Stochastic cellular automata model and Monte Carlo simulations of CD4+ T cell dynamics with a proposed alternative leukapheresis treatment for HIV/AIDS

Acquired Immunodeficiency Syndrome (AIDS) is responsible for millions of deaths worldwide. To date, many drug treatment regimens have been applied to AIDS patients but none has resulted in a successful cure. This is mainly due to the fact that free HIV particles are frequently in mutation, and infected CD4⁺ T cells normally reside in the lymphoid tissue where they cannot (so far) be eradicated. We present a stochastic cellular automaton (CA) model to computationally study what could be an alternative treatment, namely Leukapheresis (LCAP), to remove HIV infected leukocytes in the lymphoid tissue. We base our investigations on Monte Carlo computer simulations. Our major objective is to investigate how the number of infected CD4⁺ T cells changes in response to LCAP during the short-time (weeks) and long-time (years) scales of HIV/AIDS progression in an infected individual. To achieve our goal, we analyze the time evolution of the CD4⁺ T cell population in the lymphoid tissue (i.e., the lymph node) for HIV dynamics in treatment situations with various starting times and frequencies and under a no treatment condition. Our findings suggest that the effectiveness of the treatment depends mainly on the treatment starting time and the frequency of the LCAP. Other factors (e.g., the removal proportion, the treatment duration, and the state of removed cells) that likely influence disease progression are subjects for further investigation.     

Factors affecting health-related quality of life in Thai children with thalassemia

Background

Knowledge of the factors associated with health-related quality of life (HRQOL) among patients with thalassemia is essential in developing more suitable clinical, counseling, and social support programs to improve treatment outcomes of these patients. In light of the limited research in this area, this study aims to examine factors associated with HRQOL among children and adolescents with thalassemia in Thailand.

Methods

A cross-sectional survey was conducted in three selected hospitals in Thailand during June to November 2006. PedsQL? 4.0 Generic Core Scale (Thai version) was used to assess HRQOL in 315 thalassemia patients between 5 and 18 years of age. Other related clinical characteristics of the patients were collected via medical record review.

Results

The mean (SD) of the total summary score was 76.67 (11.40), while the means (SD) for the Physical Health Summary score and Psychosocial Health Summary score were 78.24 (14.77) and 75.54 (12.76), respectively. The school functioning subscale scored the lowest, with a mean of 67.89 (SD = 15.92). The following factors significantly affected the HRQOL of the patients: age; age at onset of anemia and age at first transfusion; pre-transfusion hemoglobin (Hb) level; receiving a blood transfusion during the previous three months; and disease severity. In addition, iron chelation therapy had a significant negative effect on HRQOL in the school functioning subscale. In contrast, serum ferritin level, frequency of blood transfusions per year, and gender were not significantly related to HRQOL among these patients. The results from multivariate analysis also confirmed these findings.

Conclusions

To improve HRQOL of thalassemia patients, suitable programs aimed at providing psychosocial support and a link between the patient, school officials, the family and the physician are important, especially in terms of improving the school functioning score. The findings also confirmed the importance of maintaining a pre-transfusion Hb level of at least 9-10.5 g/dL. In addition, special care and attention should be given to patients with a severe condition, and those who are receiving subcutaneous iron chelation therapy.

     

Diabetes Cost Model of a Hospital in Thailand

OBJECTIVE: This study aims to formulate a cost model from a provider perspective regarding the direct medical costs for diabetic patients who received care in a 30-bed public hospital in Thailand during the fiscal year of 2001. METHODS: This study is a retrospective prevalence-based cost of illness study. Data were collected by reviewing the medical record of each patient for the whole year. The statistical analysis employed was the stepwise multiple regression method. RESULTS: The study covered 186 diabetic patients. It was found that the average cost of caring for a diabetic patient per year was 6331 Thai baht (THB) at 2001 prices (approximately 40 THB = US 1 dollar). A major portion of this cost was spent for pharmacy services, which accounted for 45% of the whole cost, followed by outpatient services (24%), inpatient services (16%), and laboratory investigation (11%). Regarding the model for forecasting the cost, the type of diabetes and its accompanying complications, i.e., hyperlipidemia, cardiovascular accident, hypertension, hyperglycemia, hypoglycemia, gangrene, and diabetic foot, were considered as significant predictor variables (adjusted R(2) = 0.48). The quantitative effects in monetary term of these significant predictors were also demonstrated. CONCLUSIONS: The results could be beneficial in forecasting the economic burden of diabetes mellitus in Thailand. Furthermore, the results could be used as a financial tool for cost control and disease management at the community hospital level.     

Treatment costs of pneumonia, meningitis, sepsis, and other diseases among hospitalized children in Viet Nam

The aim of this study was to estimate the costs of treatment of children who present with the signs and symptoms of invasive bacterial diseases in Khanh Hoa province, Viet Nam. The study was an incidence-based cost-of-illness analysis from the health system perspective. The hospital costs included labour, materials and capital costs, both direct and indirect. Costs were determined for 980 children, with an average age of 12.67 months (standard deviation +/- 11.38), who were enrolled in a prospective surveillance at the Khanh Hoa General Hospital during 2005-2006. Of them, 57% were male. By disease-category, 80% were suspected of having pneumonia, 8% meningitis, 3% very severe disease consistent with pneumococcal sepsis, and 9% other diseases. Treatment costs for suspected pneumonia, meningitis, very severe disease, and other diseases were US$ 31, US$ 57, US$ 73, and US$ 24 respectively. Costs ranged from US$ 24 to US$ 164 across different case-categories. Both type of disease and age of patient had statistically significant effects on treatment costs. The results showed that treatment costs for bacterial diseases in children were considerable and might differ by as much as seven times among invasive pneumococcal diseases. Changes in costs were sensitive to both age of patient and case-category. These cost-of-illness data will be an important component in the overall evidence base to guide the development of vaccine policy in Viet Nam.     

Disability and cost for diabetic patients at a public district hospital in Thailand

Objective The study determined the rate of disability among diabetic patients at a public district hospital in Thailand and compared the costs of illness among different levels of severity of disability. This was the first such study carried out in Thailand. Methods The study was conducted at Waritchaphum Hospital in northeastern Thailand. Data were collected from 475 randomly selected diabetic patients identified by the World Health Organization's International Classification of Diseases, tenth revision (ICD‐10 codes E10 – E14) who received treatment from the study hospital during the fiscal year of 2008. The disability levels were determined by using Thailand ministerial guidelines as well as the Barthel index score. Cost‐of‐illness estimates followed the prevalence‐based approach and it presented the societal perspective of cost‐of‐illness of diabetes in 2008. Key findings The study results showed that 9.68% of the study participants had physical impairment while 9.26% had impairment in eyesight. The Barthel index score showed that 13.5% of the study participants were disabled. When comparing costs between independent and disabled persons, considering the Barthel index score, average costs for the disabled diabetic persons were significantly higher than for those who were independent (US$2700.29 versus 598.24; P < 0.001). Conclusions The study concluded that the presence of complications and disability among diabetic patients impacts severely on Thai society. At present, the Thai government allocates US$187.5 per annum to registered disabled persons as a disability living allowance. The study found a large difference between the direct economic outlay of the patients and the allowance provided, which suggests that there is probably a need to revise the welfare payment upwards.     

Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Objective

To explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets.

Methods

The costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the African Quinine Artesunate Malaria Treatment trial, conducted with over 5400 children. The drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. The data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (DALY) averted and the cost per death averted.

Findings

The mean cost of treating severe malaria patients was similar in the two study groups: 63.5 United States dollars (US$) (95% confidence interval, CI: 61.7–65.2) in the quinine arm and US$ 66.5 (95% CI: 63.7–69.2) in the artesunate arm. Children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 DALYs per patient; quinine arm: 3.0 DALYs per patient). Compared with quinine as a baseline, artesunate showed an incremental cost per DALY averted and an incremental cost per death averted of US$ 3.8 and US$ 123, respectively.

Conclusion

Artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. The budgetary implications of adopting artesunate for routine use in hospital-based care are negligible.