mdm Azzy Iyzati Ahmad Shanizza

Research Officer



Mdm Chan Lai Yue

Pharmacist



Statistician Ms. Mary Chok Chiew Fong

Pharmacist



Research Assistant Ms. Safura Sa’ad

Research Officer



Ms. Noor Atiqah Mat Yusoff

Research Officer



Mr. Mohd Faiz Abdul Manan

Research Officer



Reviewers of Malaysian Statistics on Medicines 2015-2016

Mdm Norazlin A. Kadir

Pharmacist

Pharmacy Practice and Development Division


Mdm Hazimah Hashim

Pharmacist



Mdm. Haarathi Chandriah

Pharmacist



vi

Technical Advisory Committee of National Medicines Utilisation Study

Chairperson Dr. Hasenah Ali

Director



Co-chairperson Dr. Roshayati Mohamad Sani

Director



Secretary Dr. Azuana Ramli

Deputy Director



Member Mdm Nur’Ain Shuhaila Shohaimi

Deputy Director



Mdm Wan Utma Sapini Wan Abdul Samad

Pharmacist



Mdm Norazlin A. Kadir

Pharmacist



Mdm Rosliza Lajis

Pharmacist



Ms. Nor Hasni Haron

Pharmacist



Ms. Teoh Iyinh Theng

Pharmacist



vii

Members of Expert Panel

CARDIOLOGY

Dr. Abd Kahar Abd Ghapar

Head of Department & Senior Consultant

Cardiologist

Serdang Hospital

Dr. Amin Ariff Nuruddin

Senior Consultant Cardiologist

National Heart Institute

Dr. Azhari Rosman

Senior Consultant Cardiologist

National Heart Institute

Prof Dr. Omar Ismail

Consultant Cardiologist

Universiti Islam Antarabangsa Sultan Abdul

Halim Mu’adzam Shah

Prof Dr. Wan Azman Wan Ahmad

Consultant Cardiologist

University Malaya Medical Centre

Dr. Wardati Mazlan Kepli

Pharmacist

Serdang Hospital

Mdm Nirmala Jagan

Pharmacist

Kuala Lumpur Hospital

Mr. Jivanraj Nagarajah

Pharmacist


DERMATOLOGY

Dr. Suganthi Thevarajah

Head of Department & Senior Consultant

Dermatologist


Dr. Preamala Gunabalasingam

Head of Department & Consultant

Dermatologist

Melaka Hospital

Dr. Tang Min Moon

Consultant Dermatologist


ENDOCRINOLOGY

Dr. Zanariah Hussein

Senior Consultant Endocrinologist & Physician

Putrajaya Hospital

Dr. Nor Afidah Karim

Endocrinologist & Physician

Tuanku Ja’afar Hospital, Seremban

Dr. Vijiya Mala Valayatham


Putrajaya Hospital

Dr. Danish Ng Ooi Yee


Selayang Hospital

Dr. Wong Hui Chin


Tengku Ampuan Rahimah Hospital, Klang

Dr. Navin Kumar Loganadan

Pharmacist

Putrajaya Hospital

Mdm Daphne Gima

Pharmacist

Putrajaya Hospital

GASTROENTEROLOGY AND HEPATOLOGY

Dr. Rosaida Md Said

Senior Consultant Gastroenterologist &

Hepatologist

Ampang Hospital

Dr. Tan Soek Siam


Hepatologist

Selayang Hospital

Dr. Muhammad Radzi Abu Hassan


Hepatologist

Sultanah Bahiyah Hospital, Alor Setar

Dr. Zalwani Zainuddin

Consultant Gastroenterologist & Hepatologist


viii

Dr. Norasiah Abu Bakar

Consultant Gastroenterologist & Hepatologist

Raja Perempuan Zainab II Hospital, Kota Bharu

HAEMATOLOGY

Dr. Jameela Sathar


Haematologist

Ampang Hospital

IMMUNIZATION/VACCINE

Dr. Rohani Jahis

Head of Section (Zoonosis Control)

Disease Control Division


Dr. Jamiatul Aida Md Sani

Public Health Specialist

Disease Control Division


Mdm Najwa Ahmad Hamdi

Pharmacist

Public Health Development Division


INFECTIOUS DISEASES

Dr. Leong Chee Loon

Infectious Disease Consultant Physician


Dr. Steven Lim Chee Loon

Infectious Disease Specialist

Raja Permaisuri Bainun Hospital, Ipoh

Dr. Rahela Ambaras Khan

Pharmacist


Mdm Hannah Md Mahir

Pharmacist

Sungai Buloh Hospital

Mdm Mak Woh Yon

Pharmacist


Mdm Preethi Raghavan

Pharmacist


NEUROLOGY

Dr. Zariah Abdul Aziz

Senior Consultant Neurologist

Sultanah Nur Zahirah Hospital, Kuala

Terengganu

Dr. Sapiah Sapuan

Consultant Neurologist


Dr. Tee Sow Kuan

Neurologist


Dr. Puvanarajah Santhi

Neurologist


Mdm Norsima Nazifah Sidek

Pharmacist


Terengganu

Mdm Tan Ai Leen

Pharmacist


OBSTETRIC AND GYNECOLOGY

Dr. Norashikin Abdul Fuad

Head of Department & Obstetrician &

Gynaecologist


Dr. Nasuha Yaacob

Obstetrician & Gynaecologist


Terengganu

Dr. Haliza Kamarudin

Obstetrician & Gynaecologist

Women and Children Hospital, Kuala Lumpur

Mdm Vanessa Liang Lu Wen

Pharmacist

Women and Children Hospital, Kuala Lumpur

ix

ONCOLOGY

Dr. Ros Suzanna Ahmad Bustaman

Head of Department & Consultant in

Radiotherapy & Oncology


Dr. Tan Chih Kiang

Clinical Oncologist

National Cancer Institute

Dr. Prathepamalar Yehgambaram

Clinical Oncologist


Ms. Nik Nuradlina Nik Adnan

Pharmacist

National Cancer Institute

Ms. Lee Mei Wah

Pharmacist


OPHTHALMOLOGY

Dr. Shamala Retnasabapathy


Ophthalmologist


Dr. Jamalia Rahmat


Ophthalmologist


Dr. Vanitha Ratnalingan

Consultant Ophthalmologist


ORTHOPAEDIC

Dr. Fazir Mohamad


Orthopaedic Surgery


OTORHINOLARYNGOLOGY

Dr. Siti Sabzah Mohd Hashim

National Head of Otorhinolaryngology Services

& Senior Consultant in Otorhinolaryngology


Dr. Abd Razak Ahmad

National Head and Neck Sub-Specialist Advisor,

Head of Department & Senior Consultant in

Otorhinolaryngology

Melaka Hospital

Dr. Zulkiflee Salahuddin

Deputy National Head of Otorhinolaryngology

Services & Senior Consultant in

Otorhinolaryngology

Raja Perempuan Zainab II Hospital, Kota Bharu

Dr. Iskandar Hailani


Otorhinolaryngology


Dr. Jothi Shanmuganathan


Otorhinolaryngology

Sultanah Aminah Hospital, Johor Bahru

Dr. Amran Mohamad

Senior Consultant in Otorhinolaryngology


Terengganu

Dr. Halimuddin Sawali


Otorhinolaryngology

Queen Elizabeth Hospital, Kota Kinabalu

Mr. Leow Wooi Leong

Pharmacist


PHARMACOECONOMIC

Mdm Wan Utma Sapini Wan Abdul Samad

Pharmacist



Mdm Rosliza Lajis

Pharmacist



x

Mdm Nazatul Syima Idrus

Pharmacist



Mr. Muhammad Md Zain

Pharmacist



Mr. Tineshwaran Velvanathan

Pharmacist

Pharmacy Policy and Strategic Planning

Division


PSYCHIATRY

Dr. Norharlina Bahar

Consultant Psychiatrist

Selayang Hospital

Dr. Chin Loi Fei



Dr. Azizul Awaluddin


Putrajaya Hospital

Dr. Noormazita Mislan



RESPIRATORY

Dr. Nabilah Salman Parasi @ Sulaiman

Consultant Pulmonologist

Institute of Respiratory Medicine

Dr. Mona Zaria Nasaruddin

Consultant Pulmonologist

Serdang Hospital

Mdm Liew Mei Yao

Pharmacist

Serdang Hospital

RHEUMATOLOGY

Dr. Gun Suk Chyn

Head of Department & Medical Consultant in

Rheumatology


Dr. Mollyza Mohd Zain

Medical Consultant in Rheumatology

Selayang Hospital

Dr. Liza Mohd Isa


Putrajaya Hospital

Dr. Chong Hwee Cheng


Melaka Hospital

Mdm Siti Rabiatul Adawiyah

Pharmacist


UTILISATION OF MEDICINES

Mdm Rozita Mohamad

Deputy Director



Dr. Rosliana Rosli

Pharmacist



Mdm Yusmiza Azmi

Pharmacist



Ms. Sarahfarina Abdul Rahim

Pharmacist



Mdm Azzy Iyzati Ahmad Shanizza

Research Officer


Division


Ms. Mary Chok Chiew Fong

Pharmacist


Division


xi

ABBREVIATIONS

ACE angiotensin converting enzyme

ACIP Advisory Committee on

Immunisation Practice

ACTH adrenocorticotropic hormone

ADHD attention deficit hyperactive

disorder

AED antiepileptic drug

AMS antimicrobial stewardship

ARB angiotensin II receptor blocker

ART assisted reproductive technology

ATC anatomical therapeutic chemical

BCG bacille Calmette-Guerin

CNS central nervous system

COPD chronic obstructive pulmonary

disease

CRE carbapenem-resistant

enterobacteriaceae

CVD cardiovascular disease

DAA direct-acting antiviral

DALY disability-adjusted life year

DDD defined daily dose

DG Director General

DOAC direct oral anticoagulant

DPP-4 dipeptidyl peptidase-4

EGFR epidermal growth factor receptor

ESBL extended-spectrum beta-

lactamases

FDA Food and Drug Administration

FDC fixed-dose combination

FET frozen-thaw embryo transfer

GDP gross domestic product

GLP-1 glucagon-like peptide-1

GORD gastro-oesophageal reflux disease

GVAP Global Vaccine Action Plan

H2RA H2-receptor antagonist

HIV human immunodeficiency virus

HMG CoA β-hydroxy β-methylglutaryl-

coenzyme A

HPV human papilloma virus

ICS inhaled corticosteroid

IVF in-vitro fertilization

JE Japanese encephalitis

LABA long-acting β2 adrenoreceptor

agonists

LARC long-acting reversible contraceptive

LDL-c low density lipoprotein cholesterol

MDR multidrug resistant

MMR measles-mumps-rubella

MNHA Malaysia National Health Accounts

MoE Ministry of Education Malaysia

MoH Ministry of Health Malaysia

MoHMF Ministry of Health Medicines

Formulary

MRSA methicillin-resistant Staphylococcus

aureus

MSOM Malaysian Statistics on Medicines

NCD non-communicable disease

NHMS National Health and Morbidity

Survey

NIP National Immunisation Programme

NMP National Medicines Policy

NMUS National Medicines Use Survey

OECD Organisation of Economic

Cooperation and Development

OHSS ovarian hyperstimulation syndrome

OPV oral polio vaccine

OSCC one stop crisis centre

OTC over-the-counter

PBS Pharmaceutical Benefits Scheme

PCI percutaneous coronary intervention

PCV pneumococcal conjugated

vaccine

PPH postpartum haemorrhage

PPI proton-pump inhibitor

PSP Pharmaceutical Services

Programme

PUD peptic ulcer disease

SABA short-acting β2 adrenoreceptor

agonists

SGLT-2 sodium-glucose co-transporter 2

SIA supplementary immunisation

activities

SSRI selective serotonin reuptake

inhibitor

TB tuberculosis

TEH total expenditure on health

TNF-α tumour necrosis factor alpha

WHO World Health Organisation

xii

CONTENTS

Preface iii

Acknowledgements iv

Project Team of National Medicines Utilisation Study v

Reviewers of Malaysian Statistics on Medicines 2015-2016 v

Technical Advisory Committee of National Medicines Utilisation Study vi

Members of Expert Panel vii

Abbreviations xi

1 Study on Medicines Utilisation in Malaysia 1

2 Utilisation of Medicines in Malaysia 5

3 Expenditures on Medicines in Malaysia 13

4 Alimentary Tract and Metabolism 18 4.1 Statistics on medicines for alimentary tract and metabolism 18

4.2 Utilisation of drugs for alimentary disorders 27

4.3 Utilisation of antiobesity drugs 28

4.4 Utilisation of antidiabetic drugs 28

5 Medicines for Blood and Blood Forming Organs 30 5.1 Statistics on medicines for blood and blood forming organs 30

6 Cardiovascular System 33 6.1 Statistics on medicines for cardiovascular system 33

6.2 Utilisation of drugs for cardiovascular disorders 40

6.3 Utilisation of drugs for hypertension 41

6.4 Utilisation of lipid modifying drugs 42

7 Dermatologicals 44 7.1 Statistics on dermatological preparations 44

7.2 Utilisation of dermatological preparations 48

8 Genito Urinary System and Sex Hormones 50 8.1 Statistics on medicines for genito urinary system and sex hormones 50

8.2 Utilisation of gynecologicals, sex hormones and hormonal contraception 54

9 Systemic Hormonal Preparations, excluding Sex Hormones and Insulins 56 9.1 Statistics on systemic hormonal preparations, excluding sex hormones and

insulins

56

9.2 Utilisation of systemic hormonal preparations 59

9.3 Utilisation of systemic glucocorticoids in rheumatology 60

10 Antiinfectives for Systemic Use 61 10.1 Statistics on antiinfectives for systemic use 61

10.2 Utilisation of systemic antiinfectives 76

10.3 Utilisation of drugs for viral hepatitis C 77

10.4 Utilisation of vaccines 77

11 Antineoplastic and Immunomodulating Agents 80 11.1 Statistics on antineoplastic and immunomodulating agents 80

11.2 Utilisation of antineoplastic agents, targeted therapy and endocrine therapy 89

11.3 Utilisation of immunosuppressive agents in rheumatology 90

12 Musculo-Skeletal System 91 12.1 Statistics on medicines for musculo-skeletal system 91

xiii

13 Nervous System 96 13.1 Statistics on medicines for nervous system 96

13.2 Utilisation of drugs for neurological disorders 102

13.3 Utilisation of drugs for psychiatric disorders 104

14 Antiparasitic Products 106 14.1 Statistics on antiparasitic products 106

14.2 Utilisation of antimalarials 110

15 Respiratory System 111 15.1 Statistics on medicines for respiratory system 111

15.2 Utilisation of antihistamines and nasal decongestants 118

15.3 Utilisation of drugs for obstructive airway diseases 118

16 Sensory Organs 120 16.1 Statistics on medicines for sensory organs 120

16.2 Utilisation of ophthalmological agents 125

16.3 Utilisation of otological agents 126

17 Various Therapeutic Products 127 17.1 Statistics on other therapeutic products 127

1

1 Study on Medicines Utilisation In Malaysia Mary Chok Chiew Fong, Azzy Iyzati Ahmad Shanizza, Tineshwaran Velvanathan, Azuana Ramli

AN OVERVIEW

Study on Medicines Utilisation and National Medicines Policy

Study on medicines utilisation in Malaysia is an initiative by Pharmaceutical Services Programme (PSP) at

the Ministry of Health Malaysia (MoH). This initiative is fundamental to support and augment the

implementation of National Medicines Policy (NMP), in which the aim is to promote equitable access and

rational use of safe, effective and affordable medicines, and ultimately lead to the improvement in

quality of health for all Malaysians.

Study on Medicines Utilisation, National Medicines Use Survey and Malaysian Statistics on Medicines

Malaysian Statistics on Medicines (MSOM) is a publication reporting the findings of a nationwide study on

medicines utilisation. Since the first publication for the year 2004, study methodology had progressively

advanced and improved. When it was first started, it was named National Medicines Use Survey (NMUS)

and the study relied heavily on nationwide survey to project medicines utilisation for Malaysian

population, particularly in the private sector. Over the years, through partnership with a private company,

data on procurement and sales of medicines by public and private sector were vastly available and

acquired. Subsequently, methods of the study had been modified to produce more reliable estimates of

national statistics on utilisation of medicines.

The aim of medicines utilisation study

Medicines utilisation study was conducted with the aim to produce high quality, trusted and timely

information on utilisation of medicines for the use in decision making pertaining to pharmaceutical

products and pharmacotherapy. Hence, the main objective of the study is to quantify current state of

medicines utilised by various sectors and levels in the nation healthcare system.

The findings of medicines utilisation study are valuable in numerous aspects of healthcare services. These

include:

i. Estimating medicines consumption and depicting extensiveness and the pattern of medicines

utilisation for various therapeutic groups,

ii. Quantifying the number of medicine users which provide clue to the exposure rate of population

to medicines of interest,

iii. Assessing the extent of disease treatment in relation to disease prevalence. Comparison of the

statistics to national disease prevalence could produce information on the extensiveness of disease

treatment,

iv. Evaluating the outcome of interventions or implementation of new policy related to

pharmaceutical services by studying the impact on trend of medicines utilisation,

v. In the field of pharmacovigilance, rate of adverse drug reactions and risk of exposure could be

estimated by examining the link between medicine utilisation and number of adverse events

observed,

vi. As a guide in estimating expenditure of medicines to support medicines budget planning.

Quantifying medicines utilisation: anatomical therapeutic chemical (ATC) classification system and

defined daily dose (DDD) as unit of measurement

Methodology on medicines utilisation study recommended by World Health Organisation (WHO) was

referred in conducting this study.1,2 This methodology recommends the use of anatomical therapeutic

chemical (ATC) classification system as a standard in grouping and coding of medicines and defined

2

daily dose (DDD) in quantifying medicines utilisation. Hence, ATC classification system and DDD is the

measuring standard and unit in presenting medicines utilisation. The uniformity in reporting of medicines

utilisation by using ATC/DDD system permits comparison of statistics at regional and international levels,

between countries, populations, various levels of services and at specific time frame.

By applying ATC classification system, each medicine of known chemical substances, either single or in

combination, is assigned a code which is classified in a hierarchy. This hierarchy consists of five levels.

Every level represents specific information related to medicines and codes are assigned accordingly.

Code assigned at Level 1 is an alphabet that represents the anatomical main group and there are 14

groups in total.

Level 1 Anatomical main group

A Alimentary tract and metabolism

B Blood and blood forming organs

C Cardiovascular system

D Dermatologicals

G Genito urinary system and sex hormones

H Systemic hormonal preparations, excluding sex hormones and insulins

J Antiinfective for systemic use

L Antineoplastic and immunomodulating agents

M Musculo-skeletal system

N Nervous system

P Antiparasitic products, insecticides and repellents

R Respiratory system

S Sensory system

V Various

At Level 2 to 5, the code is a combination of alphabet and number. Level 2 of ATC code refers to

therapeutic subgroup. The code is further divided into pharmacological and chemical subgroup at Level

3 and 4, respectively. Lastly, code at Level 5 is assigned according to chemical substances. The structure

of the code as shown below is the complete classification system by taking simvastatin as an example.

Level Group/Subgroup ATC code for simvastatin and details

Level 1 Anatomical main group C Cardiovascular system

Level 2 Therapeutic subgroup C10 Lipid modifying agents

Level 3 Pharmacological subgroup C10A Lipid modifying agents, plain

Level 4 Chemical subgroup C10A A HMG CoA reductase inhibitors

Level 5 Chemical substance C10A A01 simvastatin

Interpretation of defined daily dose (DDD), DDDs per-1,000 inhabitants per-day and DDDs per-inhabitants

per-year

DDD is the assumed average maintenance dose per-day for a drug used for its main indication in adults.

It is a technical measure of medicines utilisation and does not necessarily agree with the recommended

or prescribed daily dose. Doses for individual patients and patient groups will often vary from DDD. DDD

is often a compromise dose based on review of the available information about doses used in various

countries. It may even be a dose rarely prescribed because it is an average of two or more commonly

used doses.

Statistics on medicines reported in MSOM for most drugs are presented as numbers of DDDs per-1,000

inhabitants per-day. DDDs per-1,000 inhabitants per-day is a crude estimate of the proportion of

population treated daily with the drug. For instance, 10 DDDs per-1,000 inhabitants per-day would

represent 10 in 1,000 or 1% of the population, on average, were prescribed or administered a certain drug

or group of drugs every day in the year of study.

DDDs per-1,000 inhabitants per-day is useful for drugs used in the treatment of chronic diseases and when

agreement between average prescribed daily dose and DDD is satisfactory. For most drugs, number of

DDDs per-1,000 inhabitants per-day reported are determined for the entire population. Therefore, all age

groups and gender are included in calculation. In circumstances when drug use is limited to certain age

groups or gender, it would be more appropriate expressing the figure for the relevant age groups or

gender only, such as, DDDs per-1,000 children age below 12 years old per-day, or DDDs per-1,000 women

in reproductive age groups per-day.

3

For drugs administered for short duration, such as antiinfectives and antihistamines, utilisations are

expressed as DDD per-inhabitant per-year. This estimate is interpreted as average number of days for one

case been treated annually. Thus, 5 DDDs per-inhabitant per-year indicates that the utilisation is

equivalent to the treatment of every inhabitant with a 5-day course in respective years.

There are several limitations to be considered when interpreting the statistics on medicine utilisation. These

include:

i. DDD is based on one main indication of a medicine in adults, though the medicine may have

several indications.

ii. Medicines procured, as was the type of data collected in this study, may not all be consumed.

iii. For certain medicines, DDD may be difficult to be determined or are not assigned at all, for

instance, medicines with multiple ingredients, topical products, antineoplastics, anaesthetic

agents and contrast media.

iv. The DDD assigned to a drug is primarily based on other countries’ experience and may not reflect

the average prescribed adult dose in Malaysia.

v. Medicines newly introduced into the market may not have ATC code and DDD assigned yet.

For most parts of this report, only drugs with WHO-assigned DDDs are included in the utilisation statistics.

However, a few groups of drugs which do not have WHO-assigned DDDs, namely the antineoplastics,

dermatologicals, ophthalmologicals, otologicals, cough and cold combinations and vaccines, DDDs

were assigned based on the WHO general guidelines.2 Thus, the national utilisation and patterns of use

are presented in relative to drugs within the respective groups only.

THE METHODS

For MSOM, methodology of medicines utilisation study recommended by WHO was applied.1,2 These

methods include identifying data to be collected and used, data analysis and in interpreting statistics on

medicines.

Scope of the study

All pharmaceutical products classified as poison by legislative authority in Malaysia and listed in Poison

Act 1952 (revised 1989) were included in report.3 Other medicines included are several over-the-counter

(OTC) medicines. These include paracetamol, acetylsalicylic acid, vitamin and mineral supplements

which contain single ingredient. Medicines and other pharmaceutical products excluded from analysis

in medicines utilisation were medicated dressings, disinfectant products and medicines with no DDD

assigned or no unit of measurement. This category of medicines were anaesthetics, antidotes, dialysate,

parenteral nutritional products, contrast media and radiopharmaceutical products. Nevertheless, in

determining expenditure on medicines, all pharmaceutical products assigned with ATC code were

included, although utilisation were not reported.

Source of data

Data of year 2015 and 2016 were obtained from several sources. For public sector, contributors of data

were MoH and Ministry of Education Malaysia (MoE). There were three sources of data through which

MoH data were obtained, depending on the mode of procurement. First data source was long-term

contract supplier of pharmaceutical products which supplied medicines to all MoH health facilities.

Second source of data were short-term contract suppliers. Procurement data of other pharmaceutical

products not acquired from first and second sources were collected from all MoH health facilities that

had procured medicines in small quantities. Facilities included were hospitals, divisional health

departments or offices and health institutes. Three public university hospitals in MoE were involved in data

collection, namely Universiti Malaya Medical Centre, Universiti Sains Malaysia Hospital and Universiti

Kebangsaan Malaysia Medical Centre.

Private sector medicines sales data were acquired through IQVIA Solution Malaysia Sdn Bhd, a Human

Data Science company in Malaysia. IQVIA captures sales data of medicines and health products from

various sources. The bulk of medicine sales transacted by pharmaceutical companies in Malaysia were

obtained through main pharmaceutical distributors in Malaysia. At the time of study, this represents

approximately 63% of the pharmaceutical market coverage in Malaysia. In addition, some medicine sales

data are also collected from all direct transactions made by pharmaceutical manufacturers which are

predominantly local manufacturers, and also from other distributors and healthcare institutions. This

4

contributed an additional 8% to the total pharmaceutical market coverage. For the next 11% of the

pharmaceutical market coverage, medicines sales data were estimated through sampling from panels

of selected retailers which include sales transacted by general practitioners, pharmacies and private

hospitals. To complete the pharmaceutical market coverage, the remaining 18% were estimated from

medicine sales made to other retailers that include supermarkets, shops and convenient stores.

Data configuration and analysis

Data sets of year 2015 and 2016 for public and private sectors were acquired in October 2019 and

consolidated for analysis. Each pharmaceutical product with respect to the chemical substances and

route of administration, was assigned with ATC code, DDD and the unit of DDD.2 Quality checking on

accuracy and consistency of data coding and structuring were implemented. Subsequently,

pharmaceutical products to be included in the report of MSOM 2015-2016 were selected in prior to data

analysis.

Firstly, in the determination of medicines utilisation for each ATC code, estimated total dose of drug or

chemical substances contain in pharmaceutical products was calculated. This was followed by

determination of number of DDDs, with respect to the ATC code and year of study using following

equations:

DDDs per-1,000 inhabitants per-day = T

x 1,000 DDD x P x d

DDDs per-inhabitant per-year = T

DDD x P

T An estimate of the total dose of drug or chemical substance, by ATC code and year of study

DDD Defined daily dose assigned to medicine according to WHO ATC/DDD system

P Mid-year population

d Total number of days in year of study

Mid-year population used in above equations were 31,186,100 and 31,633,500, respectively, for year 2015

and 2016.4 Consequently, total number of DDDs for all medicines and pharmaceutical products assigned

with the same ATC code for each year of study and respectively for public and private sectors were

obtained and presented in this report. Likewise, total expenditure on medicines was calculated by

summation of total expenditure for all pharmaceutical products assigned with the same ATC code, by

year and by sector.

REFERENCES

1. Methods to Analyse Medicine Utilization and Expenditure to Support Pharmaceutical Policy

Implementation; World Health Organization: Geneva, 2018. Licence: CC BY-NC-SA 3.0 IGO.

2. Guidelines for ATC Classification and DDD Assignment 2018; WHO Collaborating Centre for Drug

Statistics Methodology: Oslo, Norway, 2017.

3. Poison Act 1952 (revised 1989), Act 336 Laws of Malaysia; International Law Book Services: Kuala

Lumpur, 1989.

4. Department of Statistics Malaysia. http://www.dosm.gov.my (accessed July 3, 2019).

^

^

^

5

2 Utilisation of Medicines in Malaysia Azzy Iyzati Ahmad Shanizza, Rosliana Rosli, Yusmiza Azmi, Sarahfarina Abdul Rahim, Rozita Mohamad, Mary Chok Chiew Fong

Accurate national medicines utilisation statistics is crucial for healthcare policy-makers to make informed

decisions in developing policies towards promoting rational use of medicines in the country. The

information is also essential to monitor the impact of any educational, regulatory or policy interventions

being made in our continuous efforts to improve the current drug use practices.

In this chapter, the national estimates of total medicines utilisation in Malaysia for both 2015 and 2016 are

reported in several tables in order of utilisation by therapeutic groups and individual drugs or chemical

substances. Medicines utilisation in the public and private sectors are also tabulated and discussed

accordingly.

Overall, the total estimated medicines utilisation in 2015 and 2016 were reported at 624.90 and 632.32

DDD/1,000 inhabitants/day, respectively (Table 2.1). In 2015, the total medicines utilisation estimated for

the public sector was 398.41 DDD/1,000 inhabitants/day, which accounted for 63.8%. Whereas the private

sector reported a total of 226.49 DDD/1,000 inhabitants/day at 36.2%. The total medicines utilisation

estimated for the public sector in 2016 was 407.82 DDD/1,000 inhabitants/day (64.5%) while the private

sector observed a slight drop at 224.5 DDD/1,000 inhabitants/day (35.5%). Year to year comparison

observed an upward trend of total medicines utilisation with a 9.7% increase from 569.55 DDD/1,000

inhabitants/day in 20141 and a modest increase of 1.2% between 2015 and 2016. The overall increase in

drug utilisation from 2015 to 2016 was mainly contributed by the public sector that had increased by 2.4%

while the private sector reported a negligible decrease of 0.9%.

Table 2.1 Total estimation of medicine utilisation, 2015-2016 (Utilisation in DDD/1,000 inhabitants/day)

Sector 2015 2016

Public 398.41 (63.8%) 407.82 (64.5%)

Private 226.49 (36.2%) 224.50 (35.5%)

Total 624.90 632.32

Total medicines utilisation for the top 50 therapeutic groups in 2016 and 2015 are presented in Table 2.2

and 2.3, respectively. Overall, there were no marked differences in therapeutic groups between the two

years, in particular the top 10 therapeutic groups. Drugs used in diabetes (A10) remained the most utilised

therapeutic group for 2015 and 2016. This was followed by calcium channel blockers (C08), agents acting

on the renin-angiotensin system (C09) and lipid modifying agents (C10), which were also ranked the same

for both years. The estimated total utilisation of these groups of drugs is consistent with the reported

diseases prevalence in National Health and Morbidity Survey (NHMS) 2015 for non-communicable

diseases (NCD), particularly cardiovascular diseases (CVD) which contributed to an estimate of 73% of

total deaths in Malaysia.2 The only new therapeutic group that climbed into the top 10 ranking in 2016

was sex hormones and modulators of the genital system (G03), pushing down the drugs for obstructive

airway diseases (R03) to the twelfth position.

Table 2.4 shows that the most significant increase in utilisation (20.0%) between 2015 and 2016 was seen

for agents acting on the renin-angiotensin system (C09) from 42.2187 to 50.6757 DDD/1,000 inhabitants/

day, followed by sex hormones and modulators of the genital system (G03) with an increase of 16.4% from

14.6267 in 2015 to 17.0276 DDD/1,000 inhabitants/day in 2016. On the other hand, utilisation for beta

blocking agents (C07) decreased by 11.6% from 20.0549 to 17.7193 DDD/1,000 inhabitants/day and

diuretics (C03) also reported a reduction in utilisation by 9.1% from 18.5823 to 16.8841 DDD/1,000

inhabitants/day.

6

Table 2.2 Top 50 utilised therapeutic groups in 2016 (Utilisation in DDD/1,000 inhabitants/day)

Rank ATC code Therapeutic group Public Private Total

1 A10 Drugs used in diabetes 61.9611 11.3131 73.2742

2 C08 Calcium channel blockers 61.5062 7.5324 69.0386

3 C09 Agents acting on the renin-angiotensin system 39.3969 11.2788 50.6757

4 C10 Lipid modifying agents 27.6987 8.9001 36.5988

5 A11 Vitamins 4.7050 18.1011 22.8061

6 R06 Antihistamines for systemic use 4.7791 17.2892 22.0683

7 C07 Beta blocking agents 14.2129 3.5064 17.7193

8 G03 Sex hormones and modulators of the genital system 8.3373 8.6904 17.0276

9 C03 Diuretics 14.9246 1.9595 16.8841

10 B03 Antianemic preparations 12.5961 3.4350 16.0311

11 B01 Antithrombotic agents 10.5104 4.3203 14.8307

12 R03 Drugs for obstructive airway diseases 8.5853 5.3016 13.8869

13 M01 Antiinflammatory and antirheumatic products 2.0019 9.6440 11.6460

14 D07 Corticosteroids, dermatological preparations 2.5007 8.5708 11.0715

15 A02 Drugs for acid related disorders 6.9301 3.6746 10.6047

16 J01 Antibacterials for systemic use 3.0980 7.1376 10.2356

17 D01 Antifungals for dermatological use 1.1965 7.7822 8.9787

18 N02 Analgesics 3.6324 5.3432 8.9757

19 R05 Cough and cold preparations 0.8765 6.7969 7.6734

20 S01 Ophthalmologicals 3.5475 2.9027 6.4502

21 H02 Corticosteroids for systemic use 2.3627 3.8385 6.2012

22 C01 Cardiac therapy 3.4076 1.3260 4.7337

23 R01 Nasal preparations 0.7375 3.9016 4.6391

24 N05 Psycholeptics 2.7182 1.2788 3.9970

25 A12 Mineral supplements 3.1342 0.4378 3.5721

26 D11 Other dermatological preparations 0.0383 3.4883 3.5266

27 D06 Antibiotics and chemotherapeutics for

dermatological use

1.1633 1.6163 2.7796

28 H03 Thyroid therapy 1.6079 1.0488 2.6567

29 A06 Drugs for constipation 1.0752 1.5805 2.6556

30 C02 Antihypertensives 2.3668 0.2655 2.6323

31 G04 Urologicals 1.6394 0.9789 2.6182

32 D05 Antipsoriatics 0.3115 2.1572 2.4687

33 N07 Other nervous system drugs 1.3078 1.1206 2.4284

34 N06 Psychoanaleptics 1.3971 0.9546 2.3517

35 A03 Drugs for functional gastrointestinal disorders 0.4834 1.7039 2.1873

36 N03 Antiepileptics 1.6813 0.3884 2.0697

37 D10 Anti-acne preparations 0.0848 1.8418 1.9266

38 M04 Antigout preparations 0.9175 0.9125 1.8300

39 J05 Antivirals for systemic use 1.2096 0.2021 1.4117

40 M03 Muscle relaxants 0.1293 0.9284 1.0578

41 A07 Antidiarrheals, intestinal antiinflammatory/

antiinfective agents

0.2799 0.6942 0.9741

42 S03 Ophthalmological and otological preparations 0.0489 0.8160 0.8649

43 N04 Anti-parkinson drugs 0.6800 0.1455 0.8255

44 M05 Drugs for treatment of bone diseases 0.2341 0.4773 0.7114

45 L04 Immunosuppressants 0.4721 0.1740 0.6460

46 J04 Antimycobacterials 0.5427 0.0881 0.6308

47 L02 Endocrine therapy 0.3582 0.2282 0.5864

48 A08 Antiobesity preparations, excluding diet products 0.0008 0.4575 0.4583

49 G01 Gynecological antiinfectives and antiseptics 0.0518 0.3163 0.3681

50 P01 Antiprotozoals 0.1607 0.1377 0.2985

7

Table 2.3 Top 50 utilised therapeutic groups in 2015 (Utilisation in DDD/1,000 inhabitants/day)

Rank ATC code Therapeutic group Public Private Total

1 A10 Drugs used in diabetes 63.7128 11.3484 75.0611

2 C08 Calcium channel blockers 59.8844 7.8863 67.7707

3 C09 Agents acting on the renin-angiotensin system 31.3996 10.8191 42.2187

4 C10 Lipid modifying agents 26.6695 8.7064 35.3759

5 A11 Vitamins 5.4220 18.0759 23.4979

6 R06 Antihistamines for systemic use 5.6576 17.0806 22.7382

7 C07 Beta blocking agents 16.3077 3.7472 20.0549

8 C03 Diuretics 16.5607 2.0216 18.5823

9 B03 Antianemic preparations 13.7792 3.2419 17.0211

10 R03 Drugs for obstructive airway diseases 9.2977 5.5902 14.8878

11 G03 Sex hormones and modulators of the genital

system

5.1826 9.4441 14.6267

12 B01 Antithrombotic agents 10.1636 4.1843 14.3480

13 M01 Antiinflammatory and antirheumatic products 2.3547 11.2517 13.6065

14 D07 Corticosteroids, dermatological preparations 2.8156 8.5429 11.3586

15 A02 Drugs for acid related disorders 7.2656 3.7382 11.0038

16 J01 Antibacterials for systemic use 3.3678 7.5133 10.8810

17 D01 Antifungals for dermatological use 1.3972 8.4211 9.8183

18 N02 Analgesics 4.1205 5.5553 9.6759

19 R05 Cough and cold preparations 0.9183 6.8790 7.7973

20 H02 Corticosteroids for systemic use 2.5610 3.9168 6.4778

21 S01 Ophthalmologicals 3.2125 2.6949 5.9074

22 R01 Nasal preparations 0.9372 3.9439 4.8811

23 C01 Cardiac therapy 3.4602 1.2999 4.7601

24 N05 Psycholeptics 2.8144 1.4146 4.2290

25 A12 Mineral supplements 3.4623 0.5894 4.0517

26 D11 Other dermatological preparations 0.0302 3.4062 3.4364

27 D06 Antibiotics and chemotherapeutics for

dermatological use

1.2411 1.5938 2.8349

28 A03 Drugs for functional gastrointestinal disorders 0.7283 2.0165 2.7448

29 H03 Thyroid therapy 1.7186 1.0058 2.7244

30 D05 Antipsoriatics 0.5463 2.0592 2.6056

31 C02 Antihypertensives 2.3031 0.2651 2.5683

32 G04 Urologicals 1.6195 0.9278 2.5474

33 N06 Psychoanaleptics 1.4205 1.0645 2.4850

34 A06 Drugs for constipation 0.7783 1.5965 2.3748

35 N07 Other nervous system drugs 1.1979 1.1139 2.3118

36 N03 Antiepileptics 1.8070 0.3652 2.1723

37 D10 Anti-acne preparations 0.1252 1.7448 1.8700

38 M04 Antigout preparations 0.9282 0.9346 1.8628

39 M03 Muscle relaxants 0.1673 1.0697 1.2370

40 J05 Antivirals for systemic use 0.9871 0.2463 1.2334

41 A07 Antidiarrheals, intestinal antiinflammatory/

antiinfective agents

0.2890 0.6690 0.9580

42 S03 Ophthalmological and otological preparations 0.0565 0.9012 0.9578

43 N04 Anti-parkinson drugs 0.7606 0.1318 0.8925

44 M05 Drugs for treatment of bone diseases 0.2941 0.5452 0.8393

45 J04 Antimycobacterials 0.6305 0.0764 0.7070

46 L02 Endocrine therapy 0.3567 0.2012 0.5579

47 A08 Antiobesity preparations, excluding diet products 0.0028 0.5394 0.5422

48 L04 Immunosuppressants 0.3728 0.1602 0.5330

49 P01 Antiprotozoals 0.1940 0.1601 0.3541

50 G01 Gynecological antiinfectives and antiseptics 0.0584 0.2920 0.3504

8

Table 2.4 Top 10 utilised therapeutic groups in public and private sector in 2016 compared to 2015

(Utilisation in DDD/1,000 inhabitants/day)

Sector ATC

code

Therapeutic group 2015 2016 Changes

from 2015 (%) Utilisation Rank Utilisation Rank

Public

and

private

A10 Drugs used in diabetes 75.0611 1 73.2742 1 -2.4

C08 Calcium channel blockers 67.7707 2 69.0386 2 1.9

C09 Agents acting on the renin-

angiotensin system

42.2187 3 50.6757 3 20.0

C10 Lipid modifying agents 35.3759 4 36.5988 4 3.5

A11 Vitamins 23.4979 5 22.8061 5 -2.9

R06 Antihistamines for systemic use 22.7382 6 22.0683 6 -2.9

C07 Beta blocking agents 20.0549 7 17.7193 7 -11.6

G03 Sex hormones and modulators of

the genital system

14.6267 11 17.0276 8 16.4

C03 Diuretics 18.5823 8 16.8841 9 -9.1

B03 Antianemic preparations 17.0211 9 16.0311 10 -5.8

Public A10 Drugs used in diabetes 63.7128 1 61.9611 1 -2.7

C08 Calcium channel blockers 59.8844 2 61.5062 2 2.7


angiotensin system

31.3996 3 39.3969 3 25.5


C03 Diuretics 16.5607 5 14.9246 5 -9.9

C07 Beta blocking agents 16.3077 6 14.2129 6 -12.8

B03 Antianemic preparations 13.7792 7 12.5961 7 -8.6

B01 Antithrombotic agents 10.1636 8 10.5104 8 3.4

R03 Drugs for obstructive airway

diseases

9.2977 9 8.5853 9 -7.7


the genital system

5.1826 13 8.3373 10 60.9

Private A11 Vitamins 18.0759 1 18.1011 1 0.1

R06 Antihistamines for systemic use 17.0806 2 17.2892 2 1.2

A10 Drugs used in diabetes 11.3484 3 11.3131 3 -0.3


angiotensin system

10.8191 5 11.2788 4 4.2

M01 Antiinflammatory and

antirheumatic products

11.2517 4 9.6440 5 -14.3



the genital system

9.4441 6 8.6904 7 -8.0

D07 Corticosteroids, dermatological

preparations

8.5429 8 8.5708 8 0.3

D01 Antifungals for dermatological use 8.4211 9 7.7822 9 -7.6

C08 Calcium channel blockers 7.8863 10 7.5324 10 -4.5

Public and private sector comparison of medicine utilisation by therapeutic groups are presented in Table

2.4. The overall increase in utilisation of sex hormones and modulators of the genital system (G03) was

mainly contributed by the public sector of which the utilisation of this therapeutic group increased by a

total of 60.9% from 5.1826 to 8.3373 DDD/1,000 inhabitants/day, particularly the hormonal contraceptives

for systemic use (G03A). This increasing trend may be contributed by the initiatives carried out by the

public primary health clinics to promote awareness in family planning as explained in chapter 8.

Utilisation of vitamins (A11) topped the list in the private sector for both 2015 and 2016 at 18.0759 and

18.1011 DDD/1,000 inhabitants/day, respectively. The use on non-prescription drugs, vitamins (A11),

antihistamines for systemic use (R06), and corticosteroid, dermatological preparations (D07) continued to

be reported higher in the private sector. Similar trend was reported in MSOM 2011-2014 whereby patients

with mild and acute conditions prefer to seek treatment at private healthcare sector, while most patients

with chronic conditions and NCDs such as diabetes mellitus, hypertension, and dyslipidaemia were being

treated in the public sector.1

9

Table 2.5 Top 50 utilised drugs/chemical substances in 2016 (Utilisation in DDD/1,000 inhabitants/day)

Rank ATC code Drug/Chemical substance Public Private Total

1 C08C A01 Amlodipine 56.8378 6.5670 63.4048

2 A10B B09 Gliclazide 31.4109 3.8507 35.2616

3 C09A A04 Perindopril 28.4049 1.5762 29.9811

4 C10A A01 Simvastatin 20.0099 2.2834 22.2933

5 A10B A02 Metformin 15.4539 2.3545 17.8084

6 B01A C06 Acetylsalicylic acid 8.5408 2.2761 10.8170

7 C03A A03 Hydrochlorothiazide 9.7083 0.6339 10.3421

8 C10A A05 Atorvastatin 6.2988 3.3942 9.6930

9 B03B B01 Folic acid 8.1811 1.4638 9.6448

10 N02B E01 Paracetamol 3.2542 4.8738 8.1280

11 R06A E07 Cetirizine 0.2769 7.7533 8.0302

12 C07A B03 Atenolol 5.7586 1.8108 7.5694

13 C07A B02 Metoprolol 6.6570 0.2888 6.9458

14 R03A C02 Salbutamol 3.0570 2.4187 5.4757

15 C03C A01 Furosemide 4.3935 0.5820 4.9755

16 C09A A02 Enalapril 4.3446 0.5258 4.8705

17 A10A D01 Insulin (human), intermediate- or long-acting

combined with fast-acting

4.7343 0.0292 4.7635

18 R06A X13 Loratadine 1.9044 2.7172 4.6216

19 R06A B04 Chlorphenamine 1.8143 2.3670 4.1812

20 H02A B06 Prednisolone 1.5117 2.5315 4.0432

21 D01A C20 Imidazoles/triazoles in combination with

corticosteroids

0.0052 3.8180 3.8232

22 C08C A02 Felodipine 3.4149 0.2913 3.7063

23 A02B A02 Ranitidine 3.3000 0.3206 3.6206

24 G03A C06 Medroxyprogesterone 2.9583 0.5052 3.4635

25 R05C A10 Expectorants, combinations 0.0056 3.3696 3.3753

26 G03A A07 Levonorgestrel and ethinylestradiol 1.6194 1.5612 3.1806

27 B03A A02 Ferrous fumarate 3.1094 0.0603 3.1698

28 A10B D02 Metformin and sulfonylureas 2.3387 0.8232 3.1619

29 A02B C01 Omeprazole 2.2826 0.8608 3.1434

30 G03A A09 Desogestrel and ethinylestradiol 1.2644 1.8766 3.1410

31 A10A B01 Insulin (human), fast-acting 3.0928 0.0083 3.1011

32 D11A C03 Selenium compounds 0.0067 3.0611 3.0678

33 M01A B05 Diclofenac 0.7215 2.2701 2.9916

34 D07A C01 Betamethasone 1.3932 1.4182 2.8114

35 C09C A01 Losartan 1.6740 1.1167 2.7907

36 J01C A04 Amoxicillin 1.1055 1.6164 2.7219

37 A10A C01 Insulin (human), intermediate-acting 2.5525 0.0050 2.5574

38 R03B A02 Budesonide 2.4663 0.0658 2.5321

39 C01E B15 Trimetazidine 1.6997 0.7260 2.4256

40 G03A C01 Norethisterone 1.6351 0.6342 2.2693

41 D07A D01 Clobetasol 0.0312 2.1441 2.1752

42 B01A C04 Clopidogrel 0.6873 1.4428 2.1301

43 C10A A07 Rosuvastatin 0.1318 1.9697 2.1015

44 C07A B07 Bisoprolol 1.3677 0.7246 2.0923

45 M01A G01 Mefenamic acid 0.5302 1.5307 2.0609

46 C09C A07 Telmisartan 1.0932 0.9527 2.0458

47 D07C C01 Betamethasone and antibiotics 0.0282 2.0113 2.0394

48 D07A A02 Hydrocortisone 0.9086 1.0742 1.9828

49 A02B C02 Pantoprazole 0.9729 0.8655 1.8384

50 A10B B01 Glibenclamide 1.1987 0.5966 1.7953

10

Table 2.6 Top 50 utilised drugs/chemical substances in 2015 (Utilisation in DDD/1,000 inhabitants/day)


1 C08C A01 Amlodipine 54.6063 6.9215 61.5278

2 A10B B09 Gliclazide 34.6899 3.5650 38.2548

3 C10A A01 Simvastatin 21.4087 2.4403 23.8490

4 C09A A04 Perindopril 21.7401 1.4823 23.2224

5 A10B A02 Metformin 16.6506 3.0228 19.6733

6 B03B B01 Folic acid 9.8231 1.6219 11.4450

7 C03A A03 Hydrochlorothiazide 10.5393 0.6105 11.1499

8 B01A C06 Acetylsalicylic acid 8.2776 2.3874 10.6650

9 C07A B03 Atenolol 6.8768 2.0422 8.9190

10 N02B E01 Paracetamol 3.8194 4.8978 8.7173

11 C07A B02 Metoprolol 8.1411 0.2942 8.4353

12 R06A E07 Cetirizine 0.4506 7.3811 7.8318

13 C10A A05 Atorvastatin 3.6784 3.2641 6.9425

14 R03A C02 Salbutamol 3.4186 2.6627 6.0813

15 C03C A01 Furosemide 5.0400 0.4685 5.5085

16 R06A B04 Chlorphenamine 2.0985 2.7515 4.8500

17 R06A X13 Loratadine 2.1142 2.4021 4.5164

18 M01A B05 Diclofenac 1.0173 3.3311 4.3484

19 H02A B06 Prednisolone 1.5955 2.6309 4.2264

20 A02B A02 Ranitidine 3.7358 0.4796 4.2154

21 C09A A02 Enalapril 3.5275 0.5672 4.0947

22 D01A C20 Imidazoles/triazoles in combination with

corticosteroids

0.0016 3.9594 3.9610

23 B03A A02 Ferrous fumarate 3.4457 0.0575 3.5033

24 C08C A02 Felodipine 3.1879 0.2795 3.4674

25 A02B C01 Omeprazole 2.4556 0.8574 3.3130

26 R05C A10 Expectorants, combinations - 3.2711 3.2711

27 A10A D01 Insulin (human), intermediate- or long-acting

combined with fast-acting

3.0917 0.0308 3.1224

28 D11A C03 Selenium compounds 0.0161 2.9619 2.9780

29 D07A C01 Betamethasone 1.3828 1.5445 2.9273

30 A10B D02 Metformin and sulfonylureas 2.0222 0.8437 2.8659

31 J01C A04 Amoxicillin 1.1254 1.6975 2.8229

32 A10B B01 Glibenclamide 2.0028 0.7251 2.7279

33 R03B A02 Budesonide 2.5870 0.0774 2.6644

34 G03A A09 Desogestrel and ethinylestradiol 0.7741 1.7994 2.5735

35 M01A G01 Mefenamic acid 0.6041 1.8817 2.4857

36 G03A A07 Levonorgestrel and ethinylestradiol 0.6550 1.7566 2.4116

37 C08C A05 Nifedipine 1.8276 0.4442 2.2719

38 D07A D01 Clobetasol 0.0860 2.1663 2.2523

39 C09C A07 Telmisartan 1.3104 0.8953 2.2057

40 D07A A02 Hydrocortisone 1.1128 1.0917 2.2045

41 G03A C06 Medroxyprogesterone 1.6554 0.5223 2.1777

42 C01E B15 Trimetazidine 1.4232 0.7033 2.1264

43 D07C C01 Betamethasone and antibiotics 0.0838 1.9918 2.0756

44 C09C A01 Losartan 0.9182 1.1337 2.0518

45 A10A C01 Insulin (human), intermediate-acting 2.0417 0.0055 2.0473

46 A10A B01 Insulin (human), fast-acting 1.9873 0.0082 1.9955

47 B01A C04 Clopidogrel 0.6856 1.2635 1.9491

48 C02C A01 Prazosin 1.8814 0.0335 1.9149

49 C10A A07 Rosuvastatin 0.1129 1.7839 1.8968

50 G03A C01 Norethisterone 1.0971 0.7864 1.8835

11

The top 50 utilisation by medicinal substances in 2016 and 2015 were presented in Table 2.5 and 2.6,

respectively. Amlodipine (C08C A01) which is mainly used for treating hypertension remained the most

utilised drug for both 2015 and 2016, respectively at 61.5278 and 63.4048 DDD/1,000 inhabitants/day. The

high usage of amlodipine was in accordance with the prevalence of hypertension in Malaysia as

reported in the NHMS and its wider accessibility due to prescriber category. Amlodipine is listed in

Category B in the Ministry of Health Medicines Formulary (MoHMF), in which the group of prescribers is

extended to medical officers at MoH.2,3 Table 2.7 shows that drugs for diabetes namely gliclazide (A10B

B09) and metformin (A10B A02) remained in the top 10 ranking for both years despite the slight decrease

in utilisation by 7.8% and 9.5%, respectively. The antihypertensive drug, perindopril (C09A A04) and drug

for hypercholesterolemia, simvastatin (C10A A01) also remained within the top 10 drugs from 2015 to 2016.

Table 2.7 Top 10 utilised drugs/chemical substances in public and private sector in 2016 compared to

2015 (Utilisation in DDD/1,000 inhabitants/day)

Sector ATC code Drug/Chemical substance 2015 2016 Changes

from 2015 (%) Utilisation Rank Utilisation Rank

Public

and

private

C08C A01 Amlodipine 61.5278 1 63.4048 1 3.1

A10B B09 Gliclazide 38.2548 2 35.2616 2 -7.8

C09A A04 Perindopril 23.2224 4 29.9811 3 29.1

C10A A01 Simvastatin 23.8490 3 22.2933 4 -6.5

A10B A02 Metformin 19.6733 5 17.8084 5 -9.5

B01A C06 Acetylsalicylic acid 10.6650 8 10.8170 6 1.4

C03A A03 Hydrochlorothiazide 11.1499 7 10.3421 7 -7.2

C10A A05 Atorvastatin 6.9425 13 9.6930 8 39.6

B03B B01 Folic acid 11.4450 6 9.6448 9 -15.7

N02B E01 Paracetamol 8.7173 10 8.1280 10 -6.8

Public C08C A01 Amlodipine 54.6063 1 56.8378 1 4.1

A10B B09 Gliclazide 34.6899 2 31.4109 2 -9.5

C09A A04 Perindopril 21.7401 3 28.4049 3 30.7

C10A A01 Simvastatin 21.4087 4 20.0099 4 -6.5

A10B A02 Metformin 16.6506 5 15.4539 5 -7.2

C03A A03 Hydrochlorothiazide 10.5393 6 9.7083 6 -7.9

B01A C06 Acetylsalicylic acid 8.2776 8 8.5408 7 3.2

B03B B01 Folic acid 9.8231 7 8.1811 8 -16.7

C07A B02 Metoprolol 8.1411 9 6.6570 9 -18.2


Private R06A E07 Cetirizine 7.3811 1 7.7533 1 5.0

C08C A01 Amlodipine 6.9215 2 6.5670 2 -5.1

N02B E01 Paracetamol 4.8978 3 4.8738 3 -0.5

A10B B09 Gliclazide 3.5650 5 3.8507 4 8.0

D01A C20 Imidazoles/triazoles in

combination with

corticosteroids

3.9594 4 3.8180 5 -3.6


R05C A10 Expectorants, combinations 3.2711 7 3.3696 7 3.0

D11A C03 Selenium compounds 2.9619 10 3.0611 8 3.3

R06A X13 Loratadine 2.4021 15 2.7172 9 13.1

H02A B06 Prednisolone 2.6309 13 2.5315 10 -3.8

Amlodipine was ranked first as the highly utilised drug in the public sector from 2015 to 2016, and came

second in the private sector, after cetirizine (R06A E07). Atorvastatin (C10A A05) was reported to have

the highest increase in utilisation within the public sector from 2015 to 2016 by 71.2% from 3.6784 to 6.2988

DDD/1,000 inhabitants/day, followed by perindopril with an increase of 30.7% from 21.7401 DDD/1,000

inhabitants/day in 2015 to 28.4049 DDD/1,000 inhabitants/day in 2016. Metoprolol (C07A B02) however,

was reported to decline in utilisation by 18.2% from 8.1411 to 6.6570 DDD/1,000 inhabitants/day.

Interestingly, beta blocking agent, atenolol (C07A B03) rightly moved out of the top 10 ranking in 2016

indicating the shift of prescribing pattern towards lower use of these agents. The reduction in use of

metoprolol and atenolol was possibly due to the change of prescriber category for a newer agent such

as bisoprolol (C07A B07) in the public practice, promoting its increase in utilisation and moved up into the

top 50 utilisation list in 2016 (Table 2.5). The drastic leap in ranking worth noting was the utilisation of insulins,

primarily combinations of intermediated- or long-acting and fast-acting insulins (A10A D01), fast-acting

12

insulins (A10A B01), and intermediate-acting insulins (A10A C01). Overall usage of these insulins had

increased by 52. 6%, 55.4% and 24.9%, respectively. The increasing trend of insulin utilisation may be linked

to the changes in usage of other antidiabetic drugs as discussed in Chapter 4.

In conclusion, overall national medicines utilisation continued to show an upward trend albeit a modest

increase of 1.2% between 2015 and 2016. No major changes were observed in the ranking of both the

therapeutic groups and drugs or chemical substances. This is in parallel with the prevalence of chronic

diseases reported in the NHMS 2015.2

REFERENCES

1. Malaysian Statistics on Medicines 2011-2014; Pharmaceutical Services Division, Ministry of Health

Malaysia: Kuala Lumpur, 2017.

2. Volume II: Non-Communicable Disease, Risk Factors and Other Health Problems. National Health and

Morbidity Survey 2015; National Institutes of Health, Ministry of Health Malaysia: Kuala Lumpur, 2015.

3. Pharmaceutical Services Programme, Ministry of Health Malaysia. https://www.pharmacy.gov.my

(accessed February 3, 2020), Ministry of Health Medicines Formulary.

13

3 Expenditures on Medicines in Malaysia Tineshwaran Velvanathan, Nazatul Syima Idrus, Muhammad Md Zain, Wan Utma Sapini Wan Abdul Samad, Rosliza Lajis

Table 3.1 Top 50 expenditure on drugs/chemical substances in 2016 (Expenditure in MYR `000)


1 A10B A02 Metformin 64,163.68 24,668.15 88,831.83

2 B03X A01 Erythropoietin 20,641.92 68,041.96 88,683.88

3 A10B B09 Gliclazide 44,033.04 37,650.74 81,683.78

4 C10A A05 Atorvastatin 7,958.14 71,697.31 79,655.46

5 J07C A06 Diphtheria-Hemophilus influenzae B-pertussis-poliomyelitis-tetanus

56,002.56 10,278.64 66,281.19

6 N02B E01 Paracetamol 20,490.62 40,394.67 60,885.30

7 J01C R02 Amoxicillin and beta-lactamase inhibitor 20,685.74 38,818.33 59,504.07

8 C10A A07 Rosuvastatin 1,757.50 54,223.53 55,981.04

9 C08C A01 Amlodipine 9,847.87 44,870.44 54,718.30

10 B01A C04 Clopidogrel 4,181.61 48,111.92 52,293.53

11 J01D C02 Cefuroxime 19,377.66 32,408.92 51,786.58

12 A02B C02 Pantoprazole 5,738.36 41,664.73 47,403.08

13 A10B D07 Metformin and sitagliptin 1,196.85 45,468.74 46,665.59

14 J01D D04 Ceftriaxone 10,068.04 35,361.48 45,429.53

15 A02B C05 Esomeprazole 7,105.84 38,258.02 45,363.86

16 C10A A01 Simvastatin 30,435.72 14,164.01 44,599.74

17 M01A H01 Celecoxib 8,710.54 33,858.55 42,569.08

18 M01A H05 Etoricoxib 1,988.51 36,067.18 38,055.69

19 C09A A04 Perindopril 24,477.76 11,878.28 36,356.05

20 A10A D01 Insulin (human), intermediate- or long-acting combined with fast-acting

34,296.71 892.61 35,189.32

21 R01B A52 Pseudoephedrine, combinations 944.35 32,287.90 33,232.26

22 V03A C03 Deferasirox 29,733.09 594.43 30,327.51

23 A11G A01 Ascorbic acid (vitamin C) 4,057.95 25,864.84 29,922.78

24 R03A C02 Salbutamol 7,427.88 22,452.26 29,880.15

25 B05A A01 Albumin 14,413.11 14,263.16 28,676.28

26 L01X C02 Rituximab 16,082.08 12,593.65 28,675.73

27 L01X C03 Trastuzumab 12,961.00 15,498.75 28,459.75

28 L01X E01 Imatinib 24,388.03 3,789.43 28,177.46

29 C09D B01 Valsartan and amlodipine 1,305.50 26,871.19 28,176.69

30 J07A L02 Pneumococcus, purified polysaccharides antigen conjugated

484.78 27,208.27 27,693.05

31 S01X A20 Artificial tears and other indifferent

preparations

1,781.13 24,886.44 26,667.57

32 L01X E08 Nilotinib 24,933.56 1,587.86 26,521.43

33 R06A A02 Diphenhydramine 22,836.73 3,085.09 25,921.83

34 N03A X16 Pregabalin 5,289.78 20,532.33 25,822.10

35 R03A K06 Salmeterol and fluticasone 11,376.50 13,433.87 24,810.37

36 R03D C03 Montelukast 929.30 23,659.51 24,588.82

37 C07A B07 Bisoprolol 4,645.61 18,754.33 23,399.94

38 G04B E03 Sildenafil 1,481.14 21,511.18 22,992.32

39 J01C A04 Amoxicillin 13,928.25 8,848.53 22,776.78

40 C07A B02 Metoprolol 20,819.16 1,671.73 22,490.89

41 C09C A07 Telmisartan 5,975.16 16,454.22 22,429.38

42 R05C A10 Expectorants, combinations 20.58 21,906.88 21,927.46

43 M01A H04 Parecoxib 1,527.11 20,170.47 21,697.58

44 J01C F02 Cloxacillin 19,449.98 2,135.81 21,585.79

45 A10A B01 Insulin (human), fast-acting 21,271.43 256.00 21,527.44

46 N05A H04 Quetiapine 17,037.73 4,300.68 21,338.41

47 B03A A02 Ferrous fumarate 20,888.70 97.92 20,986.62

48 J05A F10 Entecavir 4,506.22 16,185.97 20,692.19

49 B01A B01 Heparin 16,339.84 4,300.40 20,640.24

50 R06A E07 Cetirizine 135.00 20,253.53 20,388.53

14

Table 3.2 Top 50 expenditure on drugs/chemical substances in 2015 (Expenditure in MYR `000)


1 A10B A02 Metformin 68,134.29 25,856.82 93,991.11

2 A10B B09 Gliclazide 45,314.51 35,556.98 80,871.48

3 B03X A01 Erythropoietin 13,767.44 64,804.40 78,571.84

4 C10A A05 Atorvastatin 5,275.99 67,320.12 72,596.11

5 N02B E01 Paracetamol 24,290.25 37,450.49 61,740.74

6 J07C A06 Diphtheria-Hemophilus influenzae B-

pertussis-poliomyelitis-tetanus

57,192.64 4,163.34 61,355.99

7 C10A A01 Simvastatin 45,360.16 15,367.67 60,727.83

8 C08C A01 Amlodipine 11,416.97 45,475.01 56,891.98

9 J01C R02 Amoxicillin and beta-lactamase inhibitor 20,236.08 33,996.80 54,232.88

10 B01A C04 Clopidogrel 5,673.33 48,173.01 53,846.34

11 J01D C02 Cefuroxime 19,953.67 33,574.87 53,528.54

12 C10A A07 Rosuvastatin 1,984.49 49,498.54 51,483.04

13 A02B C05 Esomeprazole 10,585.34 37,615.07 48,200.41

14 J01D D04 Ceftriaxone 10,891.56 31,778.78 42,670.34

15 A02B C02 Pantoprazole 4,362.56 37,216.47 41,579.03

16 A10B D07 Metformin and sitagliptin 1,208.89 38,869.88 40,078.77

17 M01A H01 Celecoxib 6,882.44 30,270.36 37,152.80

18 M01A H05 Etoricoxib 2,120.50 34,593.76 36,714.26

19 R01B A52 Pseudoephedrine, combinations 1,259.47 31,357.53 32,617.00

20 V03A C03 Deferasirox 31,607.54 782.75 32,390.29

21 R03A C02 Salbutamol 8,237.47 22,905.27 31,142.74

22 C09A A04 Perindopril 19,504.34 11,372.61 30,876.95

23 R06A A02 Diphenhydramine 27,021.48 3,191.33 30,212.81

24 A11G A01 Ascorbic acid (vitamin C) 4,708.28 24,552.66 29,260.94

25 S01X A20 Artificial tears and other indifferent

preparations

1,892.95 26,797.39 28,690.34

26 C09D B01 Valsartan and amlodipine 991.32 26,339.18 27,330.50

27 C07A B02 Metoprolol 25,531.78 1,677.11 27,208.89

28 G04B E03 Sildenafil 2,323.31 24,307.54 26,630.85

29 J01C A04 Amoxicillin 17,149.94 9,405.95 26,555.89

30 L01X E08 Nilotinib 24,462.46 1,721.90 26,184.35

31 C09C A07 Telmisartan 10,370.55 15,383.97 25,754.52

32 J07A L02 Pneumococcus, purified polysaccharides

antigen conjugated

314.32 25,364.77 25,679.09

33 L01X C03 Trastuzumab 10,251.59 15,291.34 25,542.93

34 R03D C03 Montelukast 1,366.21 23,621.41 24,987.62

35 B05A A01 Albumin 15,118.04 9,416.77 24,534.81

36 R03A K06 Salmeterol and fluticasone 9,770.76 14,545.39 24,316.15

37 J01C F02 Cloxacillin 22,142.01 2,071.08 24,213.09

38 L01X C02 Rituximab 12,644.57 11,472.63 24,117.20

39 J07B M01 Papillomavirus (human types 6, 11, 16, 18) 18,249.77 5,240.61 23,490.38

40 A10A D01 Insulin (human), intermediate- or long-

acting combined with fast-acting

22,051.05 929.29 22,980.35

41 B03A A02 Ferrous fumarate 22,764.62 93.84 22,858.47

42 N03A X16 Pregabalin 3,876.92 17,637.52 21,514.44

43 B01A B01 Heparin 17,422.15 3,770.18 21,192.33

44 J05A F10 Entecavir 4,298.05 16,653.33 20,951.39

45 A02B A02 Ranitidine 14,521.77 6,326.23 20,848.00

46 C07A B07 Bisoprolol 3,239.94 17,281.83 20,521.77

47 J01F A10 Azithromycin 1,004.26 19,476.56 20,480.82

48 R05C A10 Expectorants, combinations 0.00 20,436.43 20,436.43

49 N05A H04 Quetiapine 16,716.60 3,614.17 20,330.78

50 J01D H02 Meropenem 4,670.32 15,469.62 20,139.94

15

The Malaysia National Health Accounts (MNHA) framework reported the total expenditure on health (TEH)

in Malaysia for the year 2017 was at MYR 57,361 million which accounted for 4.24% of gross domestic

product (GDP). The MHNA report stated that the Ministry of Health (MoH) alone has spent MYR 3.6 million

in year 1997 and this amount increased steeply to MYR 24.7 million in year 2017 which constituted about

43% of TEH of the respective years. In relation to GDP, the MoH expenditure specifically has taken up

about 1.83% out of the 4.24% Malaysian GDP accounted for TEH in year 2017. Approximately 10% of total

MoH expenditure was the pharmaceuticals.1

This chapter assesses drug expenditure for the year 2015 and 2016. The total estimated drug expenditure

reported in Malaysia has increased by 2.3% from MYR 5.2 billion in 2015 to MYR 5.3 billion in 2016 as shown

in Figure 3.1. This increment was mainly contributed by the drug expenditure in the private sector which

reported an increment of 5.6%. In contrast, a slight decrement of 2.8% was observed in the public sector

and this was closely related to the marginal shrinkage of the yearly budget allocation in the public sector.

It is important to note that pharmaceutical expenditure by the public sector reported here is lower than

officially reported expenditure as there are several categories of drugs excluded in the report as stated

in Chapter 1.

Figure 3.1 Estimated total expenditure on medicines from 2011 to 2016 between public and private sector,

and in total (MYR ‘000,000)

The top ten therapeutic groups contributed to the highest drug expenditures in 2015 amounted to MYR

2.4 billion and this attributed to 46% of the total expenditure for that year. In the following year, the

expenditure of these therapeutic groups amounted to MYR 2.5 billion and this is attributed to 47% of the

expenditure for that year. Drugs used in diabetes (A10) was ranked the highest both in 2015 and 2016,

followed by antibacterials for systemic use (J01). These two therapeutic groups contributed up to 15% of

the total expenditure in 2016 for public sector. Comparing between year 2015 and 2016 in public sector,

the highest increase in expenditure was observed for antineoplastic agents (L01) at 17.9%. Other

therapeutic groups that are in the top ten list included drugs for blood and blood forming agents (B05),

vaccines (J07), antithrombotic agents (B01), psycholeptics (N05), drugs acting on the renin-angiotensin

system (C09), lipid modifying agents (C10) and immunosuppressants (L04).

Further analyses comparing expenditure in 2015 versus 2016 within public and private sectors reported

that the highest expenditure in the public sector for both years were drugs used in diabetes (A01).

Whereas in the private sector, the antibacterials for systemic use (J01) topped the list. Drugs used in

diabetes (A10), antibacterials for systemic use (J01) and antineoplastic agents (L01) was in the public

sector list of top-ten therapeutic groups which was also seen in the private sector. These similarities may

be due to the prevelance of diseases frequently treated in the two sectors and prescribing pattern within

the therapeutic groups.1

2,170.822,404.07 2,505.07

2,610.20

3,195.093,374.54

1,619.23

1,987.64 1,979.84 2,083.91 2,044.09 1,987.81

3,790.05

4,391.71 4,484.914,694.11

5,239.185,362.35

0.00

1,000.00

2,000.00

3,000.00

4,000.00

5,000.00

6,000.00

2011 2012 2013 2014 2015 2016

Exp

en

ditu

re o

n m

ed

icin

es

(MY

R '0

00

,00

0)

Private Public Public + Private

16

An increasing trend in expenditure from year 2015 to 2016 was observed in the public sector for blood

substitutes and perfusion solutions (B05), followed by lipid modifying agent (C10), antineoplastic agents

(L01) and drugs used in diabetes (A10) (Table 3.3). The increase in expenditure for lipid modifying agents

may be due to the increase in utilisation of statins to treat the increasing number of diagnosed cases of

hypercholesterolaemia. In addition, new strength were added for combination of ezetimibe with

simvastatin to the Ministry of Health Medicines Formulary (MoHMF) in 2015. For antineoplastic agents, the

increase was possibly driven by the listing of highly priced new innovative drugs including targeted

therapy and the addition of new strengths and indications into the MoHMF between 2015 to 2016.

Example of such drugs are bendamustine hydrochloride and sunitinib malate, whereby both drugs were

listed in MoHMF in 2016. For bortezomib, new indications were added to the MoHMF in 2015 and new

strength for trastuzumab and erlotinib was added in 2016. The increasing trend in expenditure for drugs

used in diabetes (A10) may also be caused by the addition of new strength for insulin lispro in 2016 MoHMF.

Table 3.3 Top 10 expenditure on medicines by therapeutic groups in 2016 compared to 2015 (MYR

`000,000)

Sector ATC

code

Therapeutic group 2015 2016 Changes

from 2015 (%) Expenditure Rank Expenditure Rank

Public

and

private

A10 Drugs used in diabetes 410.23 2 455.69 1 11.1

J01 Antibacterials for systemic

use

415.72 1 408.20 2 -1.8

L01 Antineoplastic agents 245.12 4 290.91 3 18.7


angiotensin system

235.21 5 250.75 4 6.6

C10 Lipid modifying agents 247.33 3 245.79 5 -0.6

J07 Vaccines 206.28 6 210.97 6 2.3

A02 Drugs for acid related

disorders

184.22 7 189.28 7 2.7




175.96 8 176.55 9 0.3


diseases

161.35 10 155.48 10 -3.6

Public A10 Drugs used in diabetes 192.39 1 214.19 1 11.3

J01 Antibacterials for systemic

use

152.55 2 136.36 2 -10.6


B05 Blood substitutes and

perfusion solutions

69.05 8 115.03 4 66.6

J07 Vaccines 103.01 4 98.36 5 -4.5

B01 Antithrombotic agents 77.18 6 74.77 6 -3.1

N05 Psycholeptics 78.30 5 73.45 7 -6.2


angiotensin system

56.97 9 60.55 8 6.3

C10 Lipid modifying agents 73.10 7 59.41 9 -18.7

L04 Immunosuppressants 57.14 10 57.06 10 -0.1

Private J01 Antibacterials for systemic

use

263.17 1 271.84 1 3.3

A10 Drugs used in diabetes 217.83 2 241.49 2 10.9


angiotensin system

178.23 3 190.20 3 6.7




158.17 5 157.97 5 -0.1


A02 Drugs for acid related

disorders

135.84 6 145.90 7 7.4

J07 Vaccines 103.26 8 112.62 8 9.1



diseases

101.85 9 102.51 10 0.6

17

Table 3.3 shows the highest increase was seen in lipid modifying agent, drugs used in diabetes and

vaccines in private sector. The upward trend of expenditure was likely contributed by the steady increase

in utilisation of drugs in these therapeutic groups influenced by the prevalence of cardiovascular diseases,

diabetes and also seasonal outbreaks of infectious diseases which required vaccinations.

The reported average public sector share of drug expenditure in 2015 and 2016 was 39% and 37%,

respectively. Throughout the years, statistics indicate that the public sector has managed to provide wider

coverage of medicines at lower prices possibly due to effective procurement strategies.2

For drugs used in diabetes (A10), metformin (A10B A02) contributed to the highest expenditure mainly in

the public sector followed by gliclazide (A10B B09) in both sectors while combination of metformin and

sitagliptin (A10B D07) was highest in the private sector. For lipid modifying agents, the highest contributor

was the statin group specifically referring to atorvastatin (C10A A05) in the private sector followed by

simvastatin (C10A A01) in the public sector and rosuvastatin (C10A A07) in the private sector.

The top-five drugs with the highest expenditure between 2015 and 2016 were metformin (A10B A02),

erythropoietin (B03X A01), gliclazide (A10B B09), diphtheria-hemophilus influenzae B-pertussis-poliomyelitis-

tetanus vaccine (J07C A06), and atorvastatin (C10A A05). In 2015, a total of MYR 387 million was spent

on these drugs contributing to approximately 7% of the total expenditure. For metformin (A10B A02),

erythropoietin (B03X A01) and gliclazide (A10B B09), the expenditure was mainly contributed by the public

sector. Different expenditure trend was seen in Australia in which the top-five drugs by expenditure were

reported to be esomeprazole (A02B C05), combination of salmeterol and fluticasone (R03A K06),

rosuvastatin (C10A A07), pregabalin (N03A X16), adalimumab (L04A B04) and atorvastatin (C10A A05).

Overall, there is an increasing trend of expenditure over the years contributed by the increased burden

of diseases particularly non-communicable diseases, increase in ageing population and emergent of

newly innovative therapies.1

REFERENCES

1. Malaysia National Health Accounts: Health Expenditure Report 1997- 2017; Planning Division, Ministry

of Health Malaysia: Putrajaya, 2019.

2. Malaysian National Medicines Policy 2nd Edition 2012; Dasar Ubat Nasional, Edisi Kedua, 2012;

Pharmaceutical Services Division, Ministry of Health Malaysia: Kuala Lumpur, 2013.

18

4 Alimentary Tract and Metabolism

4.1 Statistics on medicines for alimentary tract and metabolism

Table 4.1 Statistics by therapeutic groups for alimentary tract and metabolism, in public and private sector

(Utilisation in DDD/1,000 inhabitants/day)

ATC code Therapeutic group 2015 2016

Public Private Total Public Private Total

A Alimentary tract and

metabolism

81.6833 38.6494 120.3327 78.5883 38.0317 116.6200

A02 Drugs for acid related disorders 7.2656 3.7382 11.0038 6.9301 3.6746 10.6047

A03 Drugs for functional

gastrointestinal disorders

0.7283 2.0165 2.7448 0.4834 1.7039 2.1873

A04 Antiemetics and antinauseants 0.0097 0.0104 0.0200 0.0128 0.0117 0.0245

A05 Bile and liver therapy 0.0115 0.0231 0.0346 0.0055 0.0202 0.0257

A06 Drugs for constipation 0.7783 1.5965 2.3748 1.0752 1.5805 2.6556

A07 Antidiarrheals, intestinal

antiinflammatory/antiinfective

agents

0.2890 0.6690 0.9580 0.2799 0.6942 0.9741

A08 Antiobesity preparations,

excluding diet products

0.0028 0.5394 0.5422 0.0008 0.4575 0.4583

A10 Drugs used in diabetes 63.7128 11.3484 75.0611 61.9611 11.3131 73.2742

A11 Vitamins 5.4220 18.0759 23.4979 4.7050 18.1011 22.8061

A12 Mineral supplements 3.4623 0.5894 4.0517 3.1342 0.4378 3.5721

A14 Anabolic agents for systemic

use

0.0001 - 0.0001 0.0001 - 0.0001

A16 Other alimentary tract and

metabolism products

0.0009 0.0426 0.0435 0.0002 0.0371 0.0373

19

Table 4.2 Drugs for acid related disorders, A02 (Utilisation in DDD/1,000 inhabitants/day)

ATC code Drug/Chemical substance 2015 2016


A02B Drugs for peptic ulcer and

gastro-oesophageal reflux

disease (GORD)

7.2656 3.7382 11.0038 6.9301 3.6746 10.6047

A02B A H2-receptor antagonists 3.7358 0.8488 4.5846 3.3000 0.7153 4.0153

A02B A01 Cimetidine - 0.1658 0.1658 - 0.1641 0.1641

A02B A02 Ranitidine 3.7358 0.4796 4.2154 3.3000 0.3206 3.6206

A02B A03 Famotidine - 0.2034 0.2034 - 0.2306 0.2306

A02B B Prostaglandins 0.0001 0.0074 0.0075 0.0003 0.0049 0.0052

A02B B01 Misoprostol 0.0001 0.0074 0.0075 0.0003 0.0049 0.0052

A02B C Proton pump inhibitors 3.5291 2.8435 6.3725 3.6294 2.9172 6.5466

A02B C01 Omeprazole 2.4556 0.8574 3.3130 2.2826 0.8608 3.1434

A02B C02 Pantoprazole 0.7027 0.7876 1.4904 0.9729 0.8655 1.8384

A02B C03 Lansoprazole 0.0377 0.1931 0.2308 0.0406 0.1199 0.1605

A02B C04 Rabeprazole 0.0097 0.1519 0.1616 0.0198 0.1735 0.1933

A02B C05 Esomeprazole 0.3225 0.6858 1.0083 0.3124 0.6477 0.9600

A02B C06 Dexlansoprazole 0.0008 0.1676 0.1684 0.0010 0.2499 0.2509

A02B D Combinations for eradication

of Helicobacter pylori

- 0.0212 0.0212 - 0.0207 0.0207

A02B D00 Omeprazole, clarithromycin

and tinidazole

- 0.0024 0.0024 - 0.0002 0.0002

A02B D05 Omeprazole, amoxicillin and

clarithromycin

- 0.0188 0.0188 - 0.0205 0.0205

A02B X Other drugs for peptic ulcer

and gastro-oesophageal

reflux disease (GORD)

0.0006 0.0173 0.0179 0.0005 0.0165 0.0170

A02B X02 Sucralfate 0.0005 0.0001 0.0006 0.0003 0.0004 0.0007

A02B X14 Rebamipide 0.0002 0.0172 0.0173 0.0002 0.0160 0.0162

Table 4.3 Drugs for functional gastrointestinal disorders, A03 (Utilisation in DDD/1,000 inhabitants/day)

ATC code Drug/Chemical substance 2015 2016


A03A Drugs for functional

gastrointestinal disorders

0.0228 0.3599 0.3827 0.0110 0.3827 0.3937

A03A A Synthetic anticholinergics,

esters with tertiary amino

group

0.0191 0.0695 0.0886 0.0070 0.0

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