Economic Impact on Health-Care Costs Related to Major Diseases Including HIV/AIDS due to Alcohol Drinking among Thai Populations

Objective:  The objective of this study was to estimate health-care costs because of diseases caused by alcohol consumption based on health system's perspective.
Methods:  Total direct health-care costs of alcohol drinking were the summation of the costs of alcohol drinking in inpatient and outpatient departments due to chronic diseases and acute conditions using prevalence-based approach. The alcohol-attributable fractions, defined as the proportion of a disease or acute condition in a population attributable to alcohol drinking, were calculated to obtain the number of patients in each disease or acute condition attributable to alcohol drinking. Health-care costs of alcohol drinking were estimated by multiplying the number of patients in each disease category attributable to alcohol drinking with the unit cost of treatment.
Results:  Total health-care costs attributed to alcohol in this research were 5491 million baht (i.e., outpatient department [2488 million baht] and inpatient department [3003 million baht]). Cost derived from inpatient department accounted for 55% of the total health-care cost attributed to alcohol.
Conclusions:  The result of this study suggested that alcohol drinking was significantly associated with a large number of health-care costs in Thailand. Estimation of health-care costs related to alcohol drinking would provide an important insight into future policy appraisal and evaluation.     

Choosing the optimal method of blood pressure measurement for limited‐resource rural communities in the “Community Health Assessment Program—Philippines”

The Community Health Assessment Program—Philippines (CHAP‐P) is an international collaboration of investigators whose aim is to adapt a previously proven Canadian community‐based cardiovascular awareness and prevention intervention to the Philippines and other low‐middle–income countries. Choosing a method of blood pressure measurement for the research program presents a challenge. There is increasing consensus globally that blood pressure measurement with automated devices is preferred. Recommendations from low‐middle–income countries, including the Philippines, are less supportive of automated blood pressure devices. The value placed on factors including device accuracy, durability, cost, energy source, and complexity differ with local context. Our goal was to support the progress of local policy concerning blood pressure measurement while testing a comprehensive approach to community‐based screening for cardiovascular risk. The authors describe the challenges in making a choice of blood pressure device and the approach to determine optimal method of measurement for our research program.     

The Current Capacity and Future Development of Economic Evaluation for Policy Decision-Making: A Survey among Researchers and Decision-Makers in Thailand

Objective:  This study aims to explore the knowledge, experience, and attitudes toward economic evaluation (EE) among decision-makers and researchers in Thailand.
Methods:  Researchers were purposively selected from Thai academics and both public and private research organizations related to EE. Decision-makers at the provincial level were purposively selected from the members of the Management Committees of Provincial Health Offices, and those at hospital level were randomly selected from members of the public and private hospital formulary drug committees throughout Thailand. The self-administered postal questionnaires were distributed. Univariate and bivariate analyses were applied.
Results:  Of the total 2575 questionnaires distributed, 758 (29.4% response rate) were completed and sent back. The majority of researchers and decision-makers were not familiar with technical terms commonly used in health EE, e.g., incremental cost-effectiveness ratio, discounting, and sensitivity analysis. More decision-makers (70.6%) had never had EE training compared to researchers (50.0%). Both roles indicated that value for money was one of the important issues to consider for health technology adoption.
Conclusions:  An extensive unmet demand for EE training among Thai researchers and decision-makers still exists. Findings from this study contribute to the short- and long-term plans for research capacity building.     

Hypertension in Older Persons: A Systematic Review of National and International Treatment Guidelines

Despite good evidence regarding the benefits of managing hypertension in elderly populations, the extent to which this evidence has been incorporated into national and international clinical hypertension treatment guidelines is unknown. A systematic review was conducted to identify recommendations in current national and international hypertension treatment guidelines with a focus on specific targets and treatment recommendations for older persons with uncomplicated hypertension. Guidelines for the management of hypertension published or updated over a 5‐year period (2009–2014) were identified by searching Medline, Google, and Google Scholar. Thirteen guidelines that met the predefined inclusion criteria were included in the review. Among these guidelines was considerable variation regarding who is considered an older person. However, there was general consensus regarding blood pressure targets. While current hypertension guidelines do include recommendations regarding management of uncomplicated hypertension in older populations, the depth and breadth of these recommendations vary considerably between guidelines and may limit the usefulness of such treatment guidelines to clinicians.     

A Case of Migraine With Aura Resolving on Warfarin But Not on Apixaban

Several case reports have associated anticoagulants such as heparin and vitamin K antagonists with reduced symptoms in migraine, but no data exist for direct acting oral factor Xa inhibitors. We report the case of a 55‐year‐old female who experienced complete remission of migraine with aura for 12 years while on warfarin, with return of symptoms within 3 weeks of switching to apixaban, and resolution of symptoms once again within days of warfarin resumption. Our case suggests that anticoagulation alone is not sufficient to improve migraine symptoms. Further study of vitamin K‐dependent proteins not involved in anticoagulation, such as the relatively novel growth arrest‐specific gene 6, may clarify the link between warfarin and migraine symptoms.     

Hypertension management research priorities from patients,caregivers, and healthcare providers: A report from the Hypertension Canada Priority Setting Partnership Group

Patient‐ and stakeholder‐oriented research is vital to improving the relevance of research. The authors aimed to identify the 10 most important research priorities of patients, caregivers, and healthcare providers (family physicians, nurses, nurse practitioners, pharmacists, and dietitians) for hypertension management. Using the James Lind Alliance approach, a national web‐based survey asked patients, caregivers, and care providers to submit their unanswered questions on hypertension management. Questions already answered from randomized controlled trial evidence were removed. A priority setting process of patient, caregiver, and healthcare providers then ranked the final top 10 research priorities in an in‐person meeting. There were 386 respondents who submitted 598 questions after exclusions. Of the respondents, 78% were patients or caregivers, 29% lived in rural areas, 78% were aged 50 to 80 years, and 75% were women. The 598 questions were distilled to 42 unique questions and from this list, the top 10 research questions prioritized included determining the combinations of healthy lifestyle modifications to reduce the need for antihypertensive medications, stress management interventions, evaluating treatment strategies based on out‐of‐office blood pressure compared with conventional (office) blood pressure, education tools and technologies to improve patient motivation and health behavior change, management strategies for ethnic groups, evaluating natural and alternative treatments, and the optimal role of different healthcare providers and caregivers in supporting patients with hypertension. These priorities can be used to guide clinicians, researchers, and funding bodies on areas that are a high priority for hypertension management research for patients, caregivers, and healthcare providers. This also highlights priority areas for improved knowledge translation and delivering patient‐centered care.