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Objectives: To evaluate the adjuvant therapy of trastuzumab cost and quality-adjusted life-years (QALYs) in lifetime horizon and describe the use of an economic evaluation in supporting policy-making decisions in the treatment of early-stage breast cancer in Thailand., Methods: A Markov model was used to evaluate the cost effectiveness of 1-year adjuvant trastuzumab for patients with early-stage breast cancer who were considered human epidermal growth factor receptor 2/neu-positive with a societal perspective and lifetime horizon. The research variables were probability of health state change, health utility, and cost of treatment. A sensitivity analysis was conducted using probabilistic methods. A budget impact analysis was also performed., Results: The results revealed that the treatment cost and QALYs in the trastuzumab group yielded 4.59 QALYs. The incremental cost-effectiveness ratio was $3387 (THB 118 572; THB = Thai baht) per QALY. On the basis of the willingness-to-pay threshold in Thailand, a 1-year adjuvant trastuzumab treatment for breast cancer was a cost-effective therapy., Conclusions: A combination therapy that includes trastuzumab is a preferable choice and should be used in early-stage breast cancer treatment. The Thai government has listed trastuzumab on the National List of Essential Medicines to be used for the early stages of breast cancer since 2014., (Copyright © 2018 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the cost effectiveness of renin-angiotensin aldosterone system (RAAS) blockade in the progression of chronic kidney disease using Thai clinical data in 2014., Methods: A Markov model for cost-effectiveness analysis was applied to estimate from a societal perspective the cost per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio of RAAS versus non-RAAS used in preventing the progression of end-stage renal disease and death stratified by diabetic and nondiabetic patients. Input parameters related to clinical outcomes were obtained from a cohort study of treatment effectiveness, whereas costs were retrieved from the Ramathibodi Hospital electronic database in 2015 and the Health Intervention and Technology Assessment Program in Thailand. One-way analysis and probabilistic sensitivity analysis were performed to evaluate uncertainty surrounding model parameters., Results: From the model, using RAAS improved QALY from 2.41 to 3.16 years and from 2.37 to 3.20 years in diabetic and nondiabetic groups, respectively. The incremental cost-effectiveness ratios for these groups were 78,250 baht (US $2,353.39) and 66,674 baht (US $2,005.22), respectively., Conclusions: Using RAAS in patients with chronic kidney disease improved QALY in both diabetic and nondiabetic patients and proved to be cost-effective., (Copyright © 2018. Published by Elsevier Inc.)

Objective: This study aimed to evaluate the cost-utility of the home-based care policy versus the no home-based care policy of factor VIII and factor IX concentrate in Thai patients with hemophilia A and B who had no inhibitor or less than 5 Bethesda units., Methods: A Markov model was used to evaluate the cost utility of the two policies. The first policy was "no home-based care" in which patients were treated with blood components only when admitted at the hospital but without home treatment. The second policy was "home-based care" in which factors were prescribed and infused for treatment of early bleeding episodes at home. Input parameters related to clinical and cost were obtained from primary data collection at the National Health Security Office, while patients' quality of life was surveyed from mailed questionnaires. Both costs and health outcomes were discounted at 3%. One-way analysis and probabilistic sensitivity analysis were performed to assess uncertainty surrounding model parameters., Results: Based on governmental perspective, the "home-based care" policy had cost saving in patients with moderate and severe hemophilia when compared with the "no home-based care" policy; in patients with mild hemophilia, the incremental cost-effectiveness ratio was 80,542 Thailand baht (THB) or US $2,684.73 (US $1 = 30 THB)., Conclusions: At the ceiling threshold of one time of gross domestic product per capita (120,000 THB per quality-adjusted life-year gained), the "home-based care" policy was cost-effective when compared with the "no home-based care" policy., (Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to examine factors that influenced the rising Coxibs expenditure., Methods: Retrospective utilization data were retrieved from hospital's database. Changes in Coxibs expenditure in 2007 and 2009, calculated by using the Laspeyres index, were attributed to two factors: cost per patient (P) and number of patients (Q) per year. By measuring quantity as defined daily dose, changes in P comprised two subfactors: cost per day (p) and days of therapy per patient (q); p was weighted average cost of Coxibs per day, and q was weighted average days of therapy of new and current patients. Furthermore, the pattern of concomitant drugs, proton pump inhibitors, was analyzed., Results: Expenditure on Coxibs rose from 57.7 to 69.4 million baht from 2007 to 2009. With Laspeyres index, total index of 1.20 was a result of three main factors. The highest impact was from change in cost per day (p index at 1.17), which was a result of a slight increase in drug cost, mainly weighted by product mix, which tended to switch drug from low to high cost. Another positive impact was the number of Coxibs patients (Q index at 1.04). Finally, the negative impact was from days of therapy per patient (q index = 0.98). Although days of therapy per patient for both new and current patients were decreased, patient mix of more current patients slowed the decrease down. In addition, the percentage of proton pump inhibitors coprescription also rose from 30.8% in 2007 to 32.3% in 2009., Conclusion: Switching drug from low to high cost is a major factor that impacted the rising of expenditure on Coxibs., (Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)