Long-term cost effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand

Objectives: To evaluate the long-term cost-effectiveness of ticagrelor and ASA versus generic and branded clopidogrel and ASA in patients with ACS based on a Thai cost database. Methods: A one-year decision tree and a long-term Markov model were constructed to estimate lifetime costs and quality-adjusted life years (QALYs). For the first year, data from PLATO (NCT00391872) were used to estimate the rate of cardiovascular events, resource use, and QALYs. For year 2 onwards, clinical effectiveness was estimated conditional on individual health states that occurred during the first year. Results: In the base-case analysis, the incremental cost-effectiveness ratio (ICER) with ticagrelor was 292,504 ($9,476) and 60,055 ($1,946) THB($)/QALY compared with generic and branded clopidogrel, respectively. The probability of ticagrelor being cost-effective was above 99% at a threshold of 160,000 THB/QALY compared with branded clopidogrel. Conclusions: This health economic analysis provides cost effectiveness data for ticagrelor compared with both generic and branded clopidogrel in Thailand. Based on this analysis, it appears that ticagrelor is an economically valuable treatment for ACS compared with branded clopidogrel within the Thai context

Characterization of hypersensitivity reactions reported among Andrographis paniculata users in Thailand using Health Product Vigilance Center (HPVC) database

Background: Andrographis paniculata (andrographis) is one of the herbal products that are widely used for various indications. Hypersensitivity reactions have been reported among subjects receiving Andrographis paniculata in Thailand. Understanding of characteristics of patients, adverse events, and clinical outcomes is essential for ensuring population safety. This study aimed to describe the characteristics of hypersensitivity reactions reported in patients receiving andrographis containing products in Thailand using national pharmacovigilance database. Methods: Thai Vigibase data from February 2001 to December 2012 involving andrographis products were used. This database includes the reports submitted through the spontaneous reporting system and intensive monitoring programmes. The database contained patient characteristic, adverse events associated with andrographis products, and details on seriousness, causality, and clinical outcomes. Case reports were included for final analysis if they met the inclusion criteria; 1) reports with andrographis being the only suspected cause, 2) reports with terms consistent with the constellation of hypersensitivity reactions, and 3) reports with terms considered critical terms according to WHO criteria. Descriptive statistics were used. Results: A total of 248 case reports of andrographis-associated adverse events were identified. Only 106 case reports specified andrographis herbal product as the only suspected drug and reported at least one term consistent with constellation of hypersensitivity reactions. Most case reports (89%) came from spontaneous reporting system with no previously documented history of drug allergy (88%). Of these, 18 case reports were classified as serious with 16 cases requiring hospitalization. For final assessment, the case reports with terms consistent with constellation of hypersensitivity reactions and critical terms were included. Thirteen case reports met such criteria including anaphylactic shock (n = 5), anaphylactic reaction (n = 4) and angioedema (n = 4). Time to development of symptoms ranged from 5 minutes to 1 day. The doses of andrographis used varied from 352 mg to 1,750 mg. Causality assessment of 13 case reports were certain (n = 3), probable (n = 8) and possible (n = 2). Conclusions: Our findings suggested that hypersensitivity reactions have been reported among patients receiving Andrographis paniculata. Healthcare professionals should be aware of this potential risk. Further investigation of the causal relationship is needed; meanwhile including hypersensitivity reactions for andrographis product labeling should be considered

Performance and Emission of Small Diesel Engine Using Diesel-Crude Palm Oil-Water Emulsion as Fuel

Diesel and crude palm oil (CPO) emulsion was drop-in replaced of diesel oil in a small diesel engine to test the engine performance and emission. In the study, the compositions of diesel/CPO/water of 95/0/5, 90/0/10, 90/5/5, 85/5/10, 85/10/5 and 80/10/10 by volume were used in a four-stroke single cylinder diesel engine having a pre-combustion chamber. The engine speed was in a range of 1000 – 2000 rpm.  From the results, it could be found that the torque and the engine power for the emulsion of 90/5/5 were close to those of from the diesel oil and the performance were poorer when the percentages of CPO and water were increased. The specific fuel consumption of the emulsified oil with the composition of 90/5/5 was quite close to that of the diesel oil at low engine speed and higher consumption was needed with higher amount of CPO and water in the emulsion due to lower heating value in the emulsion. The emissions in terms of CO, NOx and black smoke for the emulsified oil could be reduced significantly. After 200h of the operation, the wear and the physical corrosions in the engine components for the emulsified fuel of 90/5/5 composition are not much different from those for the diesel oil. Key words:  Palm –diesel emulsion; Diesel engine performance; Emissio

Reaction Kinetics of Transesterification Between Palm Oil and Methanol under Subcritical Conditions

The objective of this work was to evaluate transesterification kinetics for biodiesel production from palm oil under subcritical conditions. Experimental investigation was carried out with palm oil and methanol at molar ratio of 46:1, temperatures between 150-200 °C and pressure around 140-190 atm in a 400 ml batch  reactor.  The biodiesel products were analyzed by gas chromatography – mass spectrometry. Area percentage method was used to estimate the methyl esters in the product. Zero- and first-order kinetic models were developed. Apparent activation energy was estimated to be in the range of 91-105 kJ/mol. The reaction rate equation was best approximated by the first order kinetic model with pre-exponential factor of 1.57 x 109.Key words: Biodiesel; Critical fluids; Kinetic equations; Methyl esters; Palm oil; Renewable energ

Validation of the Thai QOL-AD version in Alzheimer's patients and caregivers

BackgroundQuality of life (QOL) plays an important role in determining the improvement of patient care in Alzheimer’s disease. The simple and easily used Thai instrument for measuring QOL is still limited.  AimsThis study aimed to translate the Quality of Life–Alzheimer’s Disease (QOL-AD) scale original version into a Thai version and test its psychometric properties.  MethodA Thai version of QOL-AD was translated following the sequential method. The validation was tested in 136 pairs of patients and their caregivers. Mild to moderate Alzheimer’s patients were recruited from outpatient clinics at Chiang Mai Neurological Hospital and Chiang Mai Psychiatry Hospital from April to September 2012. Internal consistency, factor analysis, and construct validity were evaluated. ResultsInternal consistency of Thai QOL-AD version was good for both patients (0.82) and caregivers (0.82). The results of factor analysis indicated three factors (physical and psychological well-being, social well-being, and close interpersonal relationships) in the patient group, while four factors were found (social well-being, functional ability, psychological well-being, and physical well-being) in the caregiver group. The scaling success in the patient group was around 80–83 per cent for convergent validity, and 70–83 per cent for discriminant validity. The caregiver group showed higher scaling success in convergent validity except for the psychological well-being domain. The scaling success of discriminant validity was around 44–83 per cent for caregivers.  ConclusionThe findings of the study demonstrate a good reliability of a Thai QOL-AD version for both patient and caregiver groups. Validity, especially in the caregiver group, might need to be re-examined.

Quality of life and willingness to pay for receiving hemodialysis in patients who received peritoneal dialysis in Thailand

This cross-sectional study was conducted to evaluate quality of life (QoL), willingness to pay (WTP) for receiving hemodialysis (HD), and factors influencing QoL in patients who received peritoneal dialysis (PD) in Thailand. Data of PD patients visiting secondary or tertiary hospitals from December 2020 through June 2021 were collected. EuroQoL EQ-5D-5L questionnaire was used to evaluate QoL. After the patients completed the questionnaire, they were interviewed using the contingent valuation method to derive their WTP for switching to HD. Patients randomly picked up one payment card as an initial price for receiving HD, then bidding by 100 Thai Baht (THB) up and down to reach the maximum affordable WTP amount. Multiple linear regression was used to identify factors affecting QoL. A total of 102 patients were included in this study. The mean age was 58 years. EQ-5D utility score was 0.71±0.32. Five variables were the factors that affect QoL included serum albumin, hospitalization, age, urine output, and hemoglobin level. Average WTP was 233±293 THB (7.2±9.0 USD) per HD session. Quality of life among these study patients was slightly higher than reported in Thai patients with low hemoglobin level. Treatment anemia to reach hemoglobin target and preservation of residual urine output might improve QoL. The average WTP for switching to HD among PD patients was only one-sixth of general billing price for HD

The economic costs of alcohol consumption in Thailand, 2006

<p>Abstract</p> <p>Background</p> <p>There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006.</p> <p>Methods</p> <p>This is a prevalence-based, cost-of-illness study. The estimated costs in this study included both direct and indirect costs. Direct costs included health care costs, costs of law enforcement, and costs of property damage due to road-traffic accidents. Indirect costs included costs of productivity loss due to premature mortality, and costs of reduced productivity due to absenteeism and presenteeism (reduced on-the-job productivity).</p> <p>Results</p> <p>The total economic cost of alcohol consumption in Thailand in 2006 was estimated at 156,105.4 million baht (9,627 million US$PPP) or about 1.99$ PPP), followed by cost of productivity loss due to reduced productivity (45,464.6 million baht/2,804 million US$PPP), health care cost (5,491.2 million baht/339 million US$ PPP), cost of property damage as a result of road traffic accidents (779.4 million baht/48 million US$PPP), and cost of law enforcement (242.4 million baht/15 million US$ PPP), respectively. The results from the sensitivity analysis revealed that the cost ranges from 115,160.4 million baht to 214,053.0 million baht (7,102.1 - 13,201 million US$ PPP) depending on the methods and assumptions employed.</p> <p>Conclusions</p> <p>Alcohol imposes a substantial economic burden on Thai society, and according to these findings, the Thai government needs to pay significantly more attention to implementing more effective alcohol policies/interventions in order to reduce the negative consequences associated with alcohol.</p

Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand

<p>Abstract</p> <p>Background</p> <p>This study aims to determine the maximum price at which HIV vaccination is cost-effective in the Thai healthcare setting. It also aims to identify the relative importance of vaccine characteristics and risk behavior changes among vaccine recipients to determine how they affect this cost-effectiveness.</p> <p>Methods</p> <p>A semi-Markov model was developed to estimate the costs and health outcomes of HIV prevention programs combined with HIV vaccination in comparison to the existing HIV prevention programs without vaccination. The estimation was based on a lifetime horizon period (99 years) and used the government perspective. The analysis focused on both the general population and specific high-risk population groups. The maximum price of cost-effective vaccination was defined by using threshold analysis; one-way and probabilistic sensitivity analyses were performed. The study employed an expected value of perfect information (EVPI) analysis to determine the relative importance of parameters and to prioritize future studies.</p> <p>Results</p> <p>The most expensive HIV vaccination which is cost-effective when given to the general population was 12,000 Thai baht (US$1 = 34 Thai baht in 2009). This vaccination came with 70% vaccine efficacy and lifetime protection as long as risk behavior was unchanged post-vaccination. The vaccine would be considered cost-ineffective at any price if it demonstrated low efficacy (30%) and if post-vaccination risk behavior increased by 10% or more, especially among the high-risk population groups. The incremental cost-effectiveness ratios were the most sensitive to change in post-vaccination risk behavior, followed by vaccine efficacy and duration of protection. The EVPI indicated the need to quantify vaccine efficacy, changed post-vaccination risk behavior, and the costs of vaccination programs.</p> <p>Conclusions</p> <p>The approach used in this study differentiated it from other economic evaluations and can be applied for the economic evaluation of other health interventions not available in healthcare systems. This study is important not only for researchers conducting future HIV vaccine research but also for policy decision makers who, in the future, will consider vaccine adoption.</p