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IntroductionWorld Health Organization recommends rotavirus vaccine for all national immunization programs (NIPs). To provide country-specific evidence, we conducted economic evaluation of a monovalent rotavirus vaccination using specific data of the pilot phase in Thailand.MethodA Markov model was adopted to compare the 2020 birth cohort once receiving rotavirus vaccination versus no vaccination from healthcare and societal perspective over five years. Data on disease burden, vaccine effectiveness, costs, and utilities were taken from a cohort study in two provinces of Thailand. Sensitivity analyses were performed to test the robustness of the results.ResultsRotavirus vaccination would reduce rotavirus diarrhea and costs of illness by 48% and 71%, respectively, over the first five years of life. At USD 13 per dose, vaccine was cost-effective with the ICERs of USD 4,114 and USD 1,571per QALY gained from healthcare and societal perspective, respectively. Results were sensitive to incidence and vaccine cost. The budget for vaccine purchasing was estimated at USD13 million per year.ConclusionIncorporating rotavirus vaccination into the NIP substantially reduced health and cost outcomes and was cost-effective for both perspectives. However, the government needs to negotiate vaccine price prior to program implementation to achieve favorable budget impact.

Objective: To evaluate cost of illness of locally advanced cervical cancer patients from societal perspective in three scenarios including completely cured without severe late side effects (S1), completely cured with late grade 3-4 gastrointestinal side effects (S2.1) or genitourinary side effects (S2.2), and disease recurrence and death (S3). Methods: The incidence-based approach was conducted. The cost was calculated for 5-year time horizon starting for the treatment initiation. Direct medical costs were extracted from hospital database. Cost of using two-dimensional technique and three-dimensional conformal radiation therapy were calculated separately. Direct non-medical costs and indirect costs in terms of productivity loss were based on actual expenses from the interview of 194 locally advanced cervical cancer patients from two tertiary hospitals in Bangkok, during June to December 2019. All costs were converted to US dollar in 2019 values. Results: For 5 years, cost of illness per patient for using two-dimensional technique and three-dimensional conformal radiation therapy were US $8,391 and US $10,418 for S1, US $18,018 and US $20,045 for S2.1, US $17,908 and US $19,936 for S2.2, and US $61,076 and US $63,103 for S3, respectively. The economic burden for newly diagnosed locally advanced cervical cancer patients in Thailand in 2018 was approximately US $129 million and US $131 million for using two-dimensional technique and three-dimensional conformal radiation therapy, respectively. Cost from S3 accounted for 70% of all total cost. Premature death was the most important cost driver of cost of illness accounted for 64 % of the total cost estimates. Conclusions: Cost of illness of locally advanced cervical cancer patients produced significant economic burden from societal perspective. Disease recurrence and early death from cancer was the most influential cause of this burden.

BACKGROUND: Rotavirus diarrhea is the leading cause of morbidity and mortality in young children in both developed and developing countries. Hospitalization costs are a significant burden of both governments and households. The objective of this study was to estimate the economic burden associated with the hospitalization of children with non-rotavirus and rotavirus diarrhea in two provinces in Thailand.METHOD: A prospective incidence-based cost-of-illness study was conducted on children under five years old with acute diarrhea who had been admitted to public hospitals in two provinces during October 2012 and June 2013. Caregivers were interviewed to estimate costs from a societal perspective at 2014 values. Stool samples were examined for rotavirus antigens. Multivariate regression analysis was used to assess the relationship of predictor variables to costs. Annual economic burden of rotavirus hospitalization was estimated by multiplying the number of hospitalized children and the hospitalization cost per episode. The costs were converted to international dollars (I$) using purchasing power parity (PPP) (1 USD = 12.36 baht for the year 2014).RESULTS: Seven hundred and eighty-eight cases of acute diarrhea were included in the analysis. Of the total, one hundred and ninety-seven (25%) were detected as being rotavirus positive. Total societal costs of inpatient care per episode were 822.68 USD (10,165 Baht). The average costs of children with and without rotavirus were 903.39 USD (11,162 Baht) and 795.40 USD (9,827 Baht), respectively. Based on the multiple regression analysis, rotavirus infection, severity, and younger age were significantly associated with the higher costs.CONCLUSION: Diarrhea, rotavirus diarrhea in particular, represents of a substantial economic burden in the society in Thailand. The accurate estimates that societal costs of the rotavirus diarrhea hospitalizations provide valuable input for considering a preventive program.

Background Multiple sclerosis (MS) and neuromyelitis optica spectrum (NMOSD) cause several symptoms that negatively impact on patient's quality of life. No study has ever conducted to examine the quality of life of MS and NMOSD patients, especially in terms of health utility, among the non-western population. This study aims to examine health utility among MS and NMOSD patients in Thailand. Methods A multicenter cross-sectional study including 104 MS and 186 NMOSD patients was conducted. Health utility was measured using EQ-5D questionnaire. Demographic data, clinical data and Expanded Disability Status Scales (EDSS) were also collected. Results Health utility scores of MS or NMOSD were 0.41 ± 0.36 and 0.41 ± 0.32, respectively. No significant difference between MS and NMOSD in term of health utility score was found. Pain, mobility, and anxiety/depression are the three most affected domains among both MS and NMOSD patients. Age at onset less than 40 years and EDSS score less than or equal to 2.5 were significantly associated with higher health utility score in MS and NMOSD patients. Conclusion Our findings clearly demonstrated the negative impact of MS and NMOSD on patients’ health-related quality of life. Effective interventions that target pain, mobility, and anxiety/depression should be provided to improve quality of life of these patients. Health utility estimates from this study can be used as an important input for economic evaluations of treatments for MS and NMOSD to inform resource-allocation decisions.

Antimicrobial resistance is a major health threat worldwide as it brings about poorer treatment outcome and places economic burden to the society. This study aims to estimate the annual relative increased in inpatient mortality from antimicrobial resistant (AMR) nosocomial infections (NI) in Thailand. A retrospective cohort study was conducted at Ramathibodi Hospital, Bangkok, Thailand, over 2008–2012. Survival model was used to estimate the hazard ratio of mortality of AMR relative to those patients without resistance (non-AMR) after controlling for nine potential confounders. The majority of NI (73.80%) were caused by AMR bacteria over the study period. Patients in the AMR and non-AMR groups had similar baseline clinical characteristics. Relative to patients in the non-AMR group, the expected hazard ratios of mortality for patients in the AMR group with Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were 1.92 (95% CI 0.10–35.52), 1.25 (95% CI 0.08–20.29), 1.60 (95% CI 0.13–19.10) and 1.84 (95% CI 0.04–95.58), respectively. In the complete absence of AMR bacteria, this study estimated that annually, in Thailand, there would be 111 295 fewer AMR cases and 48 258 fewer deaths.

Background - Antimicrobial resistance (AMR) is a major health threat worldwide as it brings about poorer outcomes and places economic burdens to society. This study aims to estimate the economic burdens from nosocomial infections (NI) caused by multi-drug resistant (MDR) bacteria in Thailand. Research design and methods - A retrospective cohort study was conducted at a tertiary hospital over 2011-2012. A multivariate log-linear regression model was used to estimate the excess treatment costs of AMR to those non-AMR patients. Results - Switching from a non-AMR case to an AMR infection case, resulted in 42% increase in expected average treatment costs per patient. The annual treatment from hospital perspective and antibiotic costs associated with the management of AMR infections were estimated to be US$ 2.3 billion and US$ 262 million, respectively. The estimated annual benefit from eradicating AMR NI were US$ 4.2 billion from a societal perspective with the annual gains in quality-adjusted life years (QALYs) of 0.6 million due to the absence of 111,295 AMR cases each year. Conclusions - Large amount of money was spent on treatment and antibiotic costs to manage AMR infections. Benefit of eliminating these infections was estimated and it would be highly cost-effective.

Objectives This study aimed to conduct an economic analysis of the transition of the conventional vaccine supply and logistics systems to the vendor managed inventory (VMI) system in Thailand. Study design Cost analysis of health care program. Methods An ingredients based approach was used to design the survey and collect data for an economic analysis of the immunization supply and logistics systems covering procurement, storage and distribution of vaccines from the central level to the lowest level of vaccine administration facility. Costs were presented in 2010 US dollar. Results The total cost of the vaccination program including cost of vaccine procured and logistics under the conventional system was US$0.60 per packed volume procured (cm 3 ) and US$1.35 per dose procured compared to US$0.66 per packed volume procured (cm 3 ) and US$1.43 per dose procured under the VMI system. However, the findings revealed that the transition to the VMI system and outsourcing of the supply chain system reduced the cost of immunization program at US$6.6 million per year because of reduction of un-opened vaccine wastage. Conclusions The findings demonstrated that the new supply chain system would result in efficiency improvement and potential savings to the immunization program compared to the conventional system.

Objective The study determined the rate of disability among diabetic patients at a public district hospital in Thailand and compared the costs of illness among different levels of severity of disability. This was the first such study carried out in Thailand. Methods The study was conducted at Waritchaphum Hospital in northeastern Thailand. Data were collected from 475 randomly selected diabetic patients identified by the World Health Organization's International Classification of Diseases, tenth revision (ICD-10 codes E10 – E14) who received treatment from the study hospital during the fiscal year of 2008. The disability levels were determined by using Thailand ministerial guidelines as well as the Barthel index score. Cost-of-illness estimates followed the prevalence-based approach and it presented the societal perspective of cost-of-illness of diabetes in 2008. Key findings The study results showed that 9.68% of the study participants had physical impairment while 9.26% had impairment in eyesight. The Barthel index score showed that 13.5% of the study participants were disabled. When comparing costs between independent and disabled persons, considering the Barthel index score, average costs for the disabled diabetic persons were significantly higher than for those who were independent (US$2700.29 versus 598.24; P < 0.001). Conclusions The study concluded that the presence of complications and disability among diabetic patients impacts severely on Thai society. At present, the Thai government allocates US$187.5 per annum to registered disabled persons as a disability living allowance. The study found a large difference between the direct economic outlay of the patients and the allowance provided, which suggests that there is probably a need to revise the welfare payment upwards.

BACKGROUND: Rotavirus diarrhea is a major health problem among young children worldwide with potential negative impacts on health-related quality of life (HRQoL). This study assessed the impact of rotavirus diarrhea on HRQoL of children and their caregivers.METHODS: We performed a cross-sectional study among 460 hospitalized children with diarrhea aged under 5 years and their family caregivers at three hospitals in Phetchabun province, Thailand during May 2013 and February 2014. The severity of diarrhea was assessed using the Vesikari severity scoring system while the HRQoL was assessed using the EQ-5D-3L.RESULTS: The mean EQ-5D utility of children with all-causes diarrhea was 0.604. The utility of the rotavirus diarrhea group was significantly lower than that of the non-rotavirus diarrhea group (0.593 vs. 0.612; p-value = 0.040). The family caregiver's utility was 0.964 at baseline and significantly decreased to 0.620 (p-value = 0.041) when their children were hospitalized with diarrhea. In multiple regression analyses, severity but not rotavirus infection had significant negative impacts on the utility of both the children and their caregivers.CONCLUSION: Diarrhea, either caused by rotavirus or non-rotavirus infection, resulted in substantial negative impacts on the quality of life of both the children and their caregivers.

Introduction: The cervical cancer-related burden is an important problem in Southeast Asian (SEA) countries. However, only 3 out of 11 countries implement the comprehensive prevention program. Areas covered: This is a retrospective review from all relevant studies until 2015 from two main databases, MEDLINE/Pubmed and Embase in order to provide an evidence on the health economics of HPV vaccination in the region. Expert commentary: The implementation of HPV vaccination will generate substantial health and economic benefit in SEA countries since the number of cervical cancer cases in this region are generally high. Therefore, a clear recommendation on how HPV vaccination should be implemented in a country, for example on how many doses will be used, how much cost is required or is it a school based- or clinical based-delivery, is critically required.

Background The Thai government ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2008, and the first progress report by the State Party was issued in 2012. This study assesses and identifies gaps in the Government’s implementation of the Convention. Methods Using the Deming Plan-Do-Check-Act Cycle as an analytical framework for continuous quality improvement, we reviewed five documents which are: the 2012 State Party report; the list of issues by the Committee on the Rights of Persons with Disabilities; the 2015 replies to the list of issues by the Thai government; an alternative report produced by Civil Society Organizations (CSOs); and an alternative report produced by the National Human Rights Commission of Thailand. Content analysis is applied to generate the emerging gaps in implementation. Results Thailand’s main advantage is the evolving legal frameworks operating in compliance with the convention, although further amendment is still needed, including effective law enforcement. Conflicting information between the Government’s and alternative reports reflects the shortcomings in the information system that intends to support rigorous monitoring and evaluation. Lacking of concrete measures and outcome indicators on certain articles reflects the State Party’s limited understanding of the concept of human rights and participatory approaches and insufficient institutional capacities for effective implementation. Conclusions To rectify these implementation gaps, a few actions are suggested. This includes amending the laws which violate the rights of persons with psychosocial disability; reforming governance where the monitoring bodies are truly independent from implementing agencies; strengthening cross-sectoral actions; and improving information systems which facilitate monitoring and evaluation where Disabled People’s Organizations and Civil Society Organizations are recognized as true equal partners. Implementation research can provide evidence for further effective implementation.

Background Dengue fever is a major public health concern in many parts of the tropics and subtropics. The first dengue vaccine has already been licensed in six countries. Given the growing interests in the effective use of the vaccine, it is critical to understand the economic burden of dengue fever to guide decision-makers in setting health policy priorities. Methods/Principal findings A standardized cost-of-illness study was conducted in three dengue endemic countries: Vietnam, Thailand, and Colombia. In order to capture all costs during the entire period of illness, patients were tested with rapid diagnostic tests on the first day of their clinical visits, and multiple interviews were scheduled until the patients recovered from the current illness. Various cost items were collected such as direct medical and non-medical costs, indirect costs, and non-out-of-pocket costs. In addition, socio-economic factors affecting disease severity were also identified by adopting a logit model. We found that total cost per episode ranges from $141 to $385 for inpatient and from $40 to $158 outpatient, with Colombia having the highest and Thailand having the lowest. The percentage of the private economic burden of dengue fever was highest in the low-income group and lowest in the high-income group. The logit analyses showed that early treatment, higher education, and better knowledge of dengue disease would reduce the probability of developing more severe illness. Conclusions/Significance The cost of dengue fever is substantial in the three dengue endemic countries. Our study findings can be used to consider accelerated introduction of vaccines into the public and private sector programs and prioritize alternative health interventions among competing health problems. In addition, a community would be better off by propagating the socio-economic factors identified in this study, which may prevent its members from developing severe illness in the long run., Author summary Dengue fever has been prevalent in South-East Asia and South America. Despite the increase of dengue fever cases, there continues to be a lack of economic assessment partly due to the absence of vaccines until recent times. Many of the previous economic burden studies for dengue fever were not standardized, making them difficult to compare. We implemented the standardized economic burden survey for dengue fever in a multi-country setting: Vietnam, Thailand, and Colombia. We found that the economic burden of dengue fever is substantial in all three dengue endemic countries. Our study also identified socio-economic factors which are related to the probability of experiencing severe illness. The first live attenuated, tetravalent dengue vaccine (CYD-TDV) has been already licensed in some dengue-endemic countries. As three countries will soon face decisions on whether and how to incorporate current and future vaccine candidates within their budget constraints, the updated economic burden estimates can be used to develop sustainable financing plans.

This study values informal care for disabled stroke survivors in Thailand. It applies the conventional recommended opportunity cost method to value informal care in monetary terms. Data were collected by means of face-to-face interviews conducted during 2006. The sample consisted of 101 disabled persons who had suffered a stroke at least six months prior to the interview, and who had a functional status score of less than 95 as measured by the Barthel Index. Average monthly time spent on informal care was 94.6 hours, and the major source of opportunity cost was forgone unpaid work (43.5%). The average monthly monetary value of informal care was 4642.6 baht, based on 2006 prices. This study shows that providing informal care involves a substantial opportunity cost, implying a hidden value to Thai society. © 2009 Elsevier Ltd. All rights reserved.

Background We assessed the effectiveness and possible impact of introducing rotavirus vaccine into the routine immunization program. Methods Two provinces were selected for an observational study, one where vaccine was introduced and another where vaccine was not available. In these areas, two sub-studies were linked. The prospective cohort study enrolled children 2 month old and followed them to the age of 18 months to detect all diarrhea episodes. The hospital surveillance study enrolled all children up to age 5 hospitalized with diarrhea whose fecal samples were tested for rotavirus. Rates of rotavirus hospitalizations in older children who had not been vaccinated in both settings provided data to determine whether immunization had an indirect herd effect. The key endpoints for the study were both vaccine effectiveness (VE) based upon hospitalized rotavirus diarrhea and herd protection. Findings From the cohort study, the overall VE for hospitalized rotavirus diarrhea was 88% (95%CI 76–94). Data from hospital surveillance indicated that for 2 consecutive years, the seasonal peak of rotavirus admissions was no longer present in the vaccinated area. Herd protection was observed among older children born before the rotavirus vaccine program was introduced, who experienced a 40–69% reduction in admission for rotavirus. Conclusions Rotavirus vaccine was highly effective in preventing diarrheal hospitalizations and in conferring herd protection among older children who had not been vaccinated.

This study aims to determine functioning information, rehabilitation needs, and environmental barriers of persons with disabilities (PWDs) using a developed ICF-based questionnaire with community survey approach in Thailand.A systematic review of the use of ICF and disability surveys from January 2000- June 2010 was undertaken. A questionnaire was then developed and tested in two pilot studies before using in a face-to-face interview conducted with legally registered PWDs in Nakornpanom province. Forty-six ICF codes were used in the questionnaire; two second-level codes in body functions, 18 second-level and six third-level codes in activitiesparticipation and 14 second-level and six third-level codes in environmental factors. Each code had 2-6 qualifiers.One thousand and seven PWDs (56.6% male, mean age = 48.4 ± 0.64 years) were interviewed by 16 trained-interviewers. Interview duration was approximately 17 min. The functioning profile could be revealed for both individual and population. These reflected the need for rehabilitation. Several cut-off points to identify "disabled persons" were offered. Regarding participation, PWDs were concerned more about environmental barriers. One-fourth of PWDs needed home environment adaptation, almost 13% were uneducated and 23% had limited chance to participate in social activities.ICF framework and codes can be used to develop a questionnaire to measure population functioning profile and rehabilitation needs of PWDs by community survey. Results can be used to develop a capability-oriented disability database to identify prevalence of disabilities and rehabilitation needs. Policy makers may use this database to plan, monitor and evaluate rehabilitation service programs and removal of environmental barriers.

Severe diarrhea caused by rotavirus is a health problem worldwide, including Thailand. The World Health Organization has recommended incorporating rotavirus vaccination into national immunization programs. This policy has been implemented in several countries, but not in Thailand where the mortality rate is not high. This leads to the question of whether it would be cost-effective to implement such a policy. The Thai National Vaccine Committee, through the Immunization Practice Subcommittee, has conducted an economic analysis. Their study aimed to estimate the costs of rotavirus diarrhea and of a rotavirus vaccination program, and the cost-effectiveness of such a program including budget impact analysis. The study was designed as an economic evaluation, employing modeling technique in both provider and societal perspectives. A birth cohort of Thai children in 2009 was used in the analysis, with a 5-year time horizon. Costs were composed of cost of the illness and the vaccination program. Outcomes were measured in the form of lives saved and DALYs averted. Both costs and outcomes were discounted at 3%. The study found the discounted number of deaths to be 7.02 and 20.52 for vaccinated and unvaccinated cohorts, respectively (13.5 deaths averted). Discounted DALYs were 263.33 and 826.57 for vaccinated and unvaccinated cohorts, respectively (563.24 DALYs averted). Costs of rotavirus diarrhea in a societal perspective were US$6.6 million and US$21.0 million for vaccinated and unvaccinated cohorts, respectively. At base case, the costs per additional death averted were US$5.1 million and US$5.7 for 2-dose and 3-dose vaccines, respectively, in a societal perspective. Costs per additional DALYs averted were US$128,063 and US$142,144, respectively. In a societal perspective, with a cost-effectiveness threshold at 1 GDP per capita per DALYs averted, vaccine prices per dose were US$4.98 and US$3.32 for 2-dose and 3-dose vaccines, respectively; in a provider perspective, they were US$2.90 and US$1.93. One-way and probabilistic sensitivity analyses were included. The budget required for vaccine purchase was calculated for all scenarios.

Background:Background: The Thai healthcare setting has seen patients with cervical cancer experience an increasing burden of morbidity and mortality, a stagnation in the performance of cervical screening programmes and the introduction of a vaccine for the prevention of human papillomavirus (HPV) infection. Abstract: Objective:Objective: This study aims to identify the optimum mix of interventions that are cost effective, from societal and healthcare provider perspectives, for the prevention and control of cervical cancer. Abstract: Methods:Methods: A computer-based Markov model of the natural history of cervical cancer was used to simulate an age-stratified cohort of women in Thailand. The strategy comparators, including both control and prevention programmes, were (i) conventional cytology screening (Pap smears); (ii) screening by visual inspection with acetic acid (VIA); and (iii) HPV-16, -18 vaccination. Input parameters (e.g. age-specific incidence of HPV infection, progression and regression of the infection, test performance of screening methods and efficacy of vaccine) were synthesized from a systematic review and meta-analysis. Costs (year 2007 values) and outcomes were evaluated separately, and compared for each combination. The screening strategies were started from the age of 30-40 years and repeated at 5- and 10-year intervals. In addition, HPV vaccines were introduced at age 15-60 years. Abstract: Results:Results: All of the screening strategies showed certain benefits due to a decreased number of women developing cervical cancer versus 'no intervention'. Moreover, the most cost-effective strategy from the societal perspective was the combination of VIA and sequential Pap smear (i.e. VIA every 5 years for women aged 30-45 years, followed by Pap smear every 5 years for women aged 50-60 years). This strategy was dominant, with a QALY gain of 0.01 and a total cost saving of Baht (Bt)800, compared with doing nothing. From the societal perspective, universal HPV vaccination for girls aged 15 years without screening resulted in a QALY gain of 0.06 at an additional cost of Bt8800, based on the cost of Bt15 000 for a full immunization schedule. The incremental cost-effectiveness ratio, comparing HPV vaccinations for girls aged 15 years with the current national policy of Pap smears for women aged 35-60 years every 5 years, was approximately Bt181 000 per QALY gained. This figure was relatively high for the Thai setting. Abstract: Conclusions:Conclusions: The results suggest that controlling cervical cancer by increasing the numbers of women accepting the VIA and Pap smear screening as routine and by improving the performance of the existing screening programmes is the most cost-effective policy option in Thailand.

Objectives: To construct, validate, and simulate a system dynamic financial model and compare it against the conventional method. Methods: The study was a cross-sectional analysis of secondary data retrieved from the National Health Security Office (NHSO) in the fiscal year 2004. The sample consisted of all emergency patients who received emergency services outside their registered hospital-catchments area. The dependent variable used was the amount of reimbursed money. Two types of model were constructed, namely, the system dynamic model using the STELLA software and the multiple linear regression model. The outputs of both methods were compared. Results: The study covered 284,716 patients from various levels of providers. The system dynamic model had the capability of producing various types of outputs, for example, financial and graphical analyses. For the regression analysis, statistically significant predictors were composed of service types (outpatient or inpatient), operating procedures, length of stay, illness types (accident or not), hospital characteristics, age, and hospital location (adjusted R 2 = 0.74). The total budget arrived at from using the system dynamic model and regression model was US$12,159,614.38 and US$7,301,217.18, respectively, whereas the actual NHSO reimbursement cost was US$12,840,805.69. Conclusions: The study illustrated that the system dynamic model is a useful financial management tool, although it is not easy to construct. The model is not only more accurate in prediction but is also more capable of analyzing large and complex real-world situations than the conventional method.

Purpose The aim of this study was to investigate expenditures and categories of herbal product consumption in drugstores in Thailand. Methods The study was designed as a cross-sectional descriptive research. Study population was drugs and foods produced from herbs sold in all registered drugstores in Thailand. Regarding sampling, one province was selected from each of 13 regions by convenience sampling. Drugstores in each province were included at a proportion of 1% of the population by a convenience sampling method. Purchasing documents of the drugstores were collected for two consecutive months in 2001 and 2003. The medians of prices were used to estimate value of the whole country. Results The sample included 129 and 121 drugstores in 2001 and 2003, respectively. Total consumption was 27 and 32 million US$ (1 US$ = 40 Thai baht) in the year 2001 and 2003, respectively. At constant prices, this represented an increase of 11%. The five top-ranked categories of products used in 2003 were haematonics, post-delivery drugs, anti-constipation, anti-cough, and cardiotonics. Conclusions Herbal product consumption increased by 11% from 2001 to 2003. To cover the full range of consumption of herbal products, further studies should include other outlets, for example hospital and direct sales. Copyright © 2005 John Wiley & Sons, Ltd.

Diabetes is a common metabolic disorder with increasing burden in Thailand. The chronic nature along with associated complications makes the disease very costly. In Thailand, there exist some studies on cost of diabetes; however, those studies estimated the cost either from provider or from patient perspective. In order to capture the complete picture of economic burden caused by diabetes, using prevalence-based approach; the present study estimated the cost of illness of diabetes from societal perspective, the broadest viewpoint covering all costs irrespective of who incur them. Data were collected from 475 randomly selected diabetic patients who received treatment from Waritchaphum hospital in Sakhon Nakhon province of Thailand during 2007-2008 with a response rate of 98%. A micro-costing approach was used to calculate the cost. The direct medical cost was calculated by multiplying the quantity of medical services consumed by their unit costs while indirect cost was calculated by using human capital approach. The total cost of illness of diabetes for 475 study participants was estimated as USD 418,696 for the financial year 2008 (1 USD = 32 THB). Of this, 23% was direct medical cost, 40% was direct non-medical cost and 37% was indirect cost. The average cost of illness per diabetic patient was USD 881.47 in 2008 which was 21% of per capita gross domestic product of Thailand. Existence of complications increased the cost substantially. Cost of informal care contributed 28% of total cost of illness of diabetes. Therefore, the disease not only affected the individual but also the family members, friends and neighbours. The economic and social burden of the disease therefore emphasises the need for initiatives to prevent the disease prevalence and counselling to the diabetic patients to prevent the progression of the disease and its devastating complications.

Aims The study estimated the cost of informal care for 475 randomly selected diabetic patients as identified by International Classification of Diseases, tenth revision ( ICD-10 codes = E10 – E14 ) and who received treatment at Waritchaphum hospital in Sakhon Nakhon province of Thailand during the financial year 2008. Methods Informal care was valued by using revealed preference method. Information of informal caregiving was collected through direct personal interview method either from the patients or from the caregivers. The data on time spent for informal care were collected by using recall method. Results The study covered a total of 190 informal caregivers. Average time spent on informal care was 112.38h per month. The estimated cost of informal care was USD 110,713.08 using opportunity cost approach and USD 93,896.52 using proxy good method in 2008 (1 USD=32 Thai Baht). Conclusions The study concluded that the hidden cost associated with informal caregiving is a burden for the Thai society. Hence, the economic cost associated with informal caregiving should be considered for future analyses of both the public health consequences of diabetes and interventions aimed at decreasing diabetic complications.

Objectives: To estimate the utility scores for diarrheal children aged under 5 years and their caregivers and to identify the influencing factors which affected on these. Methods: Hospitalized diarrheal children aged between 2 months and 5 years and their caregivers at were recruited in this cross-sectional study at three hospitals in Phetchabun province. The EQ-5D instrument was used to collect the quality of life (QoL) data at the first date of admission. Quality of life of diarrheal children was measured as proxy report from caregiver while QoL of caregiver was measured as self-report. The raw data was converted to utility values using the Thai algorithm. The clinical severity of diarrheal children was rated using the Vesikari clinical severity scoring system. Stepwise multivariate linear regression was applied to explore the impact of the various factors on the utility value of children and caregivers. Results: 468 children and caregivers were included in this study. Mean children's age was 1.77 years. The caregivers rated the mean child's utility and themselves as 0.604 (95%CI: 0.592, 0.615) and 0.618 (95%CI: 0.606, 0.629), respectively. Mainly domains of diarrheal children were affected as pain/discomfort and anxiety/ depression similarly to their caregivers. On multivariate regression analysis, factors which affected the children's utility significantly were Vesikari score, child's age and child's gender. Next, reduced QoL of their caregivers related to caregiver's gender and Vesikari score. Conclusions: Diarrhea had an impact on quality of life of children and their caregivers. It appeared that QoL of children with diarrhea was impacted worse in girls, those with high severity score and was associated with age. In addition, the diarrheal severity and female gender reduced the impact of diarrhea on QoL of caregivers. These results can be useful to evaluate the cost-effectiveness of vaccines against diarrhea such as rotavirus vaccines.

The provision of guidelines on cost measurement for health economic evaluations enable research to be more standardized and hence more comparable, which offers clear benefits for policy formulation and health management. The guidelines herein focus on three aspects-the cost of health intervention/health care programs, the cost of illness/health risks, and use of costs in health economic evaluation. For each aspect, the main concepts and methods are outlined, and recommendations for the Thai context are presented. There is particular focus on how to calculate various costs according to different evaluation methods and perspectives, how to evaluate source of cost data, how to make value adjustments and how to present cost measurement findings.

This analysis was undertaken to generate a set of standard costs for medical services and those incurred by patient receiving treatment, for use in health economic evaluations. Medical service unit cost data were derived from a survey of 3,091 hospital medical services in five hospitals, disaggregated by type of hospital (district or provincial/regional) and analyzed using the relative value unit method. Patient-borne ambulatory cost values were derived from data gathered through 905 patient interviews that took place in six health centers, three district hospitals, and three provincial/regional hospitals. The survey gathered data on costs a rising from the distance travelled to access the medical service, the time spent in the healthcare facility, as well as travel and meal costs. The analysis generated a set of standard cost data for Thailand that will make conducting economic evaluations more accurate, faster and more convenient, as well as allowing better comparability between studies. This is the first standard cost menu that has been developed specifically for Thailand, and as such should be revised and refined in the future. Some areas that would benefit from revision are suggested.

In developing countries family caregivers are an important community-based resource who provide care for physically disabled adults. Substantial caregiving commitment is known to adversely affect caregiver health and thereby their capacity to provide ongoing care. This systematic review focused on support interventions for caregivers using Thailand as an example. From 1964 to 2011 international and Thai electronic databases and relevant grey literature were searched. Six English papers and 34 Thai papers published between 1990 and 2010 were found. The Critical Appraisal Skills Programme (CASP) tool was modified to appraise methodological quality. All nurse-led interventions mainly focused on improving caregiving capacity; nearly half considered caregiver health. Only 15 interventions were community-based. Despite variable research quality all studies showed benefits for caregivers, care recipients, and healthcare services. In developing countries without healthy caregivers physically disabled adults would not receive care. There is an urgent need for further investment in community-based research to develop effective interventions designed to promote caregiver health and help them maintain their role.

Objectives This study aimed to develop a hospital pharmaceutical service model, together with a costing template for unit cost analysis and to analyse unit costs of hospital pharmaceutical services. Methods The study was designed on the basis of activity-based costing. A model of the services was set up by consensus of the working group. Pharmaceutical services among the study hospitals were standardised. A Microsoft Excel-based costing template was developed. Finally, the costing template was used for the unit cost analysis. Sensitivity analysis and descriptive statistics were used for further analysis. Key findings Four general and seven regional hospitals participated in the study. Hospital pharmaceutical services were divided into nine supporting activities and nine patient-service activities. Unit costs of drug dispensing per prescription by regional hospitals were approximately double that of general hospitals. In contrast, the cost of aseptic dispensing per item in regional hospitals was lower than those in general hospitals. In comparing the unit costs from standard labour costs with those from actual labour costs, both increases and decreases were found. Conclusions Costing and the use of Microsoft Excel can be applied to the development of a costing template for unit cost analysis of hospital pharmaceutical services. This programme can provide accurate unit costs for services. The results can be used when considering pharmacy service reimbursement, efficiency and service development.

The individual home rehabilitation program for ischemic stroke patients was conducted in a Thai healthcare setting. The program demonstrated that it was statistically significantly more effective than the conventional method. However for policy makers to adopt this program, the question of cost-effectiveness must be answered.To compare the costs and effects of a home rehabilitation program versus conventional hospital care for ischemic stroke patients in Thailand.Cost-effectiveness analysis was conducted alongside a clinical trial. An open-label randomized control trial was conducted to explore the efficacy of a home rehabilitation program for acute stroke care for three months after hospital discharge. The Barthel Index and Modified Rankin Scale were used to evaluate the outcome measures. Success was defined as improvement by at least one level of the outcome scales. An incremental cost-effectiveness ratio, including sensitivity analysis, was presented.Fifty-eight patients were included in the study. Patients were randomly assigned to the study and control groups (28 and 30, respectively). The cost and number of successful cases in the study group were higher than those of the control group. The incremental cost-effectiveness ratio (ICER) was lowest--13,644 Thai Baht (THB)--regarding the Modified Rankin Scale measurement. For patients achieving mild disability and no disability based on the Barthel Index, the ICERs were 14,212 THB and 24,364 THB, respectively. Sensitivity analyses regarding variations in number of patients and cost of home visits demonstrated more cost-effectiveness than the base case.Providing a home rehabilitation program with higher cost resulted in a greater number of patients avoiding disability than via conventional hospital care. The hospital had to pay approximately 24,000 THB for each additional disability-avoided patient when switching from conventional hospital care to a home rehabilitation program. This was assumed to be cost-effective when compared to per capita gross domestic product.

There is a need to develop other casemix classifications, apart from DRG for sub-acute and non-acute inpatient care payment mechanism in Thailand.To develop a casemix classification for sub-acute and non-acute inpatient service.The study began with developing a classification system, analyzing cost, assigning payment weights, and ended with testing the validity of this new casemix system. Coefficient of variation, reduction in variance, linear regression, and split-half cross-validation were employed.The casemix for sub-acute and non-acute inpatient services contained 98 groups. Two percent of them had a coefficient of variation of the cost of higher than 1.5. The reduction in variance of cost after the classification was 32%. Two classification variables (physical function and the rehabilitation impairment categories) were key determinants of the cost (adjusted R2 = 0.749, p = .001). Validity results of split-half cross-validation of sub-acute and non-acute inpatient service were high.The present study indicated that the casemix for sub-acute and non-acute inpatient services closely predicted the hospital resource use and should be further developed for payment of the inpatients sub-acute and non-acute phase.

This project is aimed at studying medicine utilization among blind people in Bangkok, Thailand.The study was designed as a cross-sectional descriptive research. The study group comprised visually impaired persons, aged at least 18 years, and living in Bangkok. Data were collected via face-to-face interviews in 2007.The study included 86 people. The majority of the subjects were 31-50 years old (65%) and male (61%). During the two weeks before the interview, the most frequently used medicines were anti-inflammatory drugs and muscle relaxants (26%), followed by antipyretics. Most of the subjects received their medicines from drugstores. During the three months before the interview, 75% of the subjects received pharmacy information through various channels. The major source was drugstores, followed by radio. With regard to procurement of medication, 79% of the subjects went to hospitals and 57% acquired the medicines by themselves. Approximately 20% of the subjects received medicines with touchable-differentiated packaging. For purposes of self-medication, the subjects were able to differentiate types, doses, and durations of drug use based on memory. Regarding pharmaceutical services, 81% of the subjects required special services intended for the disabled, as well as further explanation of the medicine's use, including drug labeling.Based on the study results, most of the blind did not receive assistance regarding medicine use. Their use of medicine was based on memory, and they were in need of improved pharmaceutical services.

Costing plays an important role in health economics, particularly economic evaluation. However, there are some controversial issues: concepts, methods and reference values. Hence, it is pivotal to standardize can be con costing methods and use these as national guidelines to produce comparable studies. This report is divided perspectives. into 3 parts: theoretical issues, international guidelines comparison, and recommendations for the Thai technology assessment guidelines. Each section is composed of three general costing steps: identification, appropriate, measuring and valuation. It is recommended to measure economic or opportunity cost mainly in societal perspective. Cost category is composed of direct medical, direct non-medical and indirect costs. The level of reliability of each kind of costing source data is provided. Valuation of resource use based on national government, standard cost menu is recommended for national policy making. The recommendations on cost measurement are appropriate for the Thai context and in the current situation.

The aim of this study was to estimate the treatment cost and formulate a cost-function for bacterial diarrhoea among patients in a Thai regional hospital. This study was an incidence-based cost-of-illness analysis from a hospital perspective, employing a micro-costing approach. It covered new episodes of both outpatients and inpatients who were diagnosed to have bacterial diarrhoea (ICD-10 code A00-A05) and who received treatment during 1 October 2000–31 July 2003. Retrospective data were collected from medical records of the hospital. The study covered 384 episodes, and the mean age of patients was 24 years. The average treatment costs (at 2002 prices; US$ 1=approximately 40 Thai baht) were US$ 11.29, 76.78, and 44.72 per outpatient episode, inpatient episode, and outpatient/inpatient combined episode respectively. Furthermore, the positive significant predictor variables were: inpatient care, other Salmonella-associated infections, shigellosis, other bacterial intestinal infections, and the health insurance scheme. The fitted model was able to predict greater than 80% of the treatment cost. The estimation of simulated patients demonstrated a wide range of costs, from US$ 10 per episode to US$ 163 per episode. Overall, hospital administrators can apply these results in cost-containment interventions.

This study aimed to determine the economic burden incurred from road traffic injuries in Thailand. It was designed as a prevalence-based cost-of-illness analysis from a societal perspective, employing a micro-costing bottom-up approach. It covered direct medical cost, direct non-medical cost, and indirect cost or productivity loss. Productivity loss covers the costs of work absence or death due to road traffic injuries suffered by persons of working age. We collected data on road traffic injuries and resource utilization which occurred in the fiscal year 2004. A simple random sampling was used to select 200 patients for analysis. The average cost of road traffic injuries per patient was USD 2,596 at 2004 prices. This can be divided into direct cost (USD 102, or 4%) and indirect cost (USD 2,494, or 96%). From these results, we can see that the indirect cost far outweighed the direct cost. To base decisions regarding road safety campaigns on savings of direct costs, particularly direct medical costs, is inadequate. Therefore, data on the complete cost of illness should be taken into account in the planning and creation of a road safety policy.

Objective: This study aimed to develop a drug cost model for injuries due to road traffic accidents for patients receiving treatment at a regional hospital in Thailand. Methods: The study was designed as a retrospective, descriptive analysis. The cases were all from road traffic accidents receiving treatment at a public regional hospital in the fiscal year 2004. Results: Three thousand seven hundred and twenty-three road accident patients were included in the study. The mean drug cost per case was USD18.20 (SD=73.49, median=2.36). The fitted drug cost model had an adjusted R2 of 0.449. The positive significant predictor variables of drug costs were prolonged length of stay, age over 30 years old, male, Universal Health Coverage Scheme, time of accident during 18:00-24:00 o’clock, and motorcycle comparing to bus. To forecast the drug budget for 2006, there were two approaches identified, the mean drug cost and the predicted average drug cost. The predicted average drug cost was calculated based on the forecasted values of statistically significant (p

Objectives This study aims to formulate a cost model from a provider perspective regarding the direct medical costs for diabetic patients who received care in a 30-bed public hospital in Thailand during the fiscal year of 2001. Methods This study is a retrospective prevalence-based cost of illness study. Data were collected by reviewing the medical record of each patient for the whole year. The statistical analysis employed was the stepwise multiple regression method. Results The study covered 186 diabetic patients. It was found that the average cost of caring for a diabetic patient per year was 6331 Thai baht (THB) at 2001 prices (approximately 40 THB=US $1). A major portion of this cost was spent for pharmacy services, which accounted for 45% of the whole cost, followed by outpatient services (24%), inpatientservices (16%), and laboratory investigation (11%). Regarding the model for forecasting the cost, the type of diabetes and its accompanying complications, i.e., hyperlipidemia, cardiovascular accident, hypertension, hyperglycemia, hypoglycemia, gangrene, and diabetic foot, were considered as significant predictor variables (adjusted R 2 = 0.48). The quantitative effects in monetary term of these significant predictors were also demonstrated. Conclusion The results could be beneficial in forecasting the economic burden of diabetes mellitus in Thailand. Furthermore, the results could be used as a financial tool for cost control and disease management at the community hospital level.

To explore the variance of unit costs of hospital medical services due to different costing methods employed in the analysis.Retrospective and descriptive study at Kaengkhoi District Hospital, Saraburi Province, Thailand, in the fiscal year 2002. The process started with a calculation of unit costs of medical services as a base case. After that, the unit costs were re-calculated based on various methods. Finally, the variations of the results obtained from various methods and the base case were computed and compared.The total annualized capital cost of buildings and capital items calculated by the accounting-based approach (averaging the capital purchase prices throughout their useful life) was 13.02% lower than that calculated by the economic-based approach (combination of depreciation cost and interest on undepreciated portion over the useful life). A change of discount rate from 3% to 6% results in a 4.76% increase of the hospital's total annualized capital cost. When the useful life of durable goods was changed from 5 to 10 years, the total annualized capital cost of the hospital decreased by 17.28% from that of the base case. Regarding alternative criteria of indirect cost allocation, unit cost of medical services changed by a range of -6.99% to +4.05%. We explored the effect on unit cost of medical services in one department. Various costing methods, including departmental allocation methods, ranged between -85% and +32% against those of the base case. Based on the variation analysis, the economic-based approach was suitable for capital cost calculation. For the useful life of capital items, appropriate duration should be studied and standardized. Regarding allocation criteria, single-output criteria might be more efficient than the combined-output and complicated ones. For the departmental allocation methods, micro-costing method was the most suitable method at the time of study.These different costing methods should be standardized and developed as guidelines since they could affect implementation of the national health insurance scheme and health financing management.

There is evidence to suggest the decline of trusting relationships in modern healthcare systems. The primary aim of this study was to investigate the role of trust in medical transactions in Thailand, using obstetric care as a tracer service. The paper proposes an explanatory framework of trust for further investigation in other healthcare settings. The study site was a 1300-bed tertiary public hospital in Bangkok which it provides two forms of obstetric care: regular obstetric practice (RP) and private obstetric practice (PP). Forty pregnant women were selected and interviewed using a set of guiding questions. A thematic analysis of the interviews was undertaken to generate understanding and develop an explanatory framework. It was found that patients' trust in obstetric services was influenced by their perceptions of risk and uncertainty in pregnancy and childbirth, and that these perceptions were linked to their social class. Social class also influenced the accessibility and affordability of care to patients. Middle class pregnant women with relatively high-level concerns about risk and uncertainty preferred using PP service as a means to achieve interpersonal trust. These women thought that an informal payment would provide the basis for interpersonal trust between themselves and the chosen obstetricians. In practice, however, obstetricians involved in PP rarely acknowledged this reciprocal relationship and hardly expressed the additional courtesy expected by patients. As a result, PP service only created an expensive impersonal trust that was mistaken as interpersonal trust by patients. Negative outcomes from PP often caused disappointment that could eventually lead to medical litigation. The study suggests that there are some negative impacts of PP within the health system. Negative experiences among PP users may undermine trust not only in the specific doctor but also trust in health professionals and hospitals more generally. Steps need to be undertaken to protect and strengthen existing impersonal trust, which combine institutional trust based on good governance and service quality with trust in the professional standard of practice. The explanatory framework developed through this study provides a foundation for further studies of trust in different specialties and care settings.