Displaying all 9 publications

  1. Wu DB, Roberts CS, Huang YC, Chien L, Fang CH, Chang CJ
    J Med Econ, 2014 May;17(5):312-9.
    PMID: 24575941 DOI: 10.3111/13696998.2014.898644
    Invasive pneumococcal disease (IPD) and pneumococcal pneumonia cause substantial morbidity and mortality worldwide. This retrospective study was conducted to estimate the disease burden from pneumococcal disease in older adults in Taiwan from a health insurer's perspective.
  2. Carapinha JL
    J Med Econ, 2016 Aug 26.
    PMID: 27564849
    To compare the pharmacoeconomic guidelines in South Africa (SA) with other middle- and high-income countries.
  3. Permsuwan U, Dilokthornsakul P, Thavorn K, Saokaew S, Chaiyakunapruk N
    J Med Econ, 2017 Feb;20(2):171-181.
    PMID: 27645706 DOI: 10.1080/13696998.2016.1238386
    OBJECTIVE: With a high prevalence of chronic kidney disease (CKD) in type 2 diabetes (T2DM) in Thailand, the appropriate treatment for the patients has become a major concern. This study aimed to evaluate long-term cost-effective of dipeptidyl peptidase-4 (DPP-4) inhibitor monothearpy vs sulfonylurea (SFU) monotherapy in people with T2DM and CKD.

    METHODS: A validated IMS CORE Diabetes Model was used to estimate the long-term costs and outcomes. The efficacy parameters were identified and synthesized using a systematic review and meta-analysis. Baseline characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. Costs were expressed in 2014 US Dollars. Outcomes were presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.

    RESULTS: From a societal perspective, treatment with DPP-4 inhibitors yielded more quality-adjusted life years (QALYs) (0.024) at a higher cost (>66,000 Thai baht (THB) or >1,829.27 USD) per person than SFU, resulting in the ICER of >2.7 million THB/QALY (>74,833.70 USD/QALY). The cost-effectiveness results were mainly driven by differences in HbA1c reduction, hypoglycemic events, and drug acquisition cost of DPP-4 inhibitors. At the ceiling ratio of 160,000 THB/QALY (4,434.59 USD/QALY), the probability that DPP-4 inhibitors are cost-effective compared to SFU was less than 10%.

    CONCLUSIONS: Compared to SFU, DPP-4 inhibitor monotherapy is not a cost-effective treatment for people with T2DM and CKD in Thailand.

  4. Permsuwan U, Thavorn K, Dilokthornsakul P, Saokaew S, Chaiyakunapruk N
    J Med Econ, 2017 Sep;20(9):991-999.
    PMID: 28649943 DOI: 10.1080/13696998.2017.1347792
    AIMS: An economic evidence is a vital tool that can inform the decision to use costly insulin analogs. This study aimed to evaluate long-term cost-effectiveness of insulin detemir (IDet) compared with insulin glargine (IGlar) in type 2 diabetes (T2DM) from the Thai payer's perspective.

    METHODS: Long-term costs and outcomes were projected using a validated IMS CORE Diabetes Model, version 8.5. Cohort characteristics, baseline risk factors, and costs of diabetes complications were derived from Thai data sources. Relative risk was derived from a systematic review and meta-analysis study. Costs and outcomes were discounted at 3% per annum. Incremental cost-effectiveness ratio (ICER) was presented in 2015 US Dollars (USD). A series of one-way and probabilistic sensitivity analyses were performed.

    RESULTS: IDet yielded slightly greater quality-adjusted life years (QALYs) (8.921 vs 8.908), but incurred higher costs than IGlar (90,417.63 USD vs 66,674.03 USD), resulting in an ICER of ∼1.7 million USD per QALY. The findings were very sensitive to the cost of IDet. With a 34% reduction in the IDet cost, treatment with IDet would become cost-effective according to the Thai threshold of 4,434.59 USD per QALY.

    CONCLUSIONS: Treatment with IDet in patients with T2DM who had uncontrolled blood glucose with oral anti-diabetic agents was not a cost-effective strategy compared with IGlar treatment in the Thai context. These findings could be generalized to other countries with a similar socioeconomics level and healthcare systems.

  5. Chongmelaxme B, Hammanee M, Phooaphirak W, Kotirum S, Hutubessy R, Chaiyakunapruk N
    J Med Econ, 2017 Oct;20(10):1094-1106.
    PMID: 28737468 DOI: 10.1080/13696998.2017.1359181
    AIMS: The World Health Organization (WHO) recommends the use of Haemophilus influenzae type b (Hib) conjugate vaccines, but China and Thailand have not used Hib vaccination in their national immunization programs. This systematic review aimed to update published economic evaluations of Hib vaccinations and to determine factors that potentially affected their cost-effectiveness.

    METHODS: Searches were performed from the inception until December 2015 using 13 databases: CAB direct; CEA registry; EconLit; EMBASE; E-library; NHSEED; PAHO; POPLINE; PubMed; Redalyc project; RePEc; SciELO; and WHOLIS. Reference lists of relevant studies and grey literature were also searched. Full economic evaluations of Hib vaccination with results of costs and outcomes were included. The WHO checklist was used to evaluate the quality of the included studies. Data from eligible studies were extracted using a standardized data collection form.

    RESULTS: Out of 830 articles, 27 were included. Almost half of the studies (12/27) were conducted in high-income countries. Twelve studies (12/27) investigated the Hib vaccine as an addition to the existing vaccination program. Most studies (17/27) examined a 3-dose schedule of Hib vaccine. Nineteen studies (19/27) reported the model used, where all were decision tree models. Most of the studies (23/27) demonstrated an economic value of Hib vaccination programs, key influential parameters being incidence rates of Hib disease and vaccine price.

    CONCLUSIONS: Hib vaccination programs are mostly found to be cost-effective across geographic regions and country income levels, and Hib vaccination is recommended for inclusion into all national immunization programs. The findings are expected to support policy-makers for making decisions on allocating limited resources of the Hib vaccination program effectively.

  6. Atieno OM, Opanga S, Martin A, Kurdi A, Godman B
    J Med Econ, 2018 Sep;21(9):878-887.
    PMID: 29860920 DOI: 10.1080/13696998.2018.1484372
    BACKGROUND: Currently the majority of cancer deaths occur in low- and middle-income countries, where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment, and those who are insured are generally not covered for the full costs of treatment. This places a considerable burden on households if family members develop cancer. However, the actual cost of cancer treatment in Kenya is unknown. Such an analysis is essential to better allocate resources as Kenya strives towards universal healthcare.

    OBJECTIVES: To evaluate the economic burden of treating cancer patients.

    METHOD: Descriptive cross-sectional cost of illness study in the leading teaching and referral hospital in Kenya, with data collected from the hospital files of sampled adult patients for treatment during 2016.

    RESULTS: In total, 412 patient files were reviewed, of which 63.4% (n = 261) were female and 36.6% (n = 151) male. The cost of cancer care is highly dependent on the modality. Most reviewed patients had surgery, chemotherapy and palliative care. The cost of cancer therapy varied with the type of cancer. Patients on chemotherapy alone cost an average of KES 138,207 (USD 1364.3); while those treated with surgery cost an average of KES 128,207 (1265.6), and those on radiotherapy KES 119,036 (1175.1). Some patients had a combination of all three, costing, on average, KES 333,462 (3291.8) per patient during the year.

    CONCLUSION: The cost of cancer treatment in Kenya depends on the type of cancer, the modality, cost of medicines and the type of inpatient admission. The greatest contributors are currently the cost of medicines and inpatient admissions. This pilot study can inform future initiatives among the government as well as private and public insurance companies to increase available resources, and better allocate available resources, to more effectively treat patients with cancer in Kenya. The authors will be monitoring developments and conducting further research.

  7. Kongpakwattana K, Dilokthornsakul P, Dejthevaporn C, Pattanaprateep O, Chaiyakunapruk N
    J Med Econ, 2018 Oct 10.
    PMID: 30303420 DOI: 10.1080/13696998.2018.1534739
    AIMS: Due to lack of study evaluating compliance or persistence with Alzheimer's Disease (AD) treatment outside High-Income Countries (HICs), we aimed to assess compliance, persistence and factors associated with non-compliance and non-persistence by utilizing existing 'real-world' information from multiregional hospital databases in Thailand.

    MATERIALS AND METHODS: We retrospectively identified study subjects from databases of five hospitals located in different regions across Thailand. AD patients aged ≥60 years who were newly prescribed with donepezil, galantamine, rivastigmine or memantine between 2013 and 2017 were eligible for analysis. The Medication Possession Ratio (MPR) was used as a proxy for compliance, while the Kaplan-Meier survival analysis was employed to estimate persistence. Logistic and the Cox regressions were used to assess determinants of non-compliance and non-persistence, adjusted for age and gender.

    RESULTS: Among 698 eligible patients, mean (SD) MPR was 0.83 (0.25) with 70.3% of the patients compliant to the treatment (having MPR ≥0.80). Half of the patients discontinued their treatment (having a treatment gap >30 days) within 177 days with 1-year persistence probability of 21.1%. The patients treated in the university-affiliated hospital were more likely to be both non-compliante (OR 1.71; 95% CI: 1.21-2.42) and non-persistent (HR 1.33; 95% CI: 1.12-1.58). In addition, non-compliance was higher for those prescribed with single AD treatment (OR 2.52; 95% CI: 1.35-4.69), while non-persistence was higher for those unable to reimburse for AD treatment (HR 1.34; 95% CI: 1.11-1.62).

    LIMITATIONS: By using retrospective databases, a difficulty in validating whether the medications are actually taken after being refilled may overestimate the levels of compliance and persistence. Meanwhile, possible random coding errors may underestimate the strength of association findings.

    CONCLUSIONS: This study reveals the situation of compliance and persistence on AD treatment for the first time outside HICs. The determinants of non-compliance and non-persistence underline key areas for improvement.

  8. Choon JWY, Wu DBC, Chong HY, Lo WTL, Chong CSY, Chung WS, et al.
    J Med Econ, 2019 Mar;22(3):273-279.
    PMID: 30561238 DOI: 10.1080/13696998.2018.1560749
    BACKGROUND: Very few data are available to demonstrate the economic benefit of early paliperidone palmitate once-monthly long-acting injectable (PP1M) treatment in patients with schizophrenia or schizoaffective disorder.

    METHODS AND MATERIALS: This study has retrospectively compared the healthcare utilization and associated costs of pre- and post-PPIM treatment in 413 patients with schizophrenia or schizoaffective disorder recruited from three major public hospitals providing psychiatric services in Hong Kong. Patients were categorized into early treatment (≤3 years since diagnosis) and chronic (>3 years) groups, and also whether they were receiving polypharmacy (POP).

    RESULTS: It was found that patients who were started on early therapy with no POP had the most favourable outcomes. Overall results of the entire cohort, including both early and late treatments, indicate that there was a slight increase in annual in-patient days (IP) per patient and outpatient visit (OP) by 3.18 and 1.87, respectively, and a decrease in emergency room visit (ER) of 0.9 (p 

  9. Chongmelaxme B, Chaiyakunapruk N, Dilokthornsakul P
    J Med Econ, 2019 Jun;22(6):554-566.
    PMID: 30663455 DOI: 10.1080/13696998.2019.1572014
    Aims: Non-adherence is associated with poor clinical outcomes among patients with asthma. While cost-effectiveness analysis (CEA) is increasingly used to inform value assessment of the interventions, most do not take into account adherence in the analyses. This study aims to: (1) Understand the extent of studies considering adherence as part of the economic analyses, and (2) summarize the methods of incorporating adherence in the economic models. Materials and methods: A literature search was performed from the inception to February 2018 using four databases: PubMed, EMBASE, NHS EED, and the Tufts CEA registry. Decision model-based CEA of asthma were identified. Outcomes of interest were the number of studies incorporating adherence in the economic models, and the incorporating methods. All data were extracted using a standardized data collection form. Results: From 1,587 articles, 23 studies were decision model-based CEA of asthma, of which four CEA (17.4%) incorporated adherence in the analyses. Only the method of incorporating adherence by adjusting treatment effectiveness according to adherence levels was demonstrated in this review. Two approaches were used to derive the associations between adherence and effectiveness. The first approach was to apply a mathematical formula, developed by an expert panel, and the second was to extrapolate the associations from previous published studies. The adherence-adjusted effectiveness was then incorporated in the economic models. Conclusions: A very low number of CEA of asthma incorporated adherence in the analyses. All the CEA adjusted treatment effectiveness according to adherence levels, applied to the economic models.
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