MyMedR

Widening Horizon of Pharmacoeconomics and Outcomes Research in the Asia-Pacific Region

Yang BM, Lee K, Chaiyakunapruk N, Guo J

Value Health Reg Issues, 2012 May;1(1):1-2.

PMID: 29702815 DOI: 10.1016/j.vhri.2012.03.017

Characterization of Statin-Associated Myopathy Case Reports in Thailand Using the Health Product Vigilance Center Database

Boonmuang P, Nathisuwan S, Chaiyakunapruk N, Suwankesawong W, Pokhagul P, Teerawattanapong N, et al.

Drug Saf, 2013 Sep;36(9):779-87.

PMID: 23615756 DOI: 10.1007/s40264-013-0055-5

HMG-CoA reductase inhibitors [statins], a widely prescribed cholesterol-lowering therapy, are associated with muscle-related adverse events. While characteristics of such events are well documented in Western countries, little data exists for the Thai population.

The effects of metformin on ovarian cancer: a systematic review

Dilokthornsakul P, Chaiyakunapruk N, Termrungruanglert W, Pratoomsoot C, Saokaew S, Sruamsiri R

Int. J. Gynecol. Cancer, 2013 Nov;23(9):1544-51.

PMID: 24172091 DOI: 10.1097/IGC.0b013e3182a80a21

OBJECTIVE: The potential therapeutic effects of metformin on several cancers were reported. However, the evidence of the effects of metformin on ovarian cancer is still limited and inconclusive. This systematic review and meta-analysis study aim to summarize the existing evidence of the therapeutic effects of metformin on ovarian cancer.

METHODS: We performed systematic searches using electronic databases including PubMed and EMBASE until December 2012. Key words included "metformin" AND ("ovarian cancer" OR "ovary tumor"). All human studies assessing the effects of metformin on ovarian cancer were eligible for inclusion. All articles were reviewed independently by 2 authors with a standardized approach for the purpose of study, study design, patient characteristics, exposure, and outcomes. The data were pooled using a random-effects model.

RESULTS: Of 190 studies retrieved, only 3 observational studies and 1 report of 2 randomized controlled trials were included. Among those studies, 2 reported the effects of metformin on survival outcomes of ovarian cancer, whereas the other 2 reported the effects of metformin on ovarian cancer prevention. The findings of studies reporting the effects on survival outcomes indicated that metformin may prolong overall, disease-specific, and progression-free survival in ovarian cancer patients. The results of studies reporting the effects of metformin on ovarian cancer prevention were meta-analyzed. It indicated that metformin tended to decrease occurrence of ovarian cancer among diabetic patients with the pooled odds ratio of 0.57 (95% confidence interval, 0.16-1.99).

CONCLUSIONS: Our findings showed the potential therapeutic effects of metformin on survival outcomes of ovarian cancer and ovarian cancer prevention. However, most of the evidence was observational studies. There is a call for further well-conducted controlled clinical trials to confirm the effects of metformin on ovarian cancer survival and ovarian cancer prevention.

Efficacy and safety of topical Trikatu preparation in, relieving mosquito bite reactions: a randomized controlled trial

Maenthaisong R, Chaiyakunapruk N, Tiyaboonchai W, Tawatsin A, Rojanawiwat A, Thavara U

Complement Ther Med, 2014 Feb;22(1):34-9.

PMID: 24559814 DOI: 10.1016/j.ctim.2013.08.014

INTRODUCTION: Trikatu is composed of dried fruits of Piper nigrum L and Piper retrofractum Vahl, and dried rhizomes of Zingiber officinale R. Although this preparation has been used to relieve pruritis, pain, and inflammation for a long time, there is no clinical evidence to confirm its efficacy and safety. Therefore, we performed a double-blind, within person-randomized controlled study of 30 healthy volunteers to determine efficacy and safety of topical Trikatu on mosquito bite reactions.
METHODS: All subjects were bitten by Aedes aegypti laboratory mosquitoes on their forearms and they were randomly assigned arms to apply either Trikatu or reference product on the mosquito bite papule. The main outcome was the difference of papule size reduction at 30 min, measured by a caliper, between the Trikatu and reference arms. Pruritis, redness, pain, and patient satisfaction were assessed at 15, 30, 60, 180, and 360 min as secondary outcomes.
RESULTS: There were no significant differences between treatment and reference arms on any outcome at any time of measurement.
CONCLUSION: Trikatu did not show additional effects for relieving mosquito bite reaction as compared with the reference product containing camphor, menthol, and eucalyptus. For further study, it is very important to consider a proper selection of subjects, comparator product, and concentration of extract when Trikatu preparation is investigated.
KEYWORDS: Eucalyptus oil; Mosquito bite; Mosquito bite symptoms; Papule size reduction; Trikatu preparation

Comparative Analysis of Calendar Time-Specific and Conventional Propensity Score Analysis for Thiazolidinedione Use in Diabetes

Dilokthornsakul P, Chaiyakunapruk N, Jeanpeerapong N, Lee TA

Value Health Reg Issues, 2014 May;3:222-228.

PMID: 29702931 DOI: 10.1016/j.vhri.2014.04.013

OBJECTIVES: To evaluate whether there are differences in propensity score (PS) and treatment effects estimated using conventional and calendar time-specific PS (CTS-PS) approaches.

METHODS: A retrospective database analysis at a university-affiliated hospital in Thailand was used. Diabetic patients receiving glucose-lowering medications from July 2008 to June 2011 were included. Patients were categorized into those exposed and not exposed to thiazolidinediones (TZDs). PSs were estimated by using conventional PS and CTS-PS. In the CTS-PS, PS was separately estimated for three specific calendar time periods. Patients were matched 1:1 using caliper matching. The outcomes were cardiovascular and all-cause hospitalizations. The TZD and non-TZD groups were compared with Cox proportional hazard models.

RESULTS: A total of 2165 patients were included. The average conventional PS was 0.198 (95% confidence interval [CI] 0.195-0.202), while the average PS in the CTS-PS approach was 0.212 (0.206-0.218), 0.180 (0.173-0.188), and 0.205 (0.197-0.213) for July 2008 to June 2009, July 2009 to June 2010, and July 2010 to June 2011, respectively. The average difference in PS was 0.012 (P < 0.001), -0.009 (P ≤ 0.002), and 0.000 (P = 0.950) in the three calendar time periods. The adjusted hazard ratios of the conventional PS-matched cohort were 0.97 (95% CI 0.39-2.45) and 0.97 (95% CI 0.78-1.20) for CVD-related and all-cause hospitalizations, while the adjusted hazard ratios of the CTS-PS-matched cohort were 1.11 (95% CI 0.43-2.88) and 1.12 (95% CI 0.91-1.39), respectively.

CONCLUSION: CTS-PS is different from PS estimated by using the conventional approach. CTS-PS should be considered when a pattern of medication use has changed over the study period.

A Year of Significant Progress for Value in Health Regional Issues

Yang BM, Lee K, Chaiyakunapruk N, Guo J

Value Health Reg Issues, 2014 May;3:172-173.

PMID: 29702923 DOI: 10.1016/j.vhri.2014.04.003

How diabetes risk assessment tools are implemented in practice: a systematic review

Dhippayom T, Chaiyakunapruk N, Krass I

Diabetes Res Clin Pract, 2014 Jun;104(3):329-42.

PMID: 24485859 DOI: 10.1016/j.diabres.2014.01.008

This review aimed to explore the extent of the use of diabetes risk assessment tools and to determine influential variables associated with the implementation of these tools. CINAHL, Google Scholar, ISI Citation Indexes, PubMed, and Scopus were searched from inception to January 2013. Studies that reported the use of diabetes risk assessment tools to identify individuals at risk of diabetes were included. Of the 1719 articles identified, 24 were included. Follow-up of high risk individuals for diagnosis of diabetes was conducted in 5 studies. Barriers to the uptake of diabetes risk assessment tools by healthcare practitioners included (1) attitudes toward the tools; (2) impracticality of using the tools and (3) lack of reimbursement and regulatory support. Individuals were reluctant to undertake self-assessment of diabetes risk due to (1) lack of perceived severity of type 2 diabetes; (2) impracticality of the tools; and (3) concerns related to finding out the results. The current use of non-invasive diabetes risk assessment scores as screening tools appears to be limited. Practical follow up systems as well as strategies to address other barriers to the implementation of diabetes risk assessment tools are essential and need to be developed.

Fulltext Strengthening Evidence Base for Traditional Medicine in Asean, Quality of Reporting of Randomised Controlled Trials of Herbal Interventions in Asean Plus Six Countries: A Systematic Review

Pratoomsoot C, Sruamsiri R, Dilokthornsakul P, Chaiyakunapruk N

Value Health, 2014 Nov;17(7):A545.

PMID: 27201762 DOI: 10.1016/j.jval.2014.08.1765

Fulltext Health and economic impact of combination therapy vs. Monotherapy for treatment of benign prostatic hyperplasia in hong kong

Wu DB, Yee CH, Ng AC, Chaiyakunapruk N, Lee KK

Value Health, 2014 Nov;17(7):A812.

PMID: 27203071 DOI: 10.1016/j.jval.2014.08.558

Fulltext Coverage Decision Framework in Asia Pacific: A Case Study of Targeted Cancer Medicines in the Treatment of Breast Cancer

Sruamsiri R, Chaiyakunapruk N, Leartsakulpanitch J

Value Health, 2014 Nov;17(7):A740.

PMID: 27202662 DOI: 10.1016/j.jval.2014.08.134

Fulltext Cost-Effectiveness Analysis of Fondaparinux Versus Enoxaparin in Non-St Elevation Acute Coronary Syndrome in Thailand

Permsuwan U, Chaiyakunapruk N, Nathisuwan S, Sukonthasarn A

Value Health, 2014 Nov;17(7):A760-1.

PMID: 27202776 DOI: 10.1016/j.jval.2014.08.257

Fulltext Understanding the Rationale for Responses to a Time-Trade-Off Assessment and Willingness-To-Pay in Lung Cancer in Thailand

Crawford B, Permsuwan U, Thongprasert S, Sakulbumrungsil R, Chaiyakunapruk N, Leartsakulpanitch J, et al.

Value Health, 2014 Nov;17(7):A738.

PMID: 27202652 DOI: 10.1016/j.jval.2014.08.121

Fulltext How Likely Warfarin Pharmacogenetic Test to be Cost-Effective in Thailand: A Threshold Analysis

Chong HY, Saokaew S, Dumrongprat K, Permsuwan U, Sritara P, Chaiyakunapruk N

Value Health, 2014 Nov;17(7):A760.

PMID: 27202779 DOI: 10.1016/j.jval.2014.08.254

Fulltext Comparison of health care utilization and costs for patietns with asthma by severity and health insurance in Thailand: using generalized linear regression model. [Abstract]

Dilokthornsakul P, Lee TA, Dhippayom T, Jeanpeerapong N, Chaiyakunapruk N

Value Health, 2014 Nov;17(7):A778.

PMID: 27202883 DOI: 10.1016/j.jval.2014.08.360

Fulltext Health Care Utilization and Cost of Management in Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Thailand

Maenthaisong R, Dilokthornsakul P, Wises K, Chunhasewee S, Rattanapan P, Chaiyakunapruk N

Value Health, 2014 Nov;17(7):A778.

PMID: 27202879 DOI: 10.1016/j.jval.2014.08.362

Fulltext Cost-Utility Analysis of Optimal Dosing of Oseltamivir Under Pandemic Influenza Using a Novel Approach: Linking Health Economics and Transmission Dynamic Models

Wu DB, Chaiyakunapruk N, Pratoomsoot C, Lee KK, Chong HY, Nelson RE, et al.

Value Health, 2014 Nov;17(7):A807.

PMID: 27203045 DOI: 10.1016/j.jval.2014.08.527

Use of the CRUSADE bleeding risk score in the prediction of major bleeding for patients with acute coronary syndrome receiving enoxaparin in Thailand

Jinatongthai P, Khaisombut N, Likittanasombat K, Chaiyakunapruk N, Watcharathanakij S, Nathisuwan S

Heart Lung Circ, 2014 Nov;23(11):1051-8.

PMID: 24931064 DOI: 10.1016/j.hlc.2014.05.002

CRUSADE risk score stands out as a simple-to-use bleeding risk model. However, its use is still doubtful for Thai population. The aim of this study was to assess the prognostic value of CRUSADE in predicting risk of major bleeding among Thai patients with acute coronary syndrome (ACS) receiving enoxaparin.

Progress toward universal health coverage in ASEAN

Van Minh H, Pocock NS, Chaiyakunapruk N, Chhorvann C, Duc HA, Hanvoravongchai P, et al.

Glob Health Action, 2014 Dec;7(1):25856.

PMID: 28672540 DOI: 10.3402/gha.v7.25856

Background The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Design Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data. Results We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency. Conclusions We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations.

Cost-effectiveness analysis of pharmacogenetic-guided warfarin dosing in Thailand

Chong HY, Saokaew S, Dumrongprat K, Permsuwan U, Wu DB, Sritara P, et al.

Thromb Res, 2014 Dec;134(6):1278-84.

PMID: 25456732 DOI: 10.1016/j.thromres.2014.10.006

Pharmacogenetic (PGx) test is a useful tool for guiding physician on an initiation of an optimal warfarin dose. To implement of such strategy, the evidence on the economic value is needed. This study aimed to determine the cost-effectiveness of PGx-guided warfarin dosing compared with usual care (UC).

Fulltext Cost-effectiveness analysis of HLA-B*5801 testing in preventing allopurinol-induced SJS/TEN in Thai population

Saokaew S, Tassaneeyakul W, Maenthaisong R, Chaiyakunapruk N

PLoS One, 2014;9(4):e94294.

PMID: 24732692 DOI: 10.1371/journal.pone.0094294

BACKGROUND: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), caused by allopurinol therapy, are strongly associated with the human leukocyte antigen (HLA), HLA-B*5801. Identification of HLA-B*5801 genotype before prescribing allopurinol offers the possibility of avoiding allopurinol-induced SJS/TEN. As there is a paucity of evidence about economic value of such testing, this study aims to determine the cost-effectiveness of HLA-B*5801 testing compared with usual care (no genetic testing) before allopurinol administration in Thailand.
METHODS AND FINDING: A decision analytical and Markov model was used to estimate life time costs and outcomes represented as quality adjusted life years (QALYs) gained. The model was populated with relevant information of the association between gene and allopurinol-induced SJS/TEN, test characteristics, costs, and epidemiologic data for Thailand from a societal perspective. Input data were obtained from the literature and a retrospective database analysis. The results were expressed as incremental cost per QALY gained. A base-case analysis was performed for patients at age 30. A series of sensitivity analyses including scenario, one-way, and probabilistic sensitivity analyses were constructed to explore the robustness of the findings. Based on a hypothetical cohort of 1,000 patients, the incremental total cost was 923,919 THB (USD 29,804) and incremental QALY was 5.89 with an ICER of 156,937.04 THB (USD 5,062) per QALY gained. The cost of gout management, incidence of SJS/TEN, case fatality rate of SJS/TEN, and cost of genetic testing are considered very influential parameters on the cost-effectiveness value of HLA-B*5801 testing.
CONCLUSIONS: The genetic testing for HLA-B*5801 before allopurinol administration is considered a highly potential cost-effective intervention in Thailand. The findings are sensitive to a number of factors. In addition to cost-effectiveness findings, consideration of other factors including ethical, legal, and social implications is needed for an informed policy decision making.

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