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.
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.
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.
Kesatuan Ekonomi ASEAN (AEC) merupakan realisasi matlamat akhir integrasi ekonomi yang diasaskan pada pemusatan keinginan negaranegara ASEAN untuk meluaskan intergrasi ekonomi melalui inisiatif baru dan sedia ada dalam kerangka masa yang telah ditetapkan. Dalam merealisasikan salah satu tindakan AEC yang telah dikenal pasti iaitu memperkasakan perlindungan pengguna ASEAN, pengharmonian undang-undang kontrak pengguna dilihat sebagai salah satu agenda penting ASEAN. Dengan berobjektifkan pengharmonian undang-undang kontrak ASEAN yang mengkhusus kepada penggunaan terma tidak adil dalam pasaran pengguna seterusnya mencadangkan ASEAN Model Law on Unfair Terms in Consumer Contracts, makalah ini mengadoptasi metodologi analisis kandungan berteraskan literatur undang-undang primer dan sekunder. Mengguna pakai undang-undang kes dan perundangan di enam negara ASEAN terpilih iaitu Malaysia, Singapura, Indonesia, Thailand, Filipina dan Brunei, penyelidikan ini mendapati wujud persamaan dalam mekanisme yang digunakan di negara-negara ASEAN ini dalam menangani permasalahan penggunaan terma tidak adil dalam kontrak pengguna. Namun walaupun perundangan dilihat sebagai mekanisme yang mampu menangani permasalahan ini, wujud perbezaan pendekatan dalam perundangan yang diadaptasi oleh negara-negara ASEAN tersebut. Penggunaan perundangan berorientasikan perlindungan pengguna bagi mengawal penggunaan terma tidak adil dalam kontrak pengguna jelas kelihatan di Malaysia, Singapura, Indonesia, Thailand dan Filipina. Penggunaan perundangan kontrak yang mengkhusus kepada terma tidak adil sebagai instrumen kawalan pula kelihatan di Singapura, Thailand dan Brunei. Dalam aspek ini, keunikan Singapura dan Thailand yang menangani permasalahan terma tidak adil dalam kontrak pengguna dengan mengadakan perlindungan melalui dua jenis perundangan yang berbeza menampakkan korpus perlindungan pengguna yang lebih mapan. Pendekatan yang berbeza yang diamalkan di beberapa negara ASEAN terpilih ini memperlihatkan satu korpus perlindungan pengguna yang unik dalam aspek kontrak pengguna tidak adil.