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Kumwichar P, Poonsiri C, Botwright S, Sirichumroonwit N, Loharjun B, Thawillarp S, Cheewaruangroj N, Chokchaisiripakdee A, Teerawattananon Y, Chongsuvivatwong V. Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data. JMIR Public Health Surveill 2024; 10:e48255. [PMID: 38441923 PMCID: PMC10951833 DOI: 10.2196/48255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/31/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. OBJECTIVE We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50%. METHODS We formed a dynamic cohort by linking records of Thai citizens aged ≥18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. RESULTS This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82% (95% CI 80.3%-84%) and 86.3% (95% CI 83.6%-84%), respectively. CONCLUSIONS In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries.
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Affiliation(s)
- Ponlagrit Kumwichar
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chittawan Poonsiri
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Siobhan Botwright
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Natchalaikorn Sirichumroonwit
- Department of Medical Services, Institute of Medical Research and Technology Assessment, Ministry of Public Health, Nonthaburi, Thailand
| | - Bootsakorn Loharjun
- Department of Medical Services, Institute of Medical Research and Technology Assessment, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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Zayar NN, Kittiratchakool N, Saeraneesopon T, Butchon R, Dabak SV, Namahoot P, Kaewchompoo T, Kingkaew P, Teerawattananon Y, Isaranuwatchai W. Telemedicine Utilization Patterns and Implications Amidst COVID-19 Outbreaks in Thailand Under Public Universal Coverage Scheme. Inquiry 2024; 61:469580241246466. [PMID: 38676535 DOI: 10.1177/00469580241246466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
During COVID-19 pandemic, telemedicine was a strategy to facilitate healthcare service delivery minimizing the risk of direct exposure among people. In Thailand, the National Health Security Office has included telemedicine services under the Universal Coverage Scheme to support social distancing policies to reduce the spread of COVID-19. This study aimed to determine the patterns of telemedicine service use during major COVID-19 outbreaks including Alpha, Delta, and Omicron in Thailand. We retrospectively analyzed a dataset of telemedicine e-claims from the National Health Security Office, which covers services reimbursed under the Universal Coverage Scheme between December 2020 and August 2022. An interrupted time-series analysis, Pearson correlation analysis and binary logistic regression were performed. Almost 70% of the patients using telemedicine services were over 40 years old. Most patients used services for mental health problems (25.6%) and major noncommunicable diseases, including essential hypertension (12.6%) and diabetes mellitus (9.2%). The daily number of using telemedicine service was strongly correlated with the number of COVID-19 new cases detected. An immediate change in the trend of using telemedicine was detected at the onset of outbreaks along with the surge of infection. The follow-up use of telemedicine services was not substantial among female, older adults patients and those with non-communicable diseases except mental health problems, and infectious diseases. Strategies need to be developed to reinforced healthcare resources for telemedicine during the surge of outbreaks and sustain the use of telemedicine services for chronic and infectious diseases, regardless of the pandemic, and promote the efficiency of healthcare systems.
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Affiliation(s)
- Nyi-Nyi Zayar
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Prince of Songkla University, Hat Yai, Thailand
| | - Nitichen Kittiratchakool
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | | | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- National University of Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- University of Toronto, Toronto, Canada
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Chen W, Wong NCB, Wang Y, Zemlyanska Y, Butani D, Virabhak S, Matchar DB, Prapinvanich T, Teerawattananon Y. Mapping the value for money of precision medicine: a systematic literature review and meta-analysis. Front Public Health 2023; 11:1151504. [PMID: 38074712 PMCID: PMC10704154 DOI: 10.3389/fpubh.2023.1151504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/04/2023] [Indexed: 12/18/2023] Open
Abstract
Objective This study aimed to quantify heterogeneity in the value for money of precision medicine (PM) by application types across contexts and conditions and to quantify sources of heterogeneity to areas of particular promises or concerns as the field of PM moves forward. Methods A systemic search was performed in Embase, Medline, EconLit, and CRD databases for studies published between 2011 and 2021 on cost-effectiveness analysis (CEA) of PM interventions. Based on a willingness-to-pay threshold of one-time GDP per capita of each study country, the net monetary benefit (NMB) of PM was pooled using random-effects meta-analyses. Sources of heterogeneity and study biases were examined using random-effects meta-regressions, jackknife sensitivity analysis, and the biases in economic studies checklist. Results Among the 275 unique CEAs of PM, publicly sponsored studies found neither genetic testing nor gene therapy cost-effective in general, which was contradictory to studies funded by commercial entities and early stage evaluations. Evidence of PM being cost-effective was concentrated in a genetic test for screening, diagnosis, or as companion diagnostics (pooled NMBs, $48,152, $8,869, $5,693, p < 0.001), in the form of multigene panel testing (pooled NMBs = $31,026, p < 0.001), which only applied to a few disease areas such as cancer and high-income countries. Incremental effectiveness was an essential value driver for varied genetic tests but not gene therapy. Conclusion Precision medicine's value for money across application types and contexts was difficult to conclude from published studies, which might be subject to systematic bias. The conducting and reporting of CEA of PM should be locally based and standardized for meaningful comparisons.
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Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nigel Chong Boon Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yaroslava Zemlyanska
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dimple Butani
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Suchin Virabhak
- Precision Health Research, Singapore (PRECISE), Singapore, Singapore
| | - David Bruce Matchar
- Precision Health Research, Singapore (PRECISE), Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
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Dulsamphan T, Juntama P, Suwanpanich C, Isaranuwatchai W, Silzle M, Poonmaksatit S, Boonsimma P, Shotelersuk V, Visudtibhan A, Lusawat A, Kamolvisit W, Kapol N, Lochid-amnuay S, Sribundit N, Samprasit N, Morton A, Teerawattananon Y. Can knowledgeable experts assess costs and outcomes as if they were ignorant? An experiment within precision medicine evaluation. Int J Technol Assess Health Care 2023; 40:e4. [PMID: 37973547 PMCID: PMC10859837 DOI: 10.1017/s0266462323002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/08/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES The purpose of this study is to evaluate the validity of the standard approach in expert judgment for evaluating precision medicines, in which experts are required to estimate outcomes as if they did not have access to diagnostic information, whereas in fact, they do. METHODS Fourteen clinicians participated in an expert judgment task to estimate the cost and medical outcomes of the use of exome sequencing in pediatric patients with intractable epilepsy in Thailand. Experts were randomly assigned to either an "unblind" or "blind" group; the former was provided with the exome sequencing results for each patient case prior to the judgment task, whereas the latter was not provided with the exome sequencing results. Both groups were asked to estimate the outcomes for the counterfactual scenario, in which patients had not been tested by exome sequencing. RESULTS Our study did not show significant results, possibly due to the small sample size of both participants and case studies. CONCLUSIONS A comparison of the unblind and blind approach did not show conclusive evidence that there is a difference in outcomes. However, until further evidence suggests otherwise, we recommend the blind approach as preferable when using expert judgment to evaluate precision medicines because this approach is more representative of the counterfactual scenario than the unblind approach.
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Affiliation(s)
- Thamonwan Dulsamphan
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Parntip Juntama
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Chotika Suwanpanich
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Madison Silzle
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Sathida Poonmaksatit
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ponghatai Boonsimma
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Anannit Visudtibhan
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wuttichart Kamolvisit
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Nattiya Kapol
- Department of Health Consumer Protection and Pharmacy Administration, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Surasit Lochid-amnuay
- Department of Health Consumer Protection and Pharmacy Administration, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Namfon Sribundit
- Department of Health Consumer Protection and Pharmacy Administration, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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Soukavong M, Luangasanatip N, Chanthavilay P, Teerawattananon Y, Dabak SV, Pan-Ngum W, Roberts T, Ashley EA, Mayxay M. Cost-effectiveness analysis of typhoid vaccination in Lao PDR. BMC Public Health 2023; 23:2270. [PMID: 37978481 PMCID: PMC10656839 DOI: 10.1186/s12889-023-17221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Typhoid vaccination has been shown to be an effective intervention to prevent enteric fever and is under consideration for inclusion in the national immunization program in Lao PDR. METHODS A cost-utility analysis was performed using an age-structured static decision tree model to estimate the costs and health outcomes of introducing TCV. Vaccination strategies combined with five delivery approaches in different age groups compared to no vaccination were considered from the societal perspective, using the Gavi price of 1.5 USD per dose. The vaccination program was considered to be cost-effective if the incremental cost-effectiveness ratio was less than a threshold of 1 GDP per capita for Lao PDR, equivalent to USD 2,535 in 2020. RESULTS In the model, we estimated 172.2 cases of enteric fever, with 1.3 deaths and a total treatment cost of USD 7,244, based on a birth cohort of 164,662 births without TCV vaccination that was followed over their lifetime. To implement a TCV vaccination program over the lifetime horizon, the estimated cost of the vaccine and administration costs would be between USD 470,934 and USD 919,186. Implementation of the TCV vaccination program would prevent between 14 and 106 cases and 0.1 to 0.8 deaths. None of the vaccination programs appeared to be cost-effective. CONCLUSIONS Inclusion of TCV in the national vaccination program in Lao PDR would only be cost-effective if the true typhoid incidence is 25-times higher than our current estimate.
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Affiliation(s)
- Mick Soukavong
- Faculty of Medicine, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | | | - Phetsavanh Chanthavilay
- Unit for Health Evidence and Policy, Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Wirichada Pan-Ngum
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Elizabeth A Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Mayfong Mayxay
- Unit for Health Evidence and Policy, Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Butani D, Faradiba D, Dabak SV, Isaranuwatchai W, Huang-Ku E, Pachanee K, Soboon B, Culyer AJ, Teerawattananon Y. Expanding access to high-cost medicines under the Universal Health Coverage scheme in Thailand: review of current practices and recommendations. J Pharm Policy Pract 2023; 16:138. [PMID: 37936171 PMCID: PMC10631213 DOI: 10.1186/s40545-023-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND There has been an increasing demand to reimburse high-cost medicines, through public health insurance schemes in Thailand. METHODS A mixed method approach was employed. First, a rapid review of select high-income countries was conducted, followed by expert consultations and an in-depth review of three countries: Australia, England and Republic of Korea to understand reimbursement mechanisms of high-cost medicines. In Thailand, current pathways for reimbursing high-cost medicines reviewed, the potential opportunity cost estimated, and stakeholder consultations were conducted to identify context specific considerations. RESULTS High-income countries reviewed have implemented a variety of pathways and mechanisms for reimbursing high-cost medicines under specific eligibility criteria, listing processes, varying cost-effectiveness thresholds and special funding arrangements. In Thailand, high-cost medicines that do not offer good value-for-money are excluded from the reimbursement process. A framework for reimbursing high-cost medicines that are not cost-effective at the current willingness-to-pay threshold was proposed for Thailand. Under this framework, specific criteria are proposed to determine their eligibility for reimbursement such life-saving nature, treatment of conditions with no alternative treatment options, and affordability. CONCLUSION High-cost medicines may become eligible for reimbursement through alternative mechanisms based on specific criteria which depend on each context. The application of HTA methods and processes is important in guiding these decisions to support sustainable access to affordable healthcare in pursuit of Universal Health Coverage (UHC).
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Affiliation(s)
- Dimple Butani
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand.
- Institute of Health Policy, Management and Evaluation, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Evan Huang-Ku
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Kumaree Pachanee
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Budsadee Soboon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Anthony J Culyer
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
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Foocharoen C, Kingkaew P, Teerawattananon Y, Mahakkanukrauh A, Suwannaroj S, Manasirisuk W, Chaiyarit J, Sangchan A. Cost-effectiveness of alginic acid in combination with proton pump inhibitor for the treatment of gastroesophageal reflux disease in systemic sclerosis patients. Int J Rheum Dis 2023; 26:2037-2046. [PMID: 37665078 DOI: 10.1111/1756-185x.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) patients often become refractory to proton pump inhibitors (PPI)-a standard treatment for gastroesophageal reflux disease (GERD)-and intolerant to PPI in combination with domperidone. PPI with alginic acid is an alternative treatment option, but alginic acid is costly. OBJECTIVES We compared the costs and effectiveness of alginic acid plus PPI versus standard treatments (PPI with/without antacids as needed and lifestyle modifications) for GERD in SSc patients unsuitable for, or intolerant to, domperidone. METHODS An economic evaluation using the Markov model was conducted among SSc patients aged between 40 and 65 years with GERD, having a partial or non-response to 4 weeks of standard-dose omeprazole (40 mg/day) and being unsuitable for or intolerant to domperidone. Using a societal perspective, we computed the incremental cost-effectiveness ratios (ICERs) in terms of Thai baht (THB) per quality-adjusted life-year (QALY) between a combination of alginic acid plus PPI and standard treatment for GERD. The lifetime time horizon was used. RESULTS The ICER for alginic acid plus PPI versus standard treatments was 377 101 THB/QALY. According to the one-way sensitivity analysis, the cost of alginic acid was the most impactful parameter. If the market prices of alginic acid plus PPI were reduced by 61%, this treatment option would become cost-effective at the willingness-to-pay threshold of 160 000 THB/QALY (34.68 THB/USD data on 25 May 2023). Furthermore, if alginic acid were included in the public health insurance program, the national budget would be increased by 66 313 THB per patient, resulting in an overall budget increase of 5 106 101 to 8 885 942 THB compared with the standard treatment. CONCLUSIONS Alginic acid plus PPI does not represent good value for money compared with the standard treatment among such SSc patients in Thailand unless its price is reduced significantly.
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Affiliation(s)
- Chingching Foocharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pritaporn Kingkaew
- The Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- The Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Witsarut Manasirisuk
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jitjira Chaiyarit
- Department of Statistics, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Apichat Sangchan
- Special Medical Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Chavarina KK, Faradiba D, Teerawattananon Y. Navigating HTA implementation: a review of Indonesia's revised HTA guideline. Lancet Reg Health Southeast Asia 2023; 17:100280. [PMID: 37727364 PMCID: PMC10506045 DOI: 10.1016/j.lansea.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/10/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Kinanti Khansa Chavarina
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand
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Painter C, Faradiba D, Chavarina KK, Sari EN, Teerawattananon Y, Aluzaite K, Ananthakrishnan A. Correction: A systematic literature review of economic evaluation studies of interventions impacting antimicrobial resistance. Antimicrob Resist Infect Control 2023; 12:108. [PMID: 37775756 PMCID: PMC10541689 DOI: 10.1186/s13756-023-01314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Affiliation(s)
- Chris Painter
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Kinanti Khansa Chavarina
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Ella Nanda Sari
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- National University of Singapore, Singapore, Singapore
| | | | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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Chen W, Wang Y, Zemlyanska Y, Butani D, Wong NCB, Virabhak S, Matchar DB, Teerawattananon Y. Evaluating the Value for Money of Precision Medicine from Early Cycle to Market Access: A Comprehensive Review of Approaches and Challenges. Value Health 2023; 26:1425-1434. [PMID: 37187236 DOI: 10.1016/j.jval.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES This study aimed to perform a comprehensive review of modeling approaches and methodological and policy challenges in the economic evaluation (EE) of precision medicine (PM) across clinical stages. METHODS First, a systematic review was performed to assess the approaches of EEs in the past 10 years. Next, a targeted review of methodological articles was conducted for methodological and policy challenges in performing EEs of PM. All findings were synthesized into a structured framework that focused on patient population, Intervention, Comparator, Outcome, Time, Equity and ethics, Adaptability and Modeling aspects, named the "PICOTEAM" framework. Finally, a stakeholder consultation was conducted to understand the major determinants of decision making in PM investment. RESULTS In 39 methodological articles, we identified major challenges to the EE of PM. These challenges include that PM applications involve complex and evolving clinical decision space, that clinical evidence is sparse because of small subgroups and complex pathways in PM settings, a one-time PM application may have lifetime or intergenerational impacts but long-term evidence is often unavailable, and that equity and ethics concerns are exceptional. In 275 EEs of PM, current approaches did not sufficiently capture the value of PM compared with targeted therapies, nor did they differentiate Early EEs from Conventional EEs. Finally, policy makers perceived the budget impact, cost savings, and cost-effectiveness of PM as the most important determinants in decision making. CONCLUSIONS There is an urgent need to modify existing guidelines or develop a new reference case that fits into the new healthcare paradigm of PM to guide decision making in research and development and market access.
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Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yaroslava Zemlyanska
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Dimple Butani
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand
| | | | | | - David Bruce Matchar
- Precision Health Research (PRECISE), Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand
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11
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Turner HC, Hori Y, Revill P, Rattanavipapong W, Arai K, Nonvignon J, Jit M, Teerawattananon Y. Analyses of the return on investment of public health interventions: a scoping review and recommendations for future studies. BMJ Glob Health 2023; 8:e012798. [PMID: 37648275 PMCID: PMC10471881 DOI: 10.1136/bmjgh-2023-012798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
Return on investment (ROI) analysis is increasingly being used for evaluating the value for money of public health interventions. Given its potential role for informing health policies, it is important that there is a more comprehensive understanding of ROI analysis within the global health field. To address this gap in the literature, we conducted a scoping review of recent research articles reporting an ROI metric for a health intervention within the public sector in any country setting. The database search was limited to literature published in English and studies published between 1 January 2018 and 14 June 2021. Uses and settings where the ROI metric is being applied, key methodological features of the calculations and the types of economic benefits included were extracted. 118 relevant studies were included within this scoping review. We found that ROI analyses of health interventions differed between those that only included fiscal savings (such as prevented medical expenses) and those which incorporated a wider range of benefits (such as monetised health benefits). This highlights the variation in the definition of ROI analyses and supports the finding that ROI analyses are used for a range of different research questions/purposes within the healthcare sector. We also found that the methodologies used in ROI calculations were inconsistent and often poorly reported. This review demonstrates that there is notable variation in the methodology surrounding recent ROI calculations of healthcare interventions, as well as the definition of ROI analysis. We recommend that ROI metrics should be carefully interpreted before they are used to inform policy decisions regarding the allocation of healthcare resources. To improve the consistency of future studies, we also set out recommended use cases for ROI analysis and a reporting checklist.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Yoshiaki Hori
- School of Public Health, Imperial College London, London, UK
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Ko Arai
- Graduate School of Business Administration, Hitotsubashi University, Tokyo, Japan
| | - Justice Nonvignon
- School of Public Health, University of Ghana, Accra, Ghana
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mark Jit
- Centre of Global Change and Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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12
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Painter C, Faradiba D, Chavarina KK, Sari EN, Teerawattananon Y, Aluzaite K, Ananthakrishnan A. A systematic literature review of economic evaluation studies of interventions impacting antimicrobial resistance. Antimicrob Resist Infect Control 2023; 12:69. [PMID: 37443104 PMCID: PMC10339577 DOI: 10.1186/s13756-023-01265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is accelerated by widespread and inappropriate use of antimicrobials. Many countries, including those in low- and middle- income contexts, have started implementing interventions to tackle AMR. However, for many interventions there is little or no economic evidence with respect to their cost-effectiveness. To help better understand the scale of this evidence gap, we conducted a systematic literature review to provide a comprehensive summary on the value for money of different interventions affecting AMR. METHODS A systematic literature review was conducted of economic evaluations on interventions addressing AMR. a narrative synthesis of findings was produced. Systematic searches for relevant studies were performed across relevant databases and grey literature sources such as unpublished studies, reports, and other relevant documents. All identified economic evaluation studies were included provided that they reported an economic outcome and stated that the analysed intervention aimed to affect AMR or antimicrobial use in the abstract. Studies that reported clinical endpoints alone were excluded. Selection for final inclusion and data extraction was performed by two independent reviewers. A quality assessment of the evidence used in the included studies was also conducted. RESULTS 28,597 articles were screened and 35 articles were identified that satisfied the inclusion criteria. The review attempted to answer the following questions: (1) What interventions to address AMR have been the subject of an economic evaluation? (2) In what types of setting (e.g. high-income, low-income, regions etc.) have these economic evaluations been focused? (3) Which interventions have been estimated to be cost-effective, and has this result been replicated in other settings/contexts? (4) What economic evaluation methods or techniques have been used to evaluate these interventions? (5) What kind and quality of data has been used in conducting economic evaluations for these interventions? DISCUSSION The review is one of the first of its kind, and the most recent, to systematically review the literature on the cost-effectiveness of AMR interventions. This review addresses an important evidence gap in the economics of AMR and can assist AMR researchers' understanding of the state of the economic evaluation literature, and therefore inform future research. Systematic review registration PROSPERO (CRD42020190310).
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Affiliation(s)
- Chris Painter
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Kinanti Khansa Chavarina
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Ella Nanda Sari
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- National University of Singapore, Singapore, Singapore
| | | | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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Kapol N, Kamolvisit W, Kongkiattikul L, Huang-Ku E, Sribundit N, Lochid-Amnuay S, Samprasit N, Dulsamphan T, Juntama P, Suwanpanich C, Boonsimma P, Shotelersuk V, Teerawattananon Y. Using an experiment among clinical experts to determine the cost and clinical impact of rapid whole exome sequencing in acute pediatric settings. Front Pediatr 2023; 11:1204853. [PMID: 37465423 PMCID: PMC10350589 DOI: 10.3389/fped.2023.1204853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Objective Evaluate the cost and clinical impacts of rapid whole-exome sequencing (rWES) for managing pediatric patients with unknown etiologies of critical illnesses through an expert elicitation experiment. Method Physicians in the intervention group (n = 10) could order rWES to complete three real-world case studies, while physicians in the control group (n = 8) could not. Costs and health outcomes between and within groups were compared. Results The cost incurred in the intervention group was consistently higher than the control by 60,000-70,000 THB. Fewer other investigation costs were incurred when rWES could provide a diagnosis. Less cost was incurred when an rWES that could lead to a change in management was ordered earlier. Diagnostic accuracy and the quality of non-pharmaceutical interventions were superior when rWES was available. Conclusion In acute pediatric settings, rWES offered clinical benefits at the average cost of 60,000-70,000 THB. Whether this test is cost-effective warrants further investigations. Several challenges, including cost and ethical concerns for assessing high-cost technology for rare diseases in resource-limited settings, were potentially overcome by our study design using expert elicitation methods.
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Affiliation(s)
- Nattiya Kapol
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Wuttichart Kamolvisit
- Center of Excellence for Medical Genomics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center in Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Lalida Kongkiattikul
- Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Evan Huang-Ku
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Namfon Sribundit
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | | | - Thamonwan Dulsamphan
- Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Parntip Juntama
- Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Chotika Suwanpanich
- Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Ponghathai Boonsimma
- Center of Excellence for Medical Genomics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center in Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Yot Teerawattananon
- Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Wang Y, Luangasanatip N, Pan-Ngum W, Isaranuwatchai W, Prawjaeng J, Saralamba S, Painter C, Briones JR, Teerawattananon Y. Assessing the cost-effectiveness of COVID-19 vaccines in a low incidence and low mortality setting: the case of Thailand at start of the pandemic. Eur J Health Econ 2023; 24:735-748. [PMID: 35951243 PMCID: PMC9366779 DOI: 10.1007/s10198-022-01505-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 07/26/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study aimed to assess the cost-effectiveness of COVID-19 vaccines, preferred COVID-19 vaccine profiles, and the preferred vaccination strategies in Thailand. METHODS An age-structured transmission dynamic model was developed based on key local data to evaluate economic consequences, including cost and health outcome in terms of life-years (LYs) saved. We considered COVID-19 vaccines with different profiles and different vaccination strategies such as vaccinating elderly age groups (over 65s) or high-incidence groups, i.e. adults between 20 and 39 years old who have contributed to more than 60% of total COVID-19 cases in the country thus far. Analyses employed a societal perspective in a 1-year time horizon using a cost-effectiveness threshold of 160,000 THB per LY saved. Deterministic and probabilistic sensitivity analyses were performed to identify and characterize uncertainty in the model. RESULTS COVID-19 vaccines that block infection combined with social distancing were cost-saving regardless of the target population compared to social distancing alone (with no vaccination). For vaccines that block infection, the preferred (cost-effective) strategy was to vaccinate the high incidence group. Meanwhile, COVID-19 vaccines that reduces severity (including hospitalization and mortality) were cost-effective when the elderly were vaccinated, while vaccinating the high-incidence group was not cost-effective with this vaccine type. Regardless of vaccine type, higher vaccination coverage, higher efficacy, and longer protection duration were always preferred. More so, vaccination with social distancing measures was always preferred to strategies without social distancing. Quarantine-related costs were a major cost component affecting the cost-effectiveness of COVID-19 vaccines. CONCLUSION COVID-19 vaccines are good value for money even in a relatively low-incidence and low-mortality setting such as Thailand, if the appropriate groups are vaccinated. The preferred vaccination strategies depend on the type of vaccine efficacy. Social distancing measures should accompany a vaccination strategy.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirichada Pan-Ngum
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Juthamas Prawjaeng
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Sompob Saralamba
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Christopher Painter
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Jamaica Roanne Briones
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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15
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Sukmanee J, Butchon R, Karunayawong P, Dabak SV, Isaranuwatchai W, Teerawattananon Y. The impact of universal health coverage and COVID-19 pandemic on out-of-pocket expenses in Thailand: an analysis of household survey from 1994 to 2021. Expert Rev Pharmacoecon Outcomes Res 2023; 23:823-830. [PMID: 37272480 DOI: 10.1080/14737167.2023.2219447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES After Thailand achieved Universal Health Coverage (UHC) in 2002, the extent of financial risk protection has not been assessed in the long term, especially after the COVID-19 pandemic. Therefore, this study aims to revisit the impact of UHC on out-of-pocket expenses (OOPE) for health and to descriptively explore the impact of COVID-19 on OOPE. METHODS This study was a secondary data analysis and used data from the Socio-Economic Survey from 1994 to 2021 in Thailand. The effect of UHC on the percentage of OOPE in total health expenditures (THE) from 1994 to 2019 was investigated with an interrupted time-series analysis. Descriptive analyses of OOPE in absolute value during the COVID-19 were conducted. RESULTS The percentage of OOPE in THE significantly decreased both before (β -2.02%; 95% CI: -2.70% to - 1.33%) and during (β 1.41%; 95% CI: 0.70% to 2.11%) the UHC period. During the pandemic, total household OOPE for medical equipment was found to have rapidly increased from 643 million THB in 2019 to 9.4 billion THB in 2020. CONCLUSIONS The trend of providing financial risk protection (measured by OOPE/THE) in Thailand continues until 2019. Providing medical equipment in sufficient and equally accessible manners should be prioritized during the future pandemic.
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Affiliation(s)
- Jarawee Sukmanee
- Department of Health, The Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Rukmanee Butchon
- Department of Health, The Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Picharee Karunayawong
- Department of Health, The Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Saudamini Vishwanath Dabak
- Department of Health, The Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Department of Health, The Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yot Teerawattananon
- Department of Health, The Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), Singapore, Singapore
- Health Administration Division, Office of the Permanent Secretary of the Ministry of Public Health, Nonthaburi, Thailand
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Luangasanatip N, Painter C, Pan-Ngum W, Saralamba S, Wichaita T, White L, Aguas R, Clapham H, Wang Y, Isaranuwatchai W, Teerawattananon Y. How to model the impact of vaccines for policymaking when the characteristics are uncertain: A case study in Thailand prior to the vaccine rollout during the COVID-19 pandemic. Vaccine 2023:S0264-410X(23)00740-5. [PMID: 37365059 PMCID: PMC10281228 DOI: 10.1016/j.vaccine.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
Thailand faced a dilemma of which groups to prioritise with a limited first tranche of COVID-19 vaccinations in early 2021, at a time when there was low incidence and low mortality in the country. A mathematical modelling analysis was performed to compare the potential short-term impact of allocating the available doses to either the high severity group (over 65-year-olds) or the high transmission group (aged 20-39). At the time of the analysis, there was uncertainty about the precise characteristics of the vaccines available, in terms of their potential impact on transmission and reductions to the severity of infection. As such, a range of vaccine characteristic scenarios, with differing levels of severity and transmission reductions were explored. Using the evidence available at the time regarding severity reduction of infection due to the vaccines, the model suggested that vaccinating high severity group should be the priority if reductions in deaths is the priority. Vaccinating this group was found to have a direct impact on reducing the number of deaths, while the incidence and hospitalisations remained unchanged. However, the model found that vaccinating the high transmission group with a vaccine with sufficiently high protection against infection (more than 70%) could provide enough herd effects to delay the expected epidemic peak, resulting in both case and death reductions in both target groups. The model explored a 12-month time horizon. These analyses helped to inform the vaccination strategy in Thailand throughout 2021 and can inform future modelling studies for policymaking when the characteristics of vaccines are uncertain.
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Affiliation(s)
| | - Chris Painter
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Thailand; Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand; Nuffield Department of Medicine, University of Oxford, United Kingdom.
| | - Wirichada Pan-Ngum
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Thailand
| | - Sompob Saralamba
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Thailand
| | - Tanaphum Wichaita
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Thailand
| | - Lisa White
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Ricardo Aguas
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Hannah Clapham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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17
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Chavarina KK, Faradiba D, Sari EN, Wang Y, Teerawattananon Y. Health economic evaluations for Indonesia: a systematic review assessing evidence quality and adherence to the Indonesian Health Technology Assessment (HTA) Guideline. Lancet Reg Health Southeast Asia 2023; 13:100184. [PMID: 37383554 PMCID: PMC10306002 DOI: 10.1016/j.lansea.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/07/2022] [Accepted: 03/16/2023] [Indexed: 06/30/2023]
Abstract
Background The Government of Indonesia implemented health technology assessment (HTA) to ensure quality and cost control in the National Health Insurance Program (Jaminan Kesehatan Nasional/JKN). The current aim of the study was to improve the usefulness of future economic evaluation for resource allocation by appraising current methodology, reporting, and source of evidence quality of studies. Methods The inclusion and exclusion criteria were applied to search for relevant studies using a systematic review. The methodology and reporting adherence were appraised according to Indonesia's HTA Guideline issued in 2017. The differences in adherence before and after the guideline dissemination were compared using Chi-square and Fisher's exact tests for methodology adherence wherever appropriate, and the Mann-Whitney test for reporting adherence. The source of evidence quality was assessed using evidence hierarchy. Two scenarios of the study start date and the guideline dissemination period were tested using sensitivity analyses. Findings Eighty-four studies were obtained from PubMed, Embase, Ovid, and two local journals. Only two articles cited the guideline. No statistically significant difference (P > 0.05) was found between the pre-dissemination and post-dissemination period with respect to methodology adherence, except for outcome choice. Studies during the post-dissemination period showed a higher score for reporting which was statistically significant (P = 0.01). However, the sensitivity analyses revealed no statistically significant difference (P > 0.05) in methodology (except for modelling type, P = 0.03) and reporting adherence between the two periods. Interpretation The guideline did not impact the methodology and reporting standard used in the included studies. Recommendations were provided to improve the usefulness of economic evaluations for Indonesia. Funding The Access and Delivery Partnership (ADP) hosted by the United Nations Development Programme (UNDP) and the Health Systems Research Institute (HSRI).
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Affiliation(s)
- Kinanti Khansa Chavarina
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Ella Nanda Sari
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
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18
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Turner HC, Sandmann FG, Downey LE, Orangi S, Teerawattananon Y, Vassall A, Jit M. What are economic costs and when should they be used in health economic studies? Cost Eff Resour Alloc 2023; 21:31. [PMID: 37189118 DOI: 10.1186/s12962-023-00436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/18/2023] [Indexed: 05/17/2023] Open
Abstract
Economic analyses of healthcare interventions are an important consideration in evidence-based policymaking. A key component of such analyses is the costs of interventions, for which most are familiar with using budgets and expenditures. However, economic theory states that the true value of a good/service is the value of the next best alternative forgone as a result of using the resource and therefore observed prices or charges do not necessarily reflect the true economic value of resources. To address this, economic costs are a fundamental concept within (health) economics. Crucially, they are intended to reflect the resources' opportunity costs (the forgone opportunity to use those resources for another purpose) and they are based on the value of the resource's next-best alternative use that has been forgone. This is a broader conceptualization of a resource's value than its financial cost and recognizes that resources can have a value that may not be fully captured by their market price and that by using a resource it makes it unavailable for productive use elsewhere. Importantly, economic costs are preferred over financial costs for any health economic analyses aimed at informing decisions regarding the optimum allocation of the limited/competing resources available for healthcare (such as health economic evaluations), and they are also important when considering the replicability and sustainability of healthcare interventions. However, despite this, economic costs and the reasons why they are used is an area that can be misunderstood by professionals without an economic background. In this paper, we outline to a broader audience the principles behind economic costs and when and why they should be used within health economic analyses. We highlight that the difference between financial and economic costs and what adjustments are needed within cost calculations will be influenced by the context of the study, the perspective, and the objective.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Frank G Sandmann
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Laura E Downey
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Stacey Orangi
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
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19
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Rattanavipapong W, Poonsiri C, Isaranuwatchai W, Iamsirithaworn S, Apakupakul J, Sonthichai C, Kitphati R, Teerawattananon Y. Economic Evaluation of Evusheld for Preexposure Prevention of COVID-19 in High-Risk Populations: Early Evidence from Thailand. Appl Health Econ Health Policy 2023; 21:511-522. [PMID: 36928779 PMCID: PMC10019402 DOI: 10.1007/s40258-023-00796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND AIMS The introduction of Coronavirus disease 2019 (COVID-19) vaccines urged all Thais to seek prevention of serious illness and death from COVID-19. However, immunocompromised individuals might not be able to achieve an efficient immune response from these vaccines. This study aimed to evaluate the cost-effectiveness and budget impact of introducing Evusheld (tixagevimab plus cilgavimab) for three patient groups-organ transplant, autoimmune disease, and dialysis patients, from the Thai government perspective. METHODS A Markov decision model was developed to compare the use of Evusheld plus COVID-19 vaccines versus COVID-19 vaccines alone. The methodology followed the National HTA Guidelines of Thailand. Model input parameters were collected locally from retrospective data and from a literature review. RESULTS Evusheld helped prevent COVID-19 infection, severe infection, and death in all three patient groups. Using the Thai threshold of 160,000 Thai Baht (THB) per quality-adjusted life year (QALY) gained, the only scenario found to be cost-effective was that of dialysis patients with inadequate immune response, with an incremental cost-effectiveness ratio (ICER) of 54,700 THB per QALY gained. To make a policy of Evusheld provision cost-effective in other groups, the price of Evusheld had to be lower (a reduction of 44-88% of its current price). The results of one-way sensitivity analysis indicated that the cost-effectiveness of Evusheld was sensitive to changes in the rate of infection, cost and efficacy of Evusheld, proportion of inadequate immune responses, and the probability of moving from a 'recovered' to 'susceptible' status. CONCLUSION Among three COVID-19-vaccinated immunocompromised patient populations, this study concluded that Evusheld was cost-effective for dialysis patients with inadequate immune response to the COVID-19 vaccine.
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Affiliation(s)
- Waranya Rattanavipapong
- Health Intervention and Technology Assessment Programme, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Rd., Muang, Nonthaburi, Thailand
| | - Chittawan Poonsiri
- Health Intervention and Technology Assessment Programme, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Rd., Muang, Nonthaburi, Thailand.
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Programme, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Rd., Muang, Nonthaburi, Thailand
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Jutarat Apakupakul
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Chaninan Sonthichai
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Rungrueng Kitphati
- Health Technical Office, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Programme, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Rd., Muang, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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20
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Luankongsomchit V, Boonma C, Soboon B, Ranron P, Isaranuwatchai W, Pimsarn N, Limpanyalert P, Sukkul AC, Panmon N, Teerawattananon Y. How Many People Experience Unsafe Medical Care in Thailand, and How Much Does It Cost under Universal Coverage Scheme? Healthcare (Basel) 2023; 11:healthcare11081121. [PMID: 37107954 PMCID: PMC10137567 DOI: 10.3390/healthcare11081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Adverse events and medical harm comprise major health concerns for people all over the world, including Thailand. The prevalence and burden of medical harm must always be monitored, and a voluntary database should not be used to represent national value. The purpose of this study is to estimate the national prevalence and economic impact of medical harm in Thailand using routine administrative data from the inpatient department electronic claim database under the Universal Coverage scheme from 2016 to 2020. Our findings show that there are approximately 400,000 visits with potentially unsafe medical care per year (or 7% of all inpatient visits under the Universal Coverage scheme). The annual cost of medical harm is estimated to be approximately USD 278 million (approximately THB 9.6 billion), with an average of 3.5 million bed-days per year. This evidence can be used to raise safety awareness and support medical harm prevention policies. Future work should focus on improving medical harm surveillance using better data quality and more comprehensive data on medical harm.
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Affiliation(s)
| | - Chulathip Boonma
- Health Intervention and Technology Assessment Program, Nonthaburi 11000, Thailand
| | - Budsadee Soboon
- Health Intervention and Technology Assessment Program, Nonthaburi 11000, Thailand
| | - Papada Ranron
- Health Intervention and Technology Assessment Program, Nonthaburi 11000, Thailand
| | | | - Nopphadol Pimsarn
- Health Intervention and Technology Assessment Program, Nonthaburi 11000, Thailand
| | - Piyawan Limpanyalert
- Healthcare Accreditation Institute (Public Organization), Nonthaburi 11000, Thailand
| | - Ake-Chitra Sukkul
- Healthcare Accreditation Institute (Public Organization), Nonthaburi 11000, Thailand
| | - Netnapa Panmon
- Healthcare Accreditation Institute (Public Organization), Nonthaburi 11000, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Nonthaburi 11000, Thailand
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21
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Kc S, Lin LW, Bayani DBS, Zemlyanska Y, Adler A, Ahn J, Chan K, Choiphel D, Genuino-Marfori AJ, Kearney B, Liu Y, Nakamura R, Pearce F, Prinja S, Pwu RF, Akmal Shafie A, Sui B, Suwantika A, Tunis S, Wu HM, Zalcberg J, Zhao K, Isaranuwatchai W, Teerawattananon Y, Wee HL. What, Where, and How to Collect Real-World Data and Generate Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia: A reflection Into the Past and A Way Forward. Int J Health Policy Manag 2023; 12:6858. [PMID: 37579427 PMCID: PMC10461954 DOI: 10.34172/ijhpm.2023.6858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Globally, there is increasing interest in the use of real-world data (RWD) and real-world evidence (RWE) to inform health technology assessment (HTA) and reimbursement decision-making. Using current practices and case studies shared by eleven health systems in Asia, a non-binding guidance that seeks to align practices for generating and using RWD/RWE for decision-making in Asia was developed by the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) Working Group, addressing a current gap and needs among HTA users and generators. METHODS The guidance document was developed over two face-to-face workshops, in addition to an online survey, a face-to-face interview and pragmatic search of literature. The specific focus was on what, where and how to collect RWD/ RWE. RESULTS All 11 REALISE member jurisdictions participated in the online survey and the first in-person workshop, 10 participated in the second in-person workshop, and 8 participated in the in-depth face-to-face interviews. The guidance document was iteratively reviewed by all working group members and the International Advisory Panel. There was substantial variation in: (a) sources and types of RWD being used in HTA, and (b) the relative importance and prioritization of RWE being used for policy-making. A list of national-level databases and other sources of RWD available in each country was compiled. A list of useful guidance on data collection, quality assurance and study design were also compiled. CONCLUSION The REALISE guidance document serves to align the collection of better quality RWD and generation of reliable RWE to ultimately inform HTA in Asia.
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Affiliation(s)
- Sarin Kc
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Lydia Wenxin Lin
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | | | - Yaroslava Zemlyanska
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Amanda Adler
- The Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, UK
| | | | - Kelvin Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Dechen Choiphel
- Essential Medicine and Technology Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | | | - Brendon Kearney
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Health Policy Advisory Committee on Technology, Brisbane, QLD, Australia
| | - Yuehua Liu
- China Health Technology Assessment Centre, National Health Development Research Centre, Ministry of Health, Beijing, China
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Fiona Pearce
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raoh-Fang Pwu
- Taiwan National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Arsul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Binyan Sui
- China Health Technology Assessment Centre, National Health Development Research Centre, Ministry of Health, Beijing, China
| | - Auliya Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Sean Tunis
- Center for Medical Technology Policy (CMTP), Baltimore, MD, USA
| | - Hui-Min Wu
- Taiwan National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - John Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
| | - Kun Zhao
- China Health Technology Assessment Centre, National Health Development Research Centre, Ministry of Health, Beijing, China
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
- Centre for Excellence in Economic Analysis Research, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore (NUS), Singapore, Singapore
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22
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Cai CGX, Lim NWH, Huynh VA, Ananthakrishnan A, Dabak SV, Dickens BSL, Faradiba D, KC S, Morton A, Park M, Rachatan C, Sittimart M, Wee HL, Lou J, Teerawattananon Y. Economic Analysis of Border Control Policies during COVID-19 Pandemic: A Modelling Study to Inform Cross-Border Travel Policy between Singapore and Thailand. Int J Environ Res Public Health 2023; 20:4011. [PMID: 36901023 PMCID: PMC10001629 DOI: 10.3390/ijerph20054011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
With countries progressing towards high COVID-19 vaccination rates, strategies for border reopening are required. This study focuses on Thailand and Singapore, two countries that share significant tourism visitation, to illustrate a framework for optimizing COVID-19 testing and quarantine policies for bilateral travel with a focus on economic recovery. The timeframe is the month of October 2021, when Thailand and Singapore were preparing to reopen borders for bilateral travel. This study was conducted to provide evidence for the border reopening policy decisions. Incremental net benefit (INB) compared to the pre-opening period was quantified through a willingness-to-travel model, a micro-simulation COVID-19 transmission model and an economic model accounting for medical and non-medical costs/benefits. Multiple testing and quarantine policies were examined, and Pareto optimal (PO) policies and the most influential components were identified. The highest possible INB for Thailand is US $125.94 million, under a PO policy with no quarantine but with antigen rapid tests (ARTs) pre-departure and upon arrival to enter both countries. The highest possible INB for Singapore is US $29.78 million, under another PO policy with no quarantine on both sides, no testing to enter Thailand, and ARTs pre-departure and upon arrival to enter Singapore. Tourism receipts and costs/profits of testing and quarantine have greater economic impacts than that from COVID-19 transmission. Provided healthcare systems have sufficient capacity, great economic benefits can be gained for both countries by relaxing border control measures.
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Affiliation(s)
- Celestine Grace Xueting Cai
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Vinh Anh Huynh
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Sarin KC
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Alec Morton
- Department of Management Science, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, UK
| | - Minah Park
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Chayapat Rachatan
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Manit Sittimart
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
- Department of Pharmacy, Faculty of Science, NUS, 18 Science Drive 4, Singapore 117559, Singapore
| | - Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
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23
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Sukmanee J, Butchon R, Karunayawong P, Saeraneesopon T, Boonma C, Teerawattananon Y, Isaranuwatchai W. Pattern of OPD utilisation during the COVID-19 pandemic under the Universal Coverage Scheme in Thailand: what can 850 million records tell us? BMC Health Serv Res 2023; 23:116. [PMID: 36737787 PMCID: PMC9897880 DOI: 10.1186/s12913-023-09121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region. METHODS This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017-2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces. RESULTS Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631-0.819) and 11% (RR 0.890, 95% CI: 0.811-0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320-0.527), while the number of visits for non-communicable diseases (ICD-10: E00-E90, I00-I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups. CONCLUSIONS Thailand's OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.
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Affiliation(s)
- Jarawee Sukmanee
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Rukmanee Butchon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Picharee Karunayawong
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Chulathip Boonma
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Yot Teerawattananon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand ,grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore ,grid.415836.d0000 0004 0576 2573Health Administration Division, Office of the Permanent Secretary of the Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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24
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Botwright S, Win EM, Kapol N, Benjawan S, Teerawattananon Y. Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures. Pharmacoeconomics 2023; 41:77-91. [PMID: 36348154 PMCID: PMC9644008 DOI: 10.1007/s40273-022-01207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. METHODS We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2) Td vaccine and aP vaccine, and (3) Td vaccine only. We constructed two decision-tree models with Markov elements, each following a different clinical pathway, to allow us to examine structural uncertainty. Costs were converted to 2021 Thai Baht (THB) and a discount rate of 3% was applied to health and cost outcomes, with sensitivity analysis at 0% and 6%. Parameter uncertainty was investigated through deterministic and probabilistic sensitivity analysis, with expected value of perfect information analysis. RESULTS Maternal pertussis vaccination would avert 27 cases and up to one death per year. The incremental cost-effectiveness ratio (ICER) for adding aP to the maternal immunisation schedule is 2,184,025 THB/QALY and the ICER for replacing maternal Td vaccination with TdaP is 3,198,101 THB/QALY. Maternal pertussis vaccination only becomes favourable in the probabilistic sensitivity analysis at cost-effectiveness thresholds above 6,000,000 THB/QALY, far above the Thai threshold of 160,000 THB/QALY. If incidence is less than 397 cases per 100,000, maternal pertussis vaccination will not be cost-effective in Thailand, within the plausible range for vaccine effectiveness and probability of hospitalisation. Budget impact is dominated by vaccination costs, which represent 12% and 18% of the 2021 national vaccine programme budget for introducing aP vaccine or for switching Td with TdaP vaccine, respectively. CONCLUSIONS We have found that maternal pertussis immunisation is not cost-effective in Thailand. Although there may be substantial under-reporting of pertussis cases, comparison with hospital data suggests that most under-reported cases are not hospitalised and therefore have negligible impact on our results. However, considerations such as affordability and local manufacturing may also be important for national immunisation programme decision-making.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Ei Mon Win
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Nattiya Kapol
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
- National University of Singapore, Singapore, Singapore
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25
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Akksilp K, Isaranuwatchai W, Teerawattananon Y, Chen C. The association between health costs and physical inactivity; analysis from the Physical Activity at Work study in Thailand. Front Public Health 2023; 11:1037699. [PMID: 36960361 PMCID: PMC10027789 DOI: 10.3389/fpubh.2023.1037699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Physical inactivity increases the risks of several common yet serious non-communicable diseases, costing a tremendous amount of health expenditure globally. This study aimed to estimate the association between health costs and physical inactivity in Thailand. Methods Data from the Physical Activity at Work cluster randomized controlled trial participants with valid objective physical activity data were extracted. Health costs were collected using the Health and Welfare Survey and the Work Productivity and Activity Impairment Questionnaire and were categorized into past-month outpatient illness, past-year inpatient illness, and past-week presenteeism and absenteeism. Time spent in moderate-to-vigorous physical activity was used to determine the activity level according to the current guideline (i.e., ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity equivalent physical activity per week). The primary analysis evaluated the association between direct cost (treatment and travel costs) and societal cost (direct cost plus absenteeism due to the illness) of past-month outpatient illness and physical inactivity using a two-part model. Results In total, 277 participants with a mean age of 38.7 were included. Average direct and societal cost due to past-month outpatient illness were 146 THB (3.99 USD) (SD = 647 THB) and 457 THB (12.5 USD) (SD = 1390 THB), respectively. Compared to active participants, direct and societal cost of past-month outpatient illness were 153 THB (4.18 USD) (95%CI: -54.7 to 360 THB) and 426 THB (11.7 USD) (95%CI: 23.3 to 829 THB) higher in physically inactive individuals, respectively, adjusted for covariates. The additional societal cost of past-month outpatient illness was 145% higher in physically inactive participants compared to active participants. On the other hand, there was no significant association in direct and societal cost of past-year inpatient illness nor past-week indirect costs between physically active and non-active participants. Discussion Results were similar to recent findings in different countries. However, the findings should be generalized with caution due to the small sample size and potential bias from reverse causation. Future research is crucial for clarifying the health costs of physical inactivity in Thailand and other countries.
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Affiliation(s)
- Katika Akksilp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Health Intervention and Technology Assessment Programme, Ministry of Public Health, Bangkok, Thailand
- *Correspondence: Katika Akksilp
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Programme, Ministry of Public Health, Bangkok, Thailand
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Health Intervention and Technology Assessment Programme, Ministry of Public Health, Bangkok, Thailand
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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26
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Akksilp K, Koh JJE, Tan V, Tong EH, Budtarad N, Xueying G, Dieterich AV, Tai BC, Müller AM, Isaranuwatchai W, Rouyard T, Nakamura R, Müller-Riemenschneider F, Teerawattananon Y, Chen C. The physical activity at work (PAW) study: a cluster randomised trial of a multicomponent short-break intervention to reduce sitting time and increase physical activity among office workers in Thailand. Lancet Reg Health Southeast Asia 2023; 8:100086. [PMID: 37384135 PMCID: PMC10305858 DOI: 10.1016/j.lansea.2022.100086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Sedentary behaviour increases the risks of non-communicable diseases. The objective of this trial was to evaluate the effect of the Physical Activity at Work multicomponent intervention to reduce sedentary behaviour in Thai office workers. Methods Offices under the Ministry of Public Health Thailand, were randomly allocated to the intervention and control group in a 1:1 ratio, stratified by office size. The intervention included individual (pedometer and lottery-based financial incentives), social (group movement breaks), environmental (posters), and organisational (leader encouragement) components. At baseline and 6-month follow-up, participants wore ActiGraphTM on the waist for ten days. The primary outcome was the between-group difference in sedentary time at 6-month, analysed using a linear mixed-effects model. Other outcomes were physical activity, biomarkers, productivity, and musculoskeletal health. Trial registration: The PAW study was registered at the Thai Clinical Trials Registry (ID TCTR20200604007) on 02 June 2020. Findings 282 office workers were recruited and randomly allocated to the control group (142 participants, nine offices) and the intervention group (140 participants, nine offices). The mean age was 38.6 years (SD = 10.4), and 81% were women. There was no evidence of intervention effects on sedentary time during waking hours (-26.8; 95% CI = -69.2 to 15.7 min), physical activity levels, or biomarkers between groups at 6-month. In the adjusted analysis, increases in time spent in moderate-to-vigorous physical activity (5.45; 95% CI = -0.15 to 11.1 min) and step count (718; 95% CI = -45 to 1481 steps) during waking hours were observed, although there was no evidence of a difference between groups. Interpretation The intervention did not significantly reduce sedentary time in Thai office workers. Suboptimal intervention uptake due to Covid-19 pandemic restrictions and loss of statistical power associated with recruitment constraints may explain this result. Further investigations are needed to evaluate the processes of the trial. Funding The Thai Health Promotion Foundation and the International Decision Support Initiative (iDSI).
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Affiliation(s)
- Katika Akksilp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Jemima Jia En Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Eunice Huiying Tong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Nuttakarn Budtarad
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Guo Xueying
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Anna Valeria Dieterich
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Thomas Rouyard
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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27
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Akksilp K, Isaranuwatchai W, Teerawattananon Y, Chen C. INADEQUATE PHYSICAL ACTIVITY ON HEALTHCARE EXPENDITURES AMONG MIDDLE AGE AND OLDER WORKING ADULTS IN THAILAND. Innov Aging 2022. [PMCID: PMC9766902 DOI: 10.1093/geroni/igac059.3060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Physical inactivity is a significant risk factor for developing non-communicable diseases. This study estimates the additional health costs due to physical inactivity in Thai middle age and older working adults. We included participants aged 40 years and above from the Physical Activity at Work study, who had valid physical activity data from ActiGraph. Health costs were collected using the Health and Welfare Survey and the Work Productivity and Activity Impairment Questionnaire in Thailand. Direct and indirect costs (absenteeism and presenteeism) of the most recent illness in the previous month were collected. Active participants were defined as having at least 150 minutes of moderate-intensity equivalent activity per week. Two-part models were used to compare health costs between active and non-active participants. Data from 105 participants aged 40 to 63 were included in the analysis, where 42% of participants were active. Inadequate physical activity was significantly associated with increased direct health costs of 160.5THB (95%CI: 31.3 to 289.7THB) (~7.8 times higher in inactive). Further adjustment for sex, age, education, obesity, and cardiovascular condition yielded similar findings. After incorporating these indirect costs, the societal cost of having inadequate physical activity was 791.22THB (95%CI: 115.6 to 1466.8THB) (~1.3 times higher in inactive), even after adjusting for the covariates. Obesity and the female were also associated with higher societal costs (551.9THB and 342.9THB, respectively), although these results were not significant. Increasing physical activity in middle age and older working adults to meet the current guidelines may reduce Thailand’s health costs.
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Affiliation(s)
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Muang Nonthaburi, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Muang Nonthaburi, Nonthaburi, Thailand
| | - Cynthia Chen
- National University of Singapore, Singapore, Singapore
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Teerawattananon Y, Dabak SV, Isaranuwatchai W, Lertwilairatanapong T, Shafie AA, Suwantika AA, Oh C, Srisasalux J, Cheanklin N. What Can We Learn From Others to Develop a Regional Centre for Infectious Diseases in ASEAN? Comment on "Operationalising Regional Cooperation for Infectious Disease Control: A Scoping Review of Regional Disease Control Bodies and Networks". Int J Health Policy Manag 2022; 11:3141-3144. [PMID: 35942957 PMCID: PMC10105200 DOI: 10.34172/ijhpm.2022.7281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has brought the need for regional collaboration on disease prevention and control to the fore. The review by Durrance-Bagale et al offers insights on the enablers, barriers and lessons learned from the experience of various regional initiatives. Translating these lessons into action, however, remains a challenge. The Association of Southeast Asian Nations (ASEAN) planned to establish a regional centre for disease control; however, many factors have slowed the realisation of these efforts. Going forward, regional initiatives should be able to address the complexity of emerging infectious diseases through a One Health approach, assess the social and economic impact of diseases on the region and study the real-world effectiveness of regional collaborations. The initiatives should seek to be inclusive of stakeholders including those from the private sector and should identify innovative measures for financing. This advancement will enable regions such as ASEAN to effectively prepare for the next pandemic.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Auliya A. Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Cecilia Oh
- HIV, Health and Development Team, United Nations Development Programme, Bangkok, Thailand
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Ananthakrishnan A, Luz ACG, KC S, Ong L, Oh C, Isaranuwatchai W, Dabak SV, Teerawattananon Y, Turner HC. How can health technology assessment support our response to public health emergencies? Health Res Policy Syst 2022; 20:124. [PMID: 36333759 PMCID: PMC9636714 DOI: 10.1186/s12961-022-00925-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Public health emergencies (PHEs), such as the COVID-19 crisis, are threats to global health and public order. We recommend that countries bolster their PHE responses by investing in health technology assessment (HTA), defined as a systematic process of gathering pertinent information on and evaluating health technologies from a medical, economic, social and ethical standpoint. We present examples of how HTA organizations in low- and middle-income countries have adapted to supporting PHE-related decisions during COVID-19 and describe the ways HTA can help the response to a PHE. In turn, we advocate for HTA capacity to be further developed globally and for increased institutional acceptance of these methods as a building block for preparedness and response to future PHEs. Finally, the long-term potential of HTA in strengthening health systems and embedding confidence and transparency into scientific policy should be recognized.
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Affiliation(s)
- Aparna Ananthakrishnan
- grid.415836.d0000 0004 0576 2573Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Alia Cynthia Gonzales Luz
- grid.415836.d0000 0004 0576 2573Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Sarin KC
- grid.415836.d0000 0004 0576 2573Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Leslie Ong
- Access and Delivery Partnership, United Nations Development Programme (UNDP), Bangkok, Thailand
| | - Cecilia Oh
- Access and Delivery Partnership, United Nations Development Programme (UNDP), Bangkok, Thailand
| | - Wanrudee Isaranuwatchai
- grid.415836.d0000 0004 0576 2573Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
| | - Saudamini Vishwanath Dabak
- grid.415836.d0000 0004 0576 2573Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- grid.415836.d0000 0004 0576 2573Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand ,grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hugo C. Turner
- grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Sukmanee J, Butchon R, Sarajan MH, Saeraneesopon T, Boonma C, Karunayawong P, Teerawattananon Y, Isaranuwatchai W. Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy. PLoS One 2022; 17:e0270241. [PMID: 36327258 PMCID: PMC9632900 DOI: 10.1371/journal.pone.0270241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy. Methods A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown. Results The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates. Conclusion The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.
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Affiliation(s)
- Jarawee Sukmanee
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Myka Harun Sarajan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Chulathip Boonma
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Picharee Karunayawong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- * E-mail:
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31
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Isaranuwatchai W, Nakamura R, Wee HL, Sarajan MH, Wang Y, Soboon B, Lou J, Chai JH, Theantawee W, Laoharuangchaiyot J, Mongkolchaipak T, Thathong T, Kingkaew P, Tungsanga K, Teerawattananon Y. What are the impacts of increasing cost-effectiveness Threshold? a protocol on an empirical study based on economic evaluations conducted in Thailand. PLoS One 2022; 17:e0274944. [PMID: 36191016 PMCID: PMC9529087 DOI: 10.1371/journal.pone.0274944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Economic evaluations have been widely used to inform and guide policy-making process in healthcare resources allocation as a part of an evidence package. An intervention is considered cost-effective if an ICER is less than a cost-effectiveness threshold (CET), where a CET represents the acceptable price for a unit of additional health gain which a decision-maker is willing to pay. There has been discussion to increase a CET in many settings such as the United Kingdom and Thailand. To the best of our knowledge, Thailand is the only country that has an explicit CET and has revised their CET, not once but twice. Hence, the situation in Thailand provides a unique opportunity for evaluating the impact of changing CET on healthcare expenditure and manufacturers’ behaviours in the real-world setting. Before we decide whether a CET should be increased, information on what happened after the CET was increased in the past could be informative and helpful. Objectives This study protocol describes a proposed plan to investigate the impact of increased cost-effectiveness threshold using Thailand as a case study. Specifically, we will examine the impact of increasing CET on the drug prices submitted by pharmaceutical companies to the National List of Essential Medicine (NLEM), the decision to include or exclude medications in the NLEM, and the overall budget impact. Materials and designs Retrospective data analysis of the impact of increased CET on national drug committee decisions in Thailand (an upper middle-income country) will be conducted and included data from various sources such as literature, local organizations (e.g. Thai Food and Drug Administration), and inputs from stakeholder consultation meetings. The outcomes include: (1) drug price submitted by the manufacturers and final drug price included in the NLEM if available; (2) decisions about whether the drug was included in the NLEM for reimbursement; and (3) budget impact. The independent variables include a CET, the variable of interest, which can take values of THB100,000, THB120,000, or THB160,000, and potential confounders such as whether this drug was for a chronic disease, market size, and primary endpoint. We will conduct separate multivariable regression analysis for each outcome specified above. Discussion Understanding the impact of increasing the CET would be helpful in assisting the decision to use and develop an appropriate threshold for one’s own setting. Due to the nature of the study design, the findings will be prone to confounding effect and biases; therefore, the analyses will be adjusted for potential confounders and statistical methods will be explored to minimize biases. Knowledge gained from the study will be conveyed to the public through various disseminations such as reports, policy briefs, academic journals, and presentations.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- * E-mail:
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study and Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Myka Harun Sarajan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Budsadee Soboon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jia Hui Chai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wannisa Theantawee
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Jutatip Laoharuangchaiyot
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Thanakrit Mongkolchaipak
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Thanisa Thathong
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Kriang Tungsanga
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Rattanavipapong W, Worakijthamrongchai T, Soboon B, Luankongsomchit V, Kongmuangpuk M, Isaranuwatchai W, Teerawattananon Y, Nilanont Y. Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand. BMJ Open 2022; 12:e064403. [PMID: 36167373 PMCID: PMC9516067 DOI: 10.1136/bmjopen-2022-064403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Endovascular therapy (EVT) has proven to be clinically effective in treating large vessel occlusion acute ischaemic stroke (AIS), either alone or in combination with intravenous alteplase. Despite this, there is a limited evidence on the cost-effectiveness of EVT in Thailand and other low-income and middle-income countries. This study aims to assess whether EVT is a cost-effective therapy for AIS, and to estimate the fiscal burden to the Thai government through budget impact analysis. METHODS An economic evaluation was performed to compare AIS therapy with and without EVT from a societal perspective. The primary outcome was incremental cost-effectiveness per quality-adjusted life year (QALY) gained. Clinical parameters were derived from both national and international literature, while cost and utility data were collected locally. The analysis applied a cost-effectiveness threshold of 160 000 Baht (~$5000) per QALY, as set by the Thai government. RESULTS Both EVT alone and EVT combined with intravenous alteplase, among patients who are ineligible and eligible for intravenous alteplase, respectively, improved health outcomes but incurred additional cost. The combination of EVT and intravenous alteplase was associated with an incremental cost-effectiveness ratio (ICER) of 146 800 THB per QALY gained compared with intravenous alteplase alone, and the ICER of EVT alone compared with supportive care among patients ineligible for intravenous alteplase was estimated at 115 000 THB per QALY gained. Sensitivity analysis showed that the price of EVT has the greatest impact on model outcomes. Over a time horizon of 5 years, the introduction of EVT into the Thai health benefit package would require an additional budget of 887 million THB, assuming 2000 new cases per year. CONCLUSIONS EVT represents good value for money in the Thai context, both when provided to patients eligible for intravenous alteplase, and when provided alone to those who are ineligible for intravenous alteplase.
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Affiliation(s)
- Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | | | - Budsadee Soboon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Vilawan Luankongsomchit
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | | | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Yongchai Nilanont
- Siriraj Stroke Center, Siriraj hospital, Bangkok, Thailand
- Department of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Shiroiwa T, Murata T, Ahn J, Li X, Nakamura R, Teerawattananon Y, Kun Z, Shafie AA, Valverde H, Lam H, Ng K, Nadjib M, Pwu RF, Nugraha RR, Chen YC, Fukuda T. Developing a New Region-Specific Preference-Based Measure in East and Southeast Asia. Value Health Reg Issues 2022; 32:62-69. [PMID: 36099801 DOI: 10.1016/j.vhri.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Almost all preference-based measures (PBMs) have been developed in Western countries, with none having been formulated in Asian countries. In this study, we construct a new generic PBM based on concept elicitation using interview surveys in East and Southeast Asian countries and qualitative analysis. METHODS This cross-sectional study included 225 adults recruited from 9 East and Southeast Asian countries or regions (Indonesia, Japan, Korea, mainland China, Malaysia, the Philippines, Singapore, Taiwan, and Thailand). Trained interviewers conducted semistructured interviews with 25 participants from the general population of each country/region. Qualitative data were analyzed using a content analysis approach. The selection of items was determined based on interview surveys and team member discussions. The description of items was considered based on a detailed qualitative analysis of the interview survey. RESULTS A new region-specific PBM-the Asia PBM 7 dimensions instrument-was designed. It reflects East and Southeast Asian values and comprises 7 items: pain, mental health, energy, mobility, work/school, interpersonal interactions, and burden to others. CONCLUSIONS The new region-specific instrument is one of the first PBMs developed in the context of non-Western countries. The Asia PBM 7 dimensions contains 7 items that address the core concepts of health-related quality of life that are deemed important based on East and Southeast Asian health concepts.
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Affiliation(s)
- Takeru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan.
| | | | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Xue Li
- China National Health Development Research Center, Beijing, China
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Kunitachi, Japan
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Zhao Kun
- China National Health Development Research Center, Beijing, China
| | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Haidee Valverde
- Institute of Health Policy and Development Studies, University of the Philippines Manila, National Institutes of Health, Manila, Philippines
| | - Hilton Lam
- Institute of Health Policy and Development Studies, University of the Philippines Manila, National Institutes of Health, Manila, Philippines
| | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health Singapore, Singapore
| | - Mardiati Nadjib
- ThinkWell, Jakarta, Indonesia; Department of Health Policy and Administration, University of Indonesia, Depok, Indonesia
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ryan Rachmad Nugraha
- Center for Health Economics and Policy Studies, School of Public Health University of Indonesia, Depok, Indonesia
| | - Yong-Chen Chen
- Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Takashi Fukuda
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
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Teerawattananon Y, Botwright S, Ozturk MH. Planning for future COVID-19 vaccine procurement. Bull World Health Organ 2022; 100:526-526A. [PMID: 36062243 PMCID: PMC9421551 DOI: 10.2471/blt.22.288729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand
| | - Siobhan Botwright
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand
| | - Murat Hakan Ozturk
- Revolving Fund for Access to Vaccines, World Health Organization Regional Office for the Americas, Washington DC, United States of America
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Pheerapanyawaranun C, Wang Y, Kittibovorndit N, Pimsarn N, Sirison K, Teerawattananon Y, Isaranuwatchai W. COVID-19 Vaccine Hesitancy Among Health Care Workers in Thailand: The Comparative Results of Two Cross-Sectional Online Surveys Before and After Vaccine Availability. Front Public Health 2022; 10:834545. [PMID: 35979452 PMCID: PMC9376379 DOI: 10.3389/fpubh.2022.834545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe arrival of COVID-19 vaccines in Thailand has supported the fight against the COVID-19 pandemic. This study examined COVID-19 vaccine acceptance among health care workers (HCWs) in Thailand before and after vaccines' availability and investigated factors (both enablers and barriers) affecting their decisions.MethodsTwo online self-administered questionnaires were distributed to HCWs in two time-periods: (1) the pre-vaccine arrival period (prior to COVID-19 vaccines' arrival in Thailand, January 28 to February 16, 2021); and (2) the post-vaccine arrival period (April 21 to May 9, 2021). Descriptive analyses and multinomial logistic regression were conducted to examine factors associated with vaccine hesitancy.ResultsThere were 55,068 respondents in the pre-vaccine arrival period and 27,319 respondents in the post-vaccine arrival period. In the pre-vaccine arrival period, 55.0% of respondents were willing to accept the vaccines, 35.4% were uncertain, and 9.6% declined. In the post-vaccine arrival period, ~16% already received two doses of either the Sinovac or AstraZeneca vaccine, and 43% were administered one dose. Approximately 12% of those who had received the first dose were uncertain or not willing to accept the second dose. Demographic and socio-demographic factors of participants, including their sex, place of residence, and whether they were frontline COVID-19 workers, were found to be the significant factors explaining vaccination hesitancy. Moreover, when comparing the pre-vaccine arrival and post-vaccine arrival periods, it was found that older HCWs were more likely to decline a COVID-19 vaccine in the pre-vaccine arrival period; on the other hand, older HCWs were less likely to decline or be uncertain to receive a COVID-19 vaccine in the post-vaccine arrival period.ConclusionInformation on HCWs' acceptance of COVID-19 vaccines, including who is more likely to accept the vaccines, could assist in planning vaccine allocation to both HCWs and the general public, who often believe HCWs' recommendations. This study's findings set out how policies can be addressed to reduce vaccine hesitancy. This study also highlights HCWs' characteristics (including gender, work region, occupation, and history of receiving influenza vaccination) and the reasons they cited for their vaccine acceptance or hesitance.
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Affiliation(s)
- Chatkamol Pheerapanyawaranun
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nachawish Kittibovorndit
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Nopphadol Pimsarn
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Kanchanok Sirison
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
- *Correspondence: Wanrudee Isaranuwatchai
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Briones J, Wang Y, Prawjaeng J, Wee HL, Kairu A, Orangi S, Barasa E, Teerawattananon Y. A Data-Driven Analysis of the Economic Cost of Non-Pharmaceutical Interventions: A Cross-Country Comparison of Kenya, Singapore, and Thailand. Int J Public Health 2022; 67:1604854. [PMID: 35837381 PMCID: PMC9273740 DOI: 10.3389/ijph.2022.1604854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To estimate the economic impact of border closure and social distancing by estimating the decline of gross domestic product (GDP) in Kenya, Singapore and Thailand.Methods: We analysed secondary data retrospectively. To calculate impact of NPIs on GDP, the relationship between GDP and stock market index was examined using ordinary least squares (OLS). Then, autoregressive and moving averages (ARMA) model was used to examine the impact of NPI on stock market index. The change in GDP due to NPIs was derived by multiplying coefficients of OLS and ARMA models.Results: An increase in stock market index correlated with an increase in GDP, while both social distancing and border closure negatively correlated with stock market index. Implementation of NPIs correlated with the decline in GDP. Thai border closure had a greater decline in GDP than social distancing; Kenya exhibited the same trends; Singapore had the opposite trend.Conclusion: We quantified the magnitude of economic impact of NPIs in terms of GDP decline by linking stock market index and GDP. This approach may be applicable in other settings.
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Affiliation(s)
- Jamaica Briones
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- *Correspondence: Yi Wang,
| | - Juthamas Prawjaeng
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Angela Kairu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Stacey Orangi
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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Oortwijn W, Husereau D, Abelson J, Barasa E, Bayani DD, Canuto Santos V, Culyer A, Facey K, Grainger D, Kieslich K, Ollendorf D, Pichon-Riviere A, Sandman L, Strammiello V, Teerawattananon Y. Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force. Value Health 2022; 25:869-886. [PMID: 35667778 PMCID: PMC7613534 DOI: 10.1016/j.jval.2022.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Deliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR-The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap. METHODS The joint Task Force consisted of 15 members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to 2 rounds of peer review. RESULTS A deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation. CONCLUSIONS The guidance and the checklist contain a series of questions, grouped by 6 phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Diana Dana Bayani
- Health Intervention and Policy Evaluation Research (HIPER), Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vania Canuto Santos
- Department of Management and Incorporation of Health Technology, Executive Secretariat of National Committee Health Technology Incorporation (CONITEC), Ministry of Health, Brasilia, Brazil
| | - Anthony Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - Karen Facey
- Evidence Based Health Policy Consultant, Drymen, Scotland
| | | | - Katharina Kieslich
- Department of Political Science, Centre for the Study of Contemporary Solidarity, University of Vienna, Vienna, Austria
| | - Daniel Ollendorf
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts University Medical Centre, Boston, MA, USA
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), University of Buenos Aires, Buenos Aires, Argentina
| | - Lars Sandman
- National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Health, Bangkok, Thailand
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Barlow E, Morton A, Dabak S, Engels S, Isaranuwatchai W, Teerawattananon Y, Chalkidou K. What is the value of explicit priority setting for health interventions? A simulation study. Health Care Manag Sci 2022; 25:460-483. [PMID: 35633404 PMCID: PMC9474606 DOI: 10.1007/s10729-022-09594-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/06/2022] [Indexed: 11/28/2022]
Abstract
Many countries seek to secure efficiency in health spending through establishing explicit priority setting institutions (PSIs). Since such institutions divert resources from frontline services which benefit patients directly, it is legitimate and reasonable to ask whether they are worth the money. We address this question by comparing, through simulation, the health benefits and costs from implementing two alternative funding approaches – one scenario in which an active PSI enables cost-effectiveness-threshold based funding decisions, and a counterfactual scenario where there is no PSI. We present indicative results for one dataset from the United Kingdom (published in 2015) and one from Malawi (published in 2018), which show that the threshold rule reliably resulted in decreased health system costs, improved health benefits, or both. Our model is implemented in Microsoft Excel and designed to be user-friendly, and both the model and a user guide are made publicly available, in order to enable others to parameterise the model based on the local setting. Although inevitably stylised, we believe that our modelling and results offer a valid perspective on the added value of explicit PSIs.
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Affiliation(s)
- Euan Barlow
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK.
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Sven Engels
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kalipso Chalkidou
- iDSI, School of Public Health, Imperial College London, London, UK.,Center for Global Development, Washington, DC, USA
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Chen W, Anothaisintawee T, Butani D, Wang Y, Zemlyanska Y, Wong CBN, Virabhak S, Hrishikesh MA, Teerawattananon Y. Assessing the cost-effectiveness of precision medicine: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e057537. [PMID: 35383079 PMCID: PMC8984003 DOI: 10.1136/bmjopen-2021-057537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Precision medicine (PM) involves gene testing to identify disease risk, enable early diagnosis or guide therapeutic choice, and targeted gene therapy. We aim to perform a systematic review and meta-analysis to quantify the cost-effectiveness profile of PM stratified by intervention type, identify sources of heterogeneity in the value-for-money of PM. METHODS AND ANALYSIS We will perform a systematic search in Embase, MEDLINE, EconLit and CRD databases for studies published in English language or with translation in English between 1 January 2011 and 8 July 2021 on the topic of cost-effectiveness analysis of PM interventions. The focus will be on studies that reported health and economic outcomes. Study quality will be assessed using the Biases in Economic Studies checklist. The incremental net benefit of PM screening, diagnostic, treatment-targeting and therapeutic interventions over conventional strategies will be respectively pooled across studies using a random-effect model if heterogeneity is present, otherwise a fixed-effect model. Subgroup analyses will be performed based on disease area, WHO region and World Bank country-income level. Additionally, we will identify the potential sources of heterogeneity with random-effect meta-regressions. Finally, biases will be detected using jackknife sensitivity analysis, funnel plot assessment and Egger's tests. ETHICS AND DISSEMINATION For this type of study ethics approval or formal consent is not required. The results will be disseminated at various presentations and feedback sessions, in conference abstracts and manuscripts that will be submitted to peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021272956.
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Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Dimple Butani
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yaroslava Zemlyanska
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Suchin Virabhak
- Precision Health Research Singapore (PRECISE), Consortium for Clinical Research and Innovation Singapore, Singapore
| | - M A Hrishikesh
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
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Teerawattananon Y, Kc S, Chi YL, Dabak S, Kazibwe J, Clapham H, Lopez Hernandez C, Leung GM, Sharifi H, Habtemariam M, Blecher M, Nishtar S, Sarkar S, Wilson D, Chalkidou K, Gorgens M, Hutubessy R, Wibulpolprasert S. Recalibrating the notion of modelling for policymaking during pandemics. Epidemics 2022; 38:100552. [PMID: 35259693 PMCID: PMC8889889 DOI: 10.1016/j.epidem.2022.100552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 disease models have aided policymakers in low-and middle-income countries (LMICs) with many critical decisions. Many challenges remain surrounding their use, from inappropriate model selection and adoption, inadequate and untimely reporting of evidence, to the lack of iterative stakeholder engagement in policy formulation and deliberation. These issues can contribute to the misuse of models and hinder effective policy implementation. Without guidance on how to address such challenges, the true potential of such models may not be realised. The COVID-19 Multi-Model Comparison Collaboration (CMCC) was formed to address this gap. CMCC is a global collaboration between decision-makers from LMICs, modellers and researchers, and development partners. To understand the limitations of existing COVID-19 disease models (primarily from high income countries) and how they could be adequately support decision-making in LMICs, a desk review of modelling experience during the COVID-19 and past disease outbreaks, two online surveys, and regular online consultations were held among the collaborators. Three key recommendations from CMCC include: A ‘fitness-for-purpose’ flowchart, a tool that concurrently walks policymakers (or their advisors) and modellers through a model selection and development process. The flowchart is organised around the following: policy aims, modelling feasibility, model implementation, model reporting commitment. Holmdahl and Buckee (2020) A ‘reporting standards trajectory’, which includes three gradually increasing standard of reports, ‘minimum’, ‘acceptable’, and ‘ideal’, and seeks collaboration from funders, modellers, and decision-makers to enhance the quality of reports over time and accountability of researchers. Malla et al. (2018) A framework for “collaborative modelling for effective policy implementation and evaluation” which extends the definition of stakeholders to funders, ground-level implementers, public, and other researchers, and outlines how each can contribute to modelling. We advocate for standardisation of modelling processes and adoption of country-owned model through iterative stakeholder participation and discuss how they can enhance trust, accountability, and public ownership to decisions. COVID-19 models need appropriate adaptation to reflect contextual differences across settings. Upholding scientific standards is equally important as providing evidence for policymaking during pandemics. Wider stakeholder engagement with an iterative process for re-evaluating decisions is required for effective policy implementation.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | - Sarin Kc
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand.
| | - Y-Ling Chi
- Centre for Global Development Europe, Great Peter House, Abbey Gardens, Great College St, Westminster, London SW1P 3SE, UK
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Hannah Clapham
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | | | - Gabriel M Leung
- Li Ka Shing Faculty of Medicine (HKUMed), Hong Kong University, 21 Sassoon Rd, Pok Fu Lam, Hong Kong
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KMU), Kerman 7616911320, Iran
| | - Mahlet Habtemariam
- Africa Centres for Disease Control and Prevention, African Union Commission, Roosevelt Streeet, Addis Ababa, Ethiopia
| | - Mark Blecher
- National Treasury, 120 Plein Street, Cape Town, Republic of South Africa
| | - Sania Nishtar
- Poverty Alleviation and Social Safety Division, Government of Pakistan, Cabinet Secretariat, 4th Floor, Evacuee Trust Complex, F-5/1, Islamabad, Pakistan
| | - Swarup Sarkar
- Indian Council for Medical Research (ICMR), Government of India, V. Ramalingaswami Bhawan, P.O. Box No. 4911, Ansari Nagar, New Delhi 110029, India
| | - David Wilson
- Bill and Melinda Gates Foundation (BMGF), 500 5th Ave N, Seattle, WA 98109, USA
| | - Kalipso Chalkidou
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - Marelize Gorgens
- World Bank Group (WBG), 1818H Street, N.W., Washington, DC 20433, USA
| | - Raymond Hutubessy
- World Health Organisation (WHO), Avenue Appia 20, 1211 Geneva, Switzerland
| | - Suwit Wibulpolprasert
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Rd., Nonthaburi 11000, Thailand
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Teerawattananon Y, Anothaisintawee T, Pheerapanyawaranun C, Botwright S, Akksilp K, Sirichumroonwit N, Budtarad N, Isaranuwatchai W. A systematic review of methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines: Advising resource-constrained settings. PLoS One 2022; 17:e0261930. [PMID: 35015761 PMCID: PMC8752025 DOI: 10.1371/journal.pone.0261930] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/13/2021] [Indexed: 01/19/2023] Open
Abstract
Real-world effectiveness studies are important for monitoring performance of COVID-19 vaccination programmes and informing COVID-19 prevention and control policies. We aimed to synthesise methodological approaches used in COVID-19 vaccine effectiveness studies, in order to evaluate which approaches are most appropriate to implement in low- and middle-income countries (LMICs). For this rapid systematic review, we searched PubMed and Scopus for articles published from inception to July 7, 2021, without language restrictions. We included any type of peer-reviewed observational study measuring COVID-19 vaccine effectiveness, for any population. We excluded randomised control trials and modelling studies. All data used in the analysis were extracted from included papers. We used a standardised data extraction form, modified from STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). Study quality was assessed using the REal Life EVidence AssessmeNt Tool (RELEVANT) tool. This study is registered with PROSPERO, CRD42021264658. Our search identified 3,327 studies, of which 42 were eligible for analysis. Most studies (97.5%) were conducted in high-income countries and the majority assessed mRNA vaccines (78% mRNA only, 17% mRNA and viral vector, 2.5% viral vector, 2.5% inactivated vaccine). Thirty-five of the studies (83%) used a cohort study design. Across studies, short follow-up time and limited assessment and mitigation of potential confounders, including previous SARS-CoV-2 infection and healthcare seeking behaviour, were major limitations. This review summarises methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines and highlights the lack of such studies in LMICs, as well as the importance of context-specific vaccine effectiveness data. Further research in LMICs will refine guidance for conducting real-world COVID-19 vaccine effectiveness studies in resource-constrained settings.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Siobhan Botwright
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- * E-mail:
| | - Katika Akksilp
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Nuttakarn Budtarad
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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KC S, Faradiba D, Sittimart M, Isaranuwatchai W, Ananthakrishnan A, Rachatan C, Dabak S, Shafie AA, Guerrero AM, Suwantika A, Kang G, Ahn J, Hsu LY, Mayxay M, Howard N, Wattanasri P, Nakamura R, George TK, Teerawattananon Y. Factors associated with the opposition to COVID-19 vaccination certificates: A multi-country observational study from Asia. Travel Med Infect Dis 2022; 48:102358. [PMID: 35595199 PMCID: PMC9113761 DOI: 10.1016/j.tmaid.2022.102358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/27/2022] [Accepted: 05/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND There are ongoing calls to harmonise and increase the use of COVID-19 vaccination certificates (CVCs) in Asia. Identifying groups in Asian societies who oppose CVCs and understanding their reasons can help formulate an effective CVCs policy in the region. However, no formal studies have explored this issue in Asia. METHOD The COVID-19 Vaccination Policy Research and Decision-Support Initiative in Asia (CORESIA) was established to address policy questions related to CVCs. An online cross-sectional survey was conducted from June to October 2021 in nine Asian countries. Multivariable logistical regression analyses were performed to identify potential opposers of CVCs. RESULTS Six groups were identified as potential opposers of CVCs: (i) unvaccinated (Odd Ratio (OR): 2.01, 95% Confidence Interval (CI): 1.65-2.46); vaccine hesitant and those without access to COVID-19 vaccines; (ii) those not wanting existing NPIs to continue (OR: 2.97, 95% CI: 2.51-3.53); (iii) those with low level of trust in governments (OR: 1.25, 95% CI: 1.02-2.52); (iv) those without travel plans (OR: 1.58, 95% CI: 1.31-1.90); (v) those expecting no financial gains from CVCs (OR: 2.35, 95% CI: 1.98-2.78); and (vi) those disagreeing to use CVCs for employment, education, events, hospitality, and domestic travel. CONCLUSIONS Addressing recurring public health bottlenecks such as vaccine hesitancy and equitable access, adherence to policies, public trust, and changing the narrative from 'societal-benefit' to 'personal-benefit' may be necessary and may help increase wider adoption of CVCs in Asia.
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Affiliation(s)
- Sarin KC
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Manit Sittimart
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand,Corresponding author
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand,Institute of Health Policy, Management and Evaluation, St. Michael's Hospital, University of Toronto, 30 Bond St Toronto, ON M5B 1W8, Canada
| | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Chayapat Rachatan
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, 11800, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | | | - Auliya Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung-Sumedang Km. 21 Jatinangor, Sumedang, 45363, West Java, Indonesia
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, The Christian Medical College (CMC), IDA Scudder Rd, Vellore, Tamil Nadu, 632004, India
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | - Mayfong Mayxay
- Department of Medicine, University of Health Sciences, Samsenthai Road P.O. Box 7444, Vientiane, Laos,Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vietiane, Laos,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Natasha Howard
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore,London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Parinda Wattanasri
- Department of Disease Control, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Faculty Building II, 2-1, Naka, Kunitachi, 186 - 8601, Japan
| | - Tarun K. George
- Department of General Internal Medicine, The Christian Medical College (CMC), IDA Scudder Rd, Vellore, Tamil Nadu, 632004, India
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand,Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
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Kaur G, Chauhan AS, Prinja S, Teerawattananon Y, Muniyandi M, Rastogi A, Jyani G, Nagarajan K, Lakshmi P, Gupta A, Selvam JM, Bhansali A, Jain S. Cost-effectiveness of population-based screening for diabetes and hypertension in India: an economic modelling study. Lancet Public Health 2021; 7:e65-e73. [PMID: 34774219 DOI: 10.1016/s2468-2667(21)00199-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND India faces a high burden of diabetes and hypertension. Currently, there is a dearth of economic evidence about screening programmes, affected age groups, and frequency of screening for these diseases in Indian settings. We assessed the cost effectiveness of population-based screening for diabetes and hypertension compared with current practice in India for different scenarios, according to type of screening test, population age group, and pattern of health-care use. METHODS We used a hybrid decision model (decision tree and Markov model) to estimate the lifetime costs and consequences from a societal perspective. A meta-analysis was done to assess the effectiveness of population-based screening. Primary data were collected from two Indian states (Haryana and Tamil Nadu) to assess the cost of screening. The data from the National Health System Cost Database and the Costing of Health Services in India study were used to determine the health system cost of diagnostic tests and cost of treating diabetes or hypertension and their complications. A total of 962 patients were recruited to assess out-of-pocket expenditure and quality of life. Parameter uncertainty was evaluated using univariate and multivariable probabilistic sensitivity analyses. Finally, we estimated the incremental cost per quality-adjusted life-year (QALY) gained with alternative scenarios of scaling up primary health care through a health and wellness centre programme for the treatment of diabetes and hypertension. FINDINGS The incremental cost per QALY gained across various strategies for population-based screening for diabetes and hypertension ranged from US$0·02 million to $0·03 million. At the current pattern of health services use, none of the screening strategies of annual screening, screening every 3 years, and screening every 5 years was cost-effective at a threshold of 1-time per capita gross domestic product in India. In the scenario in which health and wellness centres provided primary care to 20% of patients who were newly diagnosed with uncomplicated diabetes or hypertension, screening the group aged between 30 and 65 years every 5 years or 3 years for either diabetes, hypertension, or a comorbid state (both diabetes and hypertension) became cost-effective. If the share of treatment for patients with newly diagnosed uncomplicated diabetes or hypertension at health and wellness centres increases to 70%, from the existing 4% at subcentres and primary health centres, annual population-based screening becomes a cost saving strategy. INTERPRETATION Population-based screening for diabetes and hypertension in India could potentially reduce time to diagnosis and treatment and be cost-effective if it is linked to comprehensive primary health care through health and wellness centres for provision of treatment to patients who screen positive. FUNDING None.
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Affiliation(s)
- Gunjeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | | | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Pvm Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jerard M Selvam
- Department of Health & Family Welfare, Government of Tamil Nadu, Chennai, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wang Y, Rattanavipapong W, Teerawattananon Y. Using health technology assessment to set priority, inform target product profiles, and design clinical study for health innovation. Technol Forecast Soc Change 2021; 172:121000. [PMID: 34732945 PMCID: PMC8524319 DOI: 10.1016/j.techfore.2021.121000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/04/2021] [Accepted: 06/25/2021] [Indexed: 05/29/2023]
Abstract
Early health technology assessment (early HTA) is a useful tool in guiding the innovation development process in medical technology development. However, the application of early HTA is sub-optimal amongst research and development (R&D) communities due to several challenges. In this paper, we presented a case study of application of early HTA by drawing on the experience from a workshop conducted for the Singapore government's medical technology innovation agency. The framework developed can help maximise the chance of the newly developed technology being accepted and widely used. By providing step-by-step guidance, this work aims to translate early HTA into a practical tool and promote the application of early HTA amongst R&D communities.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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45
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Jit M, Ananthakrishnan A, McKee M, Wouters OJ, Beutels P, Teerawattananon Y. Multi-country collaboration in responding to global infectious disease threats: lessons for Europe from the COVID-19 pandemic. Lancet Reg Health Eur 2021; 9:100221. [PMID: 34642675 PMCID: PMC8495250 DOI: 10.1016/j.lanepe.2021.100221] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Since 2005, the world has faced several public health emergencies of international concern arising from infectious disease outbreaks. Of these, the COVID-19 pandemic has had by far the greatest health and economic consequences. During these emergencies, responses taken by one country often have an impact on other countries. The implication is that coordination between countries is likely to achieve better outcomes, individually and collectively, than each country independently pursuing its own self-interest. During the COVID-19 pandemic, gaps in multilateral cooperation on research and information sharing, vaccine development and deployment, and travel policies have hampered the speed and equity of global recovery. In this Health Policy article, we explore how multilateral collaboration between countries is crucial to successful responses to public health emergencies linked to infectious disease outbreaks. Responding to future global infectious disease threats and other health emergencies will require the creation of stronger mechanisms for multilateral collaboration before they arise. A change to the governance of multilateral institutions is a logical next step, with a focus on providing equal ownership and leadership opportunities to all member countries. Europe can be an example and advocate for stronger and better governed multilateral institutions.
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Affiliation(s)
- Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
| | - Martin McKee
- Department of Health Services and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier J. Wouters
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Philippe Beutels
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
- School of Public health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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46
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Teerawattananon Y, Painter C, Dabak S, Ottersen T, Gopinathan U, Chola L, Chalkidou K, Culyer AJ. Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making. Cost Eff Resour Alloc 2021; 19:62. [PMID: 34551780 PMCID: PMC8456560 DOI: 10.1186/s12962-021-00308-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite the documented benefits of using health technology assessments (HTA) to inform resource allocation in health care systems, HTA remains underused, especially in low- and middle-income countries. A survey of global health practitioners was conducted to reveal the top reasons ("excuses") that they had heard from colleagues, policymakers or other stakeholders for not using HTA in their settings. METHODS There were 193 respondents to the survey. Most responses were from individuals in research organisations (37%), ministries of health (27%) and other government agencies (14%). Participants came from Southeast Asia (40%), the Western Pacific (30%), Africa (15%), Europe (7%), the Americas (7%) and the Eastern Mediterranean region (2%). RESULTS The top five reasons encountered by respondents related to lack of data, lack of technical skills for HTA, the technocratic nature of the work, the lack of explicit decision rules and the perception that HTA puts a "price on life". CONCLUSIONS This study aimed to understand and address the top reasons for not using HTA. They fall into three categories: (1) misconceptions about HTA; (2) feasibility issues; and (3) values, attitudes and politics. Previous literature has shown that these reasons can be addressed when identified, and even imperfect HTA analyses can provide useful information to a decision-maker.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chris Painter
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Lumbwe Chola
- Norwegian Institute of Public Health, Oslo, Norway
| | - Kalipso Chalkidou
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
- Imperial College London, London, UK
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47
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Chua BWB, Huynh VA, Lou J, Goh FT, Clapham H, Teerawattananon Y, Wee HL. Protocol for the economic evaluation of COVID-19 pandemic response policies. BMJ Open 2021; 11:e051503. [PMID: 34521677 PMCID: PMC8441219 DOI: 10.1136/bmjopen-2021-051503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Several treatment options are available for COVID-19 to date. However, the use of a combination of non-pharmaceutical interventions (NPIs) is necessary for jurisdictions to contain its spread. Although the implementation cost of NPIs may be low from the healthcare system perspective, it can be costly when considering the indirect costs from the societal perspective. COVID-19 vaccination campaigns have begun in several countries worldwide. Nonetheless, the quantity of vaccines available remain limited over the next 1 to 2 years. A tool for informing vaccine prioritisation that considers both cost and effectiveness will be highly useful. This study aims to identify the most cost-effective combination of COVID-19 response policies, using Singapore as an example. METHODS AND ANALYSIS An age-stratified Susceptible-Exposed-Infectious-Recovered model will be used to generate the number of infections stratified by disease severity under different intervention scenarios. Polices of interest include test-trace-isolate, travel restriction, compulsory face mask and hygiene practices, social distancing, dexamethasone/remdesivir therapy and vaccination. The latest phase 3 trial results and the WHO Target Product Profiles for COVID-19 vaccines will be used to model vaccine characteristics. A cost (expected resource utilisation and productivity losses) and quality-adjusted life years (QALYs) will be attached to these outputs for a cost-utility analysis. The primary outcome measure will be the incremental cost-effectiveness ratio generated from the incremental cost of policy alternatives expressed as a ratio of the incremental benefits (QALYs gained). Efficacy of policy options will be gathered from literature review and from its observed impacts in Singapore. Cost data will be gathered from healthcare institutions, Ministry of Health and published data. Sensitivity analysis such as threshold analysis and scenario analysis will be conducted. ETHICS AND DISSEMINATION Ethics approval was not required for this study. The study findings will be disseminated through peer-reviewed journals.
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Affiliation(s)
| | - Vinh Anh Huynh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Fang Ting Goh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Hannah Clapham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore
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Turner HC, Archer RA, Downey LE, Isaranuwatchai W, Chalkidou K, Jit M, Teerawattananon Y. An Introduction to the Main Types of Economic Evaluations Used for Informing Priority Setting and Resource Allocation in Healthcare: Key Features, Uses, and Limitations. Front Public Health 2021; 9:722927. [PMID: 34513790 PMCID: PMC8424074 DOI: 10.3389/fpubh.2021.722927] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Economic evidence is increasingly being used for informing health policies. However, the underlining principles of health economic analyses are not always fully understood by non-health economists, and inappropriate types of analyses, as well as inconsistent methodologies, may be being used for informing health policy decisions. In addition, there is a lack of open access information and methodological guidance targeted to public health professionals, particularly those based in low- and middle-income country (LMIC) settings. The objective of this review is to provide a comprehensive and accessible introduction to economic evaluations for public health professionals with a focus on LMIC settings. We cover the main principles underlining the most common types of full economic evaluations used in healthcare decision making in the context of priority setting (namely cost-effectiveness/cost-utility analyses, cost-benefit analyses), and outline their key features, strengths and weaknesses. It is envisioned that this will help those conducting such analyses, as well as stakeholders that need to interpret their output, gain a greater understanding of these methods and help them select/distinguish between the different approaches. In particular, we highlight the need for greater awareness of the methods used to place a monetary value on the health benefits of interventions, and the potential for such estimates to be misinterpreted. Specifically, the economic benefits reported are typically an approximation, summarising the health benefits experienced by a population monetarily in terms of individual preferences or potential productivity gains, rather than actual realisable or fiscal monetary benefits to payers or society.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Rachel A Archer
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Laura E Downey
- School of Public Health, Imperial College London, London, United Kingdom
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Modelling and Economics Unit, Public Health England, London, United Kingdom
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Ananthakrishnan A, Painter C, Teerawattananon Y. A protocol for a systematic literature review of economic evaluation studies of interventions to address antimicrobial resistance. Syst Rev 2021; 10:242. [PMID: 34488879 PMCID: PMC8421239 DOI: 10.1186/s13643-021-01794-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is accelerated by the widespread and often indiscriminate use of antimicrobials in humans, animals, and the environment. In 2015, the World Health Organization recognised AMR as one of the top ten global health threats, due to its potential to neutralise humanity's advancements in western medicine by enabling the emergence of new strains of existing pathogens, many of which have no available treatments. Over the past decade, several countries, including those in low- and middle-income contexts, have started implementing interventions to tackle AMR. However, economic evidence regarding the cost-effectiveness of these interventions remains weak. To address this evidence gap, we will conduct a systematic literature review to provide a comprehensive summary on the value for money of different AMR interventions. METHODS We aim to conduct a systematic literature review of all available economic evaluations on interventions addressing AMR and will provide a narrative synthesis of our findings. Systematic searches for relevant studies will be performed across all suitable databases as well as in grey literature sources such as unpublished studies, reports, and other relevant documents. All economic evaluation studies will be included as long as they report an economic outcome and have stated that the analysed intervention will reduce antimicrobial resistance or antimicrobial use in the abstract. Those studies reporting clinical endpoints alone will be excluded. Selection for final inclusion and data extraction will be performed by two independent reviewers. DISCUSSION The review will be one of the first of its kind, and the most recent, to systematically review literature on the cost-effectiveness of AMR interventions, an important evidence gap in the economics of AMR. The findings will enable policy and decision-makers, particularly in resource-constrained settings, to better use available resources when selecting interventions to address AMR burdens, SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020190310.
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Affiliation(s)
- Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Tiwanon Road, Muang District, 11000, Nonthaburi, Thailand.,Overseas Development Institute, London, UK
| | - Chris Painter
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Tiwanon Road, Muang District, 11000, Nonthaburi, Thailand. .,Overseas Development Institute, London, UK.
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Tiwanon Road, Muang District, 11000, Nonthaburi, Thailand
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Rattanavipapong W, Wang Y, Butchon R, Kittiratchakool N, Thammatacharee J, Teerawattananon Y, Isaranuwatchai W. Retrospective secondary data analysis to identify high-cost users in inpatient department of hospitals in Thailand, a middle-income country with universal healthcare coverage. BMJ Open 2021; 11:e047330. [PMID: 34321299 PMCID: PMC8319992 DOI: 10.1136/bmjopen-2020-047330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study aims to identify high-cost users (HCUs) in the inpatient departments of hospitals in Thailand including their common characteristics, patterns of healthcare utilisation and expenditure compared with low-cost users, and to explore potential factors associated with HCUs so the healthcare system can be prepared to support the HCUs including those who have increased chances of becoming HCUs. DESIGN AND SETTING A retrospective secondary data analysis using hospitalisation data from Thailand's Universal Coverage Scheme (UCS) obtained from the National Health Security Office over a 5-year period from October 2014 to September 2019 (fiscal year 2014-2018). PARTICIPANTS Study participants included Thai citizens who had at least one inpatient admission to hospitals under the UCS over the study period. RESULTS Over the 5-year period, the top 5% of the hospitalised population (or HCUs) consumed almost 50% of the health expenditure each year. HCUs were more likely to have longer hospital stays, a higher annual number of visits and be admitted to multiple hospitals each year when compared with the low-cost users (the bottom 50% of the hospitalised population). The study further reported that the chance of becoming an HCU is associated with several factors such as increasing age, being male, having a comorbidity and being admitted to hospitals in Bangkok. CONCLUSIONS This study confirmed that the HCU phenomenon existed in Thailand, where a majority of inpatient care spending is concentrated in the top 5% of the hospitalised population. The study findings call attention to potential initiatives that can help monitor the magnitude and trend of HCUs and develop policies to prevent HCUs.
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Affiliation(s)
- Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Nitichen Kittiratchakool
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Institute or Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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