Million Million UROLOGY FACILITIES AND DEVICES

80 Table 19. 2 Oncology Technologies. Gaps in Medical Technology in Malaysia Expert Opinion Rank of Importance 1. Helical TomoTherapy machine. Availability: Marketed. Function: Therapeutic. Existing Alternative Options: Linear accelerator. Clinical Effectiveness: Less morbidity associated with treatment, better dose escalation. Good to consider technological improvement in terms of reduction radiation exposure. Life-Saving Outcomes: Better with more precise treatment. Health-Cost Implications: Very expensive machine, treatment cost per patient is very much higher Safety Issues: Increased risk if used by inexperienced doctors Prioritization: To be introduced within the next 5 years. 1 81 Table 19. 3 Anaesthesiology and Intensive Care Technologies. Gaps in Medical Technology in Malaysia Expert Opinion Rank of Importance 1. Whole-body cooling system. Availability: Marketed. Function: Assistive. Existing Alternative Options: Water blankets mattresses. Clinical Effectiveness: Avoids immediate and long- term morbidity associated with hypothermia. Ease of use and easier monitoring. Life-Saving Outcomes: Reduces mortality and morbidity associated with newborn hypothermia. Health-Cost Implications: Less costly than selective head cooling system. Safety Issues: Prioritization: To be reintroduced within the next 2 years 1 2. Amplitude-integrated Electroencephalography aEEG Availability: Marketed Function: Diagnostic and assistive Existing Alternative Options: Clinical assessment. The conventional full 12-lead EEG for the same indication is impractical. Clinical Effectiveness: Detection of seizures, level of consciousness, state of sleep or sedation of baby. Able to provide trending over a period of time especially for newborns with moderate to severe birth asphyxia. Life-Saving Outcomes: Health-Cost Implications: Safety Issues: Need to interpret aEEG correctly. Prioritization: To be introduced within the next 2 years. 2 3. Infant Transport Mattress Availability: Marketed. Function: Assistive. Existing Alternative Options: None. Clinical Effectiveness: This chemical mattress is used together with the overhead radiant warmer during the resuscitation of extremely low birth weight babies and transport to the neonatal intensive care NICU following the resuscitation. This would avoid the complications of hypothermia. Life-Saving Outcomes: Reduces mortality. Health-Cost Implications: - Safety Issues: May occasionally overheat the baby. Prioritization: To be introduced within the next 5 years. 3 82 4. Olympic Cool Cap System for Selective Head Cooling Availability: Marketed. Function: Therapeutic. Existing Alternative Options: Supportive therapy, no deinitive therapy available. Clinical Effectiveness: Has been shown to reduce mortality and neuro-developmental abnormalities associated with birth asphyxia. Induced hypothermia needs to be carefully controlled and Cool Cap is often used with amplitude EEG monitoring. Life-Saving Outcomes: Reduces mortality. Health-Cost Implications: 1. Expensive system may not be easily available. 2. Total cost with EEG is about RM200,000. However, if effective in reducing disabilities, it may save cost of rehabilitation for both parents and the Ministry of Health. Safety Issues: 1. FDA approved. 2. Complications associated with hypothermia 3. Sinus bradycardia, arrhythmias, hypotension, coagulopathy and increased risk of infections 4. Does technology reduce mortality but increase major disability in survivors? Prioritization: To be introduced within the next 5 years. Additional comments: 1. Although theoretically, the whole body cooling system is more effective, there are no studies comparing these two modalities and results of 3 large multicentre randomized clinical trials on the safety and effectiveness of the whole body cooling systems are still pending. 4