Economic analysis for national immunization program planning: A case of rotavirus vaccines in Burundi

BackgroundIn Burundi, diarrhea is the third leading cause of mortality among children under five years of age. This study conducted an economic analysis of rotavirus vaccination program in Burundi.MethodsA Markov model was constructed to simulate clinical and economic outcomes for the 2019 birth cohort for a period of 5 years. Empirical costing data were collected. ICER per episode averted, ICER per death averted, ICER per DALY averted, net present value, and budget impact were estimated for 4 brands of WHO pre-qualified rotavirus vaccines. One-way and probabilistic sensitivity analysis as well as threshold analysis were performed.ResultsFor the base case, while all four WHO pre-qualified rotavirus vaccines were cost-effective (ICER < 3 GDP per capita), three of them (i.e. Rotarix, Rotavac and Rotasiil) were very cost-effective (ICER <1 GDP per capita) from both the provider and societal perspectives. The vaccines were still very cost-effective at a price increase of up to US$ 5.09, US$ 3.16, US$ 3.89, and US$ 2.69 for Rotarix, RotaTeq, Rotavac, and Rotasiil, respectively. Probabilistic sensitivity analysis indicated that vaccination programs with Rotarix, RotaTeq, Rotavac, and Rotasiil are cost-effective at a probability of 93.8%, 27%, 99.1%, and 92.7%, respectively. All vaccination programs were cost-beneficial with a net present value in the range of US$ 5,214,912 and US$ 11,135,997.The budget required to run the vaccination program, estimated with break-even prices, ranged between US$ 42,249,498 and US$ 53,487,935 for a 5-year time period. When compared to the GDP of Burundi in 2019, these are are less than 2%.ConclusionThe rotavirus vaccine is good value for money. Findings from this study offer evidence on potential economic benefits as well as the required budget for different rotavirus vaccination programs, which could be useful for future planning related to rotavirus vaccine coverage in Burundi after graduation from GAVI.     

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.     

Factors associated with intention to use hormone replacement therapy among Thai middle-aged women

OBJECTIVES: To examine the differences among those who express their intentions to use hormone replacement therapy (intenders), those who express their intentions not to use hormone replacement therapy (non-intenders), and those who are undecided, and to examine the factors associated with hormone replacement therapy (HRT) intention among Thai middle-aged women. METHODS: A total of 420 women aged 40-59 years, recruited from one hospital in Bangkok were asked to complete a self-administered questionnaire. RESULTS: Compared to intenders and non-intenders, the undecided were significantly less knowledgeable about menopause and HRT, and perceived the highest level of decisional uncertainty. Being inadequately informed was the most important factor that distinguished the undecided from intenders and non-intenders. When looking at intenders and non-intenders, no significant differences in perceived information inadequacy, level of knowledge, and perceived risks of HRT were found. However, it was found that intenders perceived higher benefit over risk of HRT (OR = 1.05, 95% CI = 1.02, 1.07), held more negative beliefs towards menopause (OR = 1.61, 95% CI = 1.03, 2.53), and were approximately two times more likely to have ever used oral contraceptives (OR = 1.99, 95% CI = 1.13, 3.47) than non-intenders. CONCLUSION: The findings reveal the importance of being informed about menopause and HRT in making decision about HRT use. Changes in knowledge, and beliefs are promising avenues to study to see how these impacts HRT use.     

Exploration of a cultural-adaptation of the EQ-5D for Thai population: A “bolt-on” experiment

Quality of Life Research - As the EQ-5D was developed in western countries with only five dimensions, it might be insensitive to non-western populations including Thai. This study examined the...     

Economic burden of rotavirus diarrhea in Thailand: Report from a pilot study on rotavirus vaccination

Background

Rotavirus diarrhea is the leading cause of morbidity and mortality in young children in both developed and developing countries. Hospitalization costs are a significant burden of both governments and households. The objective of this study was to estimate the economic burden associated with the hospitalization of children with non-rotavirus and rotavirus diarrhea in two provinces in Thailand.

The economic costs of alcohol consumption in Thailand, 2006

Background  

There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006.     

Reliability and validity of the Thai version of the Pediatric Quality of Life Inventory 4.0

Purpose

The study aimed to evaluate the reliability and validity of the Thai version of the Pediatric Quality of Life Inventory? 4.0 Core Scales (PedsQL) as a measure of health-related quality of life (HRQOL).

Methods

The PedsQL items were completed by 2,086 pupils aged 8–15 years and 1,914 parents from four schools, and 100 pediatric outpatients and 100 parents from a University Hospital. Test–retest reliability was conducted in a randomly selected of 150 pupils at a 1-month interval.

Results

Internal consistency reliability for the Total Scale score (α = 0.84 self-report, 0.88 proxy-report), Physical Health Summary score (α = 0.76 self-report, 0.79 proxy-report), and Psychosocial Health Summary score (α = 0.74 self-report, 0.85 proxy-report) exceeded the minimum reliability standard of 0.70. School children had significantly higher mean HRQOL scores compared to those with chronic health conditions for all subscales with the mean differences of 3.1–12.4 for self-report (p < 0.03) and 7.7–15.6 for proxy-report (p < 0.001). Test–retest reliability showed intraclass correlation coefficients above 0.60 in all subscales (p < 0.001).

Conclusions

The Thai version of PedsQL had adequate reliability and validity and could be used as an outcome measure of HRQOL in Thai children aged 8–15 years.     

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.     

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.

     

The economic impact of alcohol consumption: a systematic review

Background  

Many opiate users entering British prisons require prescribed medication to help them achieve abstinence. This commonly takes the form of a detoxification regime. Previously, a range of detoxification agents have been prescribed without a clear evidence base to recommend a drug of choice. There are few trials and very few in the prison setting. This study compares dihydrocodeine with buprenorphine.