Patient Self-testing (PST) could be an option for present anticoagulation therapy monitoring, but current evidence on its cost-effectiveness is limited. This study aims to estimate the cost-effectiveness of PST to other different care approaches for anticoagulation therapy in Thailand, a low-to-middle income country (LMIC). A Markov model was used to compare lifetime costs and quality-adjusted life years (QALYs) accrued to patients receiving warfarin through PST or either anticoagulation clinic (AC) or usual care (UC). The model was populated with relevant information from literature, network meta-analysis, and database analyses. Incremental cost-effectiveness ratios (ICERs) were presented as the year 2015 values. A base-case analysis was performed for patients at age 45-year-old. Sensitivity analyses including one-way and probabilistic sensitivity analyses (PSA) were constructed to determine the robustness of the findings. From societal perspective, PST increased QALY by 0.87 and costs by 112,461 THB compared with UC. Compared with AC, PST increased QALY by 0.161 and costs by 21,019 THB. The ICER with PST was 128,697 (3625 USD) and 130,493 THB (3676 USD) per QALY gained compared with UC and AC, respectively. The probability of PST being cost-effective is 74.1% and 51.9%, compared to UC and AC, respectively, in Thai context. Results were sensitive to the efficacy of PST, age and frequency of hospital visit or self-testing. This analysis suggested that PST is highly cost-effective compared with usual care and less cost-effective against anticoagulation clinic. Patient self-testing strategy appears to be economically valuable to include into healthcare system within the LMIC context.
It has been reported that oestrogen receptor alpha (ER-α) polymorphisms are associated with knee osteoarthritis (OA). In this study, we assessed whether there was any association between the codon 594 (G>A) polymorphism in ER-α and radiographic features of OA or patient function. Radiographs, WOMAC score and patient reported time of symptom onset were assessed in 194 patients presenting for total knee replacement at Ramathibodi hospital over a one year period. ESR-1 genotyping was assessed. There were 107 (55.15%) patients with common homozygote (GG), 78 (40.20%) patients with heterozygote (GA) and nine (4.65%) patients with rare homozygote (AA). There was poor correlation (r = <0.2) between group difference in the radiographic parameters, time of onset of symptom , or in WOMAC scores. This polymorphism is not associated with the clinical features of knee osteoarthritis. The role of this polymorphism is unlikely then to be used as a biological marker predicting the progression of knee OA.
Asia-Pacific Burden of Respiratory Diseases (APBORD) was a cross-sectional, observational study examining the burden of respiratory disease in adults across 6 Asia-Pacific countries.This article reports symptoms, healthcare resource utilization (HCRU), work impairment and cost burden associated with allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis in Thailand.Consecutive participants aged ≥18 years with a primary diagnosis of AR, asthma, COPD, or rhinosinusitis were enrolled at 4 hospitals in Thailand during October 2012 and October 2013. Participants completed a survey detailing respiratory symptoms, HCRU, work productivity, and activity impairment. Locally sourced unit costs were used in the calculation of total costs.The study enrolled 1000 patients. The most frequent primary diagnosis was AR (44.2%), followed by rhinosinusitis (24.1%), asthma (23.7%), and COPD (8.0%). Overall, 316 (31.6%) of patients were diagnosed with some combination of the 4 diseases. Blocked nose or congestion (17%) and cough or coughing up phlegm (16%) were the main reasons for the current medical visit. The mean annual cost for patients with a respiratory disease was US$1495 (SD 3133) per patient. Costs associated with work productivity loss were the principal contributor for AR and rhinosinusitis patients while medication costs were the highest contributor for asthma and COPD patients.The study findings highlight the burden associated with 4 prevalent respiratory diseases in Thailand. Thorough investigation of concomitant conditions and improved disease management may help to reduce the burden of these respiratory diseases.
A hybrid climate model (HCM) is a novel proposed model based on the combination of self-organizing map (SOM) and analog method (AM). The main purpose was to improve the accuracy in rainfall forecasting using HCM. In combination process of HCM, SOM algorithm classifies high dimensional input data to low dimensional of several disjointed clusters in which similar input is grouped. AM searches the future day that has similar property with the day in the past. Consequently, the analog day is mapped to each cluster of SOM to investigate rainfall. In this study, the input data, geopotential height at 850 hPa from the Climate Forecast System Reanalysis (CFSR) are training set data and also the complete rainfall data at 30-meteorological stations from Thai meteorological department (TMD) are observed. To improve capability of rainfall forecasting, three different measures were evaluated. The experimental results showed that the performance of HCM is better than the traditional AM. It is illustrated that the HCM can forecast rainfall proficiently.
The intercountry border areas of Thailand have high malaria receptivity and vulnerability that present numerous problems in the control of malaria transmission. This study focused on the 30 provinces of Thailand situated next to neighboring countries, which can be divided into 4 groups: the Thai-Myanmar border (10 provinces), the Thai-Cambodia border (6 provinces), the Thai-Lao border (10 provinces) and the Thai-Malaysia border (4 provinces). The purpose of the present study was to describe the pattern and trend of malaria incidence in the highly endemic provinces along the Thai borders for the 11 years from 1991 to 2001. Analysis of trends showed the distribution of malaria parasites to have shifted from a preponderance of Plasmodium falciparum to Plasmodium vivax along the western border with Myanmar, the northern border with Lao PDR and along the eastern border with Cambodia whereas the southern border with Malaysia the pattern changed from a preponderance of P. vivax to P. falciparum, since 1997. There was a significant difference in annual parasite incidence between borders and non-border districts, especially along the Thai-Myanmar and Thai-Cambodia borders. It is thus evident that all border districts should pay more attention to control of malaria transmission and the activities of the malaria surveillance system, and that monitoring and evaluation of the Thai Malaria Control Program needs to be performed consistently, including some areas where a few malaria cases were found as well as in malaria free areas.
Six species in the genus Busonia Distant are described and illustrated, including five new species from Thailand and Malaysia: Busonia curvata, B. fusca, B. lactata, B. micrata, B. serrata, spp. nov., and one newly recorded species from China: Busonia albilateralis Maldonado-Capriles. A redescription of this genus is provided together with a key to species for separation of males.
To date, only the type species Lissonotocoris membranaceus Usinger & Matsuda 1959 is known and recorded from Vietnam and China, Hainan Island. Four new species of the previously monotypic genus Lissonotocoris are described and figured: loebli n.sp. (Thailand), glabronotus n.sp. (N.Vietnam), pachycerus n.sp. (Malaysia) and siamensis n.sp. (Thailand). A key for the identification of all 5 species is provided.
The genus Lichnofugia is reported for the first time from India with a description of Lichnofugia umshingensis sp. nov. from Shillong, Meghalaya. The distribution of Lichnofugia thus extends eastward from Peninsular Malaysia and Thailand to north- eastern India.
The south-east Asian genus Eupoa is redescribed and diagnosed. Seven new species are diagnosed, described and illustrated: E. daklak sp. n. (♀) from Viet-Nam; E. lehtineni sp. n. (♂♀) from India, Thailand and Viet-Nam; E. lobli sp. n. (♂) from Malaysia; E. pappi sp. n. (♂) from Thailand; E. pulchella sp. n.(♂) from Thailand; E. schwendingeri sp. n. (♂♀) from Thailand; and E. thailandica sp. n. (♂♀) from Thailand. Eupoa prima Żabka, 1985 and E. yunnanensis Peng & Kim, 1997 are redescribed and illustrated on the basis of type and/or newly collected materials. The female of E. yunnanensis Peng & Kim, 1997 is found and described for the first time.
AIMS: Clinical smoking cessation interventions have been found typically to be highly cost-effective in many high-income countries. There is a need to extend this to low- and middle-income countries and undertake comparative analyses. This study aimed to estimate the incremental cost-effectiveness ratio of a range of clinical smoking cessation interventions available in Thailand.
METHODS: Using a Markov model, cost-effectiveness, in terms of cost per quality-adjusted life years (QALY) gained, from a range of interventions was estimated from a societal perspective for males and females aged 40 years who smoke at least 10 cigarettes per day. Interventions considered were: counselling in hospital, phone counselling (Quitline) and counselling plus nicotine gum, nicotine patch, bupropion, nortriptyline or varenicline. An annual discounting rate of 3% was used. Probabilistic sensitivity analyses were conducted and a cost-effectiveness acceptability curve (CEAC) plotted. Comparisons between interventions were conducted involving application of a 'decision rule' process.
RESULTS: Counselling with varenicline and counselling with nortriptyline were found to be cost-effective. Hospital counselling only, nicotine patch and bupropion were dominated by Quitline, nortriptyline and varenicline, respectively, according to the decision rule. When compared with unassisted cessation, probabilistic sensitivity analysis revealed that all interventions have very high probabilities (95%) of being cost-saving except for nicotine replacement therapy (NRT) patch (74%).
CONCLUSION: In middle-income countries such as Thailand, nortriptyline and varenicline appear to provide cost-effective clinical options for supporting smokers to quit.
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective.