Using big data to improve population health and resource allocation for people with diabetes in Malaysia

The project aims to inform public policies concerning diabetes in Malaysia by producing evidence of its impact on people living with diabetes, on the health care system and society in general. Living with diabetes is a challenge and we will analyse how it affects people's health, for example by damaging the heart, eyes, feet and kidneys. We will also investigate the pressure that diabetes puts on Malaysia as a country, in terms of both human suffering and money. With the cost pressure set to grow, there are several opportunities to improve care for people with diabetes. We will analyse how the type of patient and access to different types of care may affect the health of people with diabetes, with a special focus on the poorest groups of society. The most deprived homes are likely to experience more harmful consequences of diabetes than those least deprived and tailored care approaches should be designed to meet the diversity of needs within the diabetic population.

The project will use data from people with type 2 diabetes in Malaysia provided through several large health datasets including the Malaysian National Diabetes Register, several clinical trials and a cohort study. Researchers from Malaysia and the United Kingdom will collaborate closely to develop a type 2 diabetes simulation model suitable for the Malaysian diabetic population. We will use the model to predict both diabetes-related health consequences and costs over the lifetime of people with diabetes in Malaysia. This will help identify opportunities and strategies for improving care for people with diabetes. These strategies are likely to incorporate a variety of complementary actions, from increasing the support for lifestyle changing behaviour, to improving education about diabetes and introducing health-improving and cost-saving drugs. Using the simulation model, we will be able to measure the impact of the proposed care plans relative to current care and evaluate whether they could achieve improvements in the health of people with diabetes and represent good value for money in Malaysia. Furthermore, in addition to assessing the healthcare system expenditure due to diabetes, we will also compare the difference in private payments between people with and without diabetes. This is to learn whether people with diabetes are at increased risk of poverty, and to inform debates about what additional financial support they may need compared to people without diabetes.

The findings from the project will be used to support national health policy and planning in Malaysia and improve healthcare spending for the treatment and prevention of diabetes. We intend to work closely with policy-makers and aim to help them build their capacity to tackle the challenges presented by diabetes. For example, we will hold workshops in Malaysia that will focus on the use of simulation models to strengthen evidence-based policy.

The project aims to promote the economic development, health and welfare of Malaysia. In a close collaboration between researchers from Malaysia and the UK, this involves developing economic/epidemiological programmes aimed at improving policies to treat and prevent diabetes in Malaysia. The project will take advantage of large clinical datasets, which are currently held by the University of Oxford (and include long-term follow-up of people from Malaysia with diabetes). We will also analyse data collected by the Malaysian National Diabetes Register and the JADE study to understand patient characteristics, treatment patterns and access to care, as well as how these influence outcomes for people with diabetes, with a special focus on more deprived groups.

A key component of the project is to use big data to develop a diabetes simulation model for making short-, mid- and long-term projections of health outcomes and associated costs for people in Malaysia with type 2 diabetes. This model will then be used to evaluate the cost-effectiveness of various interventions including different health service models, diabetes medications and lifestyle modifications. Using large nationally representative household survey data, we will also compare the size of out-of-pocket (OOP) medical payments that diabetic people make compared to those without diabetes, and their vulnerability to 'catastrophic' or impoverishing payments. These analyses will provide evidence to allocate resources for the prevention and treatment of diabetes efficiently and equitably, and inform national health policy and planning. As part of the project, we intend to build research capacity in Malaysia through running workshops and providing training on the use of simulation models. Finally, we will develop strong policy links with the Ministries of Education and Health to provide evidence to inform decisions on more efficient and equitable resource allocations in Malaysia.

The findings from the project will be used to support national health policy and planning in Malaysia and improve healthcare spending for the treatment and prevention of diabetes. There are currently a wide variety of therapies for treating diabetes and a wide variation in the cost of these treatments (with some of the new drug costs up to 20 times existing medications). We intend to develop a simulation modelling tool to assist the Malaysian Ministry of Health and researchers in Malaysia to determine which strategies for preventing and treating diabetes represent value for money.

We also intend to work closely with policy-makers and will aim to build capacity through workshops in Malaysia which will focus on the use of simulation models to strengthen evidence-based policy. Finally, the project may provide a guide for other low-and-middle income countries in Asia to adopt an evidence based process for developing their own strategies for tackling diabetes and other non-communicable diseases.