Burden of disease in Thailand: changes in health gap between 1999 and 2004

<p>Abstract</p> <p>Background</p> <p>Continuing comprehensive assessment of population health gap is essential for effective health planning. This paper assessed changes in the magnitude and pattern of disease burden in Thailand between 1999 and 2004. It further drew lessons learned from applying the global burden of disease (GBD) methods to the Thai context for other developing country settings.</p> <p>Methods</p> <p>Multiple sources of mortality and morbidity data for both years were assessed and used to estimate Disability-Adjusted Life Years (DALYs) loss for 110 specific diseases and conditions relevant to the country's health problems. Causes of death from national vital registration were adjusted for misclassification from a verbal autopsy study.</p> <p>Results</p> <p>Between 1999 and 2004, DALYs loss per 1,000 population in 2004 slightly decreased in men but a minor increase in women was observed. HIV/AIDS maintained the highest burden for men in both 1999 and 2004 while in 2004, stroke took over the 1999 first rank of HIV/AIDS in women. Among the top twenty diseases, there was a slight increase of the proportion of non-communicable diseases and two out of three infectious diseases revealed a decrease burden except for lower respiratory tract infections.</p> <p>Conclusion</p> <p>The study highlights unique pattern of disease burden in Thailand whereby epidemiological transition have occurred as non-communicable diseases were on the rise but burden from HIV/AIDS resulting from the epidemic in the 1990s remains high and injuries show negligent change. Lessons point that assessing DALY over time critically requires continuing improvement in data sources particularly on cause of death statistics, institutional capacity and long term commitments.</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

Schizophrenia in Thailand: prevalence and burden of disease

Background: A previous estimate of the burden of schizophrenia in Thailand relied on epidemiological estimates from elsewhere. The aim of this study is to estimate the prevalence and disease burden of schizophrenia in Thailand using local data sources that recently have become available

The national burden of road traffic injuries in Thailand

Background: This study quantifies the burden of road traffic injuries (RTIs) in Thailand in 2004, incorporating new Thai data on mortality and the frequency and severity of long-term disability

Sobriety checkpoints in Thailand: A review of effectiveness and developments over time

This review describes the legal basis for and implementation of sobriety checkpoints in Thailand and identifies factors that influenced their historical development and effectiveness. The first alcohol and traffic injury control law in Thailand was implemented in 1934. The 0.05 g/100 mL blood alcohol concentration limit was set in 1994. Currently, 3 types of sobriety checkpoints are used: general police checkpoints, selective breath testing, and special event sobriety checkpoints. The authors found few reports on the strategies, frequencies, and outcomes for any of these types of checkpoints, despite Thailand having devoted many resources to their implementation. In Thailand and other low-middle income countries, it is necessary to address the country-specific barriers to successful enforcement (including political and logistical issues, lack of equipment, and absence of other supportive alcohol harm reduction measures) before sobriety checkpoints can be expected to be as effective as reported in high-income countries