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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
Ministry of Health Malaysia
Published by Pharmaceutical Services Programme
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
Coordinator Mr. Tineshwaran Velvanathan
Pharmacist
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Mdm Azzy Iyzati Ahmad Shanizza
Research Officer
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Mdm Chan Lai Yue
Pharmacist
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Statistician Ms. Mary Chok Chiew Fong
Pharmacist
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Research Assistant Ms. Safura Sa’ad
Research Officer
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Ms. Noor Atiqah Mat Yusoff
Research Officer
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Mr. Mohd Faiz Abdul Manan
Research Officer
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Reviewers of Malaysian Statistics on Medicines 2015-2016
Mdm Norazlin A. Kadir
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm Hazimah Hashim
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm. Haarathi Chandriah
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
vi
Technical Advisory Committee of National Medicines Utilisation Study
Chairperson Dr. Hasenah Ali
Director
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Co-chairperson Dr. Roshayati Mohamad Sani
Director
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Secretary Dr. Azuana Ramli
Deputy Director
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Member Mdm Nur’Ain Shuhaila Shohaimi
Deputy Director
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
Mdm Wan Utma Sapini Wan Abdul Samad
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm Norazlin A. Kadir
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm Rosliza Lajis
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Ms. Nor Hasni Haron
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Ms. Teoh Iyinh Theng
Pharmacist
Pharmacy Policy and Strategic Planning Division
Ministry of Health Malaysia
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
Kuala Lumpur Hospital
DERMATOLOGY
Dr. Suganthi Thevarajah
Head of Department & Senior Consultant
Dermatologist
Kuala Lumpur Hospital
Dr. Preamala Gunabalasingam
Head of Department & Consultant
Dermatologist
Melaka Hospital
Dr. Tang Min Moon
Consultant Dermatologist
Kuala Lumpur Hospital
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
Endocrinologist & Physician
Putrajaya Hospital
Dr. Danish Ng Ooi Yee
Endocrinologist & Physician
Selayang Hospital
Dr. Wong Hui Chin
Endocrinologist & Physician
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
Senior Consultant Gastroenterologist &
Hepatologist
Selayang Hospital
Dr. Muhammad Radzi Abu Hassan
Senior Consultant Gastroenterologist &
Hepatologist
Sultanah Bahiyah Hospital, Alor Setar
Dr. Zalwani Zainuddin
Consultant Gastroenterologist & Hepatologist
Sultanah Bahiyah Hospital, Alor Setar
viii
Dr. Norasiah Abu Bakar
Consultant Gastroenterologist & Hepatologist
Raja Perempuan Zainab II Hospital, Kota Bharu
HAEMATOLOGY
Dr. Jameela Sathar
Head of Department & Consultant
Haematologist
Ampang Hospital
IMMUNIZATION/VACCINE
Dr. Rohani Jahis
Head of Section (Zoonosis Control)
Disease Control Division
Ministry of Health Malaysia
Dr. Jamiatul Aida Md Sani
Public Health Specialist
Disease Control Division
Ministry of Health Malaysia
Mdm Najwa Ahmad Hamdi
Pharmacist
Public Health Development Division
Ministry of Health Malaysia
INFECTIOUS DISEASES
Dr. Leong Chee Loon
Infectious Disease Consultant Physician
Kuala Lumpur Hospital
Dr. Steven Lim Chee Loon
Infectious Disease Specialist
Raja Permaisuri Bainun Hospital, Ipoh
Dr. Rahela Ambaras Khan
Pharmacist
Kuala Lumpur Hospital
Mdm Hannah Md Mahir
Pharmacist
Sungai Buloh Hospital
Mdm Mak Woh Yon
Pharmacist
Kuala Lumpur Hospital
Mdm Preethi Raghavan
Pharmacist
Sungai Buloh Hospital
NEUROLOGY
Dr. Zariah Abdul Aziz
Senior Consultant Neurologist
Sultanah Nur Zahirah Hospital, Kuala
Terengganu
Dr. Sapiah Sapuan
Consultant Neurologist
Sungai Buloh Hospital
Dr. Tee Sow Kuan
Neurologist
Kuala Lumpur Hospital
Dr. Puvanarajah Santhi
Neurologist
Kuala Lumpur Hospital
Mdm Norsima Nazifah Sidek
Pharmacist
Sultanah Nur Zahirah Hospital, Kuala
Terengganu
Mdm Tan Ai Leen
Pharmacist
Kuala Lumpur Hospital
OBSTETRIC AND GYNECOLOGY
Dr. Norashikin Abdul Fuad
Head of Department & Obstetrician &
Gynaecologist
Sungai Buloh Hospital
Dr. Nasuha Yaacob
Obstetrician & Gynaecologist
Sultanah Nur Zahirah Hospital, Kuala
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
Kuala Lumpur Hospital
Dr. Tan Chih Kiang
Clinical Oncologist
National Cancer Institute
Dr. Prathepamalar Yehgambaram
Clinical Oncologist
Kuala Lumpur Hospital
Ms. Nik Nuradlina Nik Adnan
Pharmacist
National Cancer Institute
Ms. Lee Mei Wah
Pharmacist
Kuala Lumpur Hospital
OPHTHALMOLOGY
Dr. Shamala Retnasabapathy
Head of Department & Consultant
Ophthalmologist
Sungai Buloh Hospital
Dr. Jamalia Rahmat
Head of Department & Consultant
Ophthalmologist
Kuala Lumpur Hospital
Dr. Vanitha Ratnalingan
Consultant Ophthalmologist
Sungai Buloh Hospital
ORTHOPAEDIC
Dr. Fazir Mohamad
Head of Department & Consultant in
Orthopaedic Surgery
Kuala Lumpur Hospital
OTORHINOLARYNGOLOGY
Dr. Siti Sabzah Mohd Hashim
National Head of Otorhinolaryngology Services
& Senior Consultant in Otorhinolaryngology
Sultanah Bahiyah Hospital, Alor Setar
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
Head of Department & Senior Consultant in
Otorhinolaryngology
Kuala Lumpur Hospital
Dr. Jothi Shanmuganathan
Head of Department & Senior Consultant in
Otorhinolaryngology
Sultanah Aminah Hospital, Johor Bahru
Dr. Amran Mohamad
Senior Consultant in Otorhinolaryngology
Sultanah Nur Zahirah Hospital, Kuala
Terengganu
Dr. Halimuddin Sawali
Head of Department & Consultant in
Otorhinolaryngology
Queen Elizabeth Hospital, Kota Kinabalu
Mr. Leow Wooi Leong
Pharmacist
Kuala Lumpur Hospital
PHARMACOECONOMIC
Mdm Wan Utma Sapini Wan Abdul Samad
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm Rosliza Lajis
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
x
Mdm Nazatul Syima Idrus
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mr. Muhammad Md Zain
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mr. Tineshwaran Velvanathan
Pharmacist
Pharmacy Policy and Strategic Planning
Division
Ministry of Health Malaysia
PSYCHIATRY
Dr. Norharlina Bahar
Consultant Psychiatrist
Selayang Hospital
Dr. Chin Loi Fei
Consultant Psychiatrist
Sungai Buloh Hospital
Dr. Azizul Awaluddin
Consultant Psychiatrist
Putrajaya Hospital
Dr. Noormazita Mislan
Consultant Psychiatrist
Tuanku Ja’afar Hospital, Seremban
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
Tuanku Ja’afar Hospital, Seremban
Dr. Mollyza Mohd Zain
Medical Consultant in Rheumatology
Selayang Hospital
Dr. Liza Mohd Isa
Medical Consultant in Rheumatology
Putrajaya Hospital
Dr. Chong Hwee Cheng
Medical Consultant in Rheumatology
Melaka Hospital
Mdm Siti Rabiatul Adawiyah
Pharmacist
Tuanku Ja’afar Hospital, Seremban
UTILISATION OF MEDICINES
Mdm Rozita Mohamad
Deputy Director
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Dr. Rosliana Rosli
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm Yusmiza Azmi
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Ms. Sarahfarina Abdul Rahim
Pharmacist
Pharmacy Practice and Development Division
Ministry of Health Malaysia
Mdm Azzy Iyzati Ahmad Shanizza
Research Officer
Pharmacy Policy and Strategic Planning
Division
Ministry of Health Malaysia
Ms. Mary Chok Chiew Fong
Pharmacist
Pharmacy Policy and Strategic Planning
Division
Ministry of Health Malaysia
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
C09 Agents acting on the renin-
angiotensin system
31.3996 3 39.3969 3 25.5
C10 Lipid modifying agents 26.6695 4 27.6987 4 3.9
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
G03 Sex hormones and modulators of
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
C09 Agents acting on the renin-
angiotensin system
10.8191 5 11.2788 4 4.2
M01 Antiinflammatory and
antirheumatic products
11.2517 4 9.6440 5 -14.3
C10 Lipid modifying agents 8.7064 7 8.9001 6 2.2
G03 Sex hormones and modulators of
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)
Rank ATC code Drug/Chemical substance Public Private Total
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
C10A A05 Atorvastatin 3.6784 14 6.2988 10 71.2
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
C10A A05 Atorvastatin 3.2641 8 3.3942 6 4.0
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)
Rank ATC code Drug/Chemical substance Public Private Total
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)
Rank ATC code Drug/Chemical substance Public Private Total
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
C09 Agents acting on the renin-
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
B01 Antithrombotic agents 175.34 9 182.82 8 4.3
M01 Antiinflammatory and
antirheumatic products
175.96 8 176.55 9 0.3
R03 Drugs for obstructive airway
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
L01 Antineoplastic agents 114.24 3 134.71 3 17.9
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
C09 Agents acting on the renin-
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
C09 Agents acting on the renin-
angiotensin system
178.23 3 190.20 3 6.7
C10 Lipid modifying agents 174.24 4 186.38 4 7.0
M01 Antiinflammatory and
antirheumatic products
158.17 5 157.97 5 -0.1
L01 Antineoplastic agents 130.89 7 156.20 6 19.3
A02 Drugs for acid related
disorders
135.84 6 145.90 7 7.4
J07 Vaccines 103.26 8 112.62 8 9.1
B01 Antithrombotic agents 98.16 10 108.05 9 10.1
R03 Drugs for obstructive airway
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
Public Private Total Public Private Total
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
Public Private Total Public Private Total
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
Recommended