A model-based study to estimate the health and economic impact of health technology assessment in Thailand

Objectives: Health technology assessment (HTA) plays a central role in the coverage and reimbursement decision-making process for public health expenditure in many countries, including Thailand. However, there have been few attempts to quantitatively understand the benefits of using HTA to inform resource allocation decisions. The objective of this research was to simulate the expected net monetary benefit (NMB) from using HTA-based decision criteria compared to a first-come, first-served approach using data from Thailand. Methods: A previously published simulation model was adapted to the Thai context which aimed to simulate the impact of using different decision-making criteria to adopt or reject health technologies for public reimbursement. Specifically, the simulation model provides a quantitative comparison between an HTA-based funding rule and a counterfactual (first-come, first-served) funding rule to make decisions on which health technologies should be funded. The primary output of the model was the NMB of using HTA-based decision criteria compared to the counterfactual approach. The HTA-based decision rule in the model involved measuring incremental cost-effectiveness ratios against a cost-effectiveness threshold. The counterfactual decision rule was a first-come, first-served (random) selection of health technologies. Results: The HTA-based decision rule was associated with a greater NMB compared to the counterfactual. In the investigated analyses, the NMB ranged from THB24,238 million (USD725 million) to THB759,328 million (USD22,719 million). HTA-based decisions led to fewer costs, superior health outcomes (more quality-adjusted life years). Conclusions: The results support the hypothesis that HTA can provide health and economic benefits by improving the efficiency of resource allocation decision-making

Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations:A Report of the SHEER Task Force

BackgroundOmission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed.AimTo promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice.MethodsA modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds.ResultsThis report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed.ConclusionsConsideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation

Health Related Quality of Life among Patients with Tuberculosis and HIV in Thailand

INTRODUCTION: Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease. METHODS: We collected health utility data from Thai patients who were on TB treatment or had been successfully treated for TB for the purpose of economic modeling. Structured questionnaire and EuroQol (EQ-5D) and EuroQol visual analog scale (EQ-VAS) instruments were used as data collection tools. We compared utility of patients with two co-morbidities calculated using multiplicative model (U(CAL)) with the direct measures and fitted Tobit regression models to examine factors predictive of health utility and to assess difference in health utilities of patients in various medical conditions. RESULTS: Of 222 patients analyzed, 138 (62%) were male; median age at enrollment was 40 years (interquartile range [IQR], 35-47). Median monthly household income was 6,000 Baht (187 US$; IQR, 4,000-15,000 Baht [125-469 US$]). Concordance correlation coefficient between utilities measured using EQ-5D and EQ-VAS (U(EQ-5D) and U(VAS), respectively) was 0.6. U(CAL) for HIV-infected TB patients was statistically different from the measured U(EQ-5D) (p-value<0.01) and U(VAS) (p-value<0.01). In tobit regression analysis, factors independently predictive of U(EQ-5D) included age and monthly household income. Patients aged ≥40 years old rated U(EQ-5D) significantly lower than younger persons. Higher U(EQ-5D) was significantly associated with higher monthly household income in a dose response fashion. The median U(EQ-5D) was highest among patients who had been successfully treated for TB and lowest among multi-drug resistant TB (MDR-TB) patients who were on treatment. CONCLUSIONS: U(CAL) of patients with two co-morbidities overestimated the measured utilities, warranting further research of how best to estimate utilities of patients with such conditions. TB and MDR-TB treatments impacted on patients' self perceived health status. This effect diminished after successful treatment

Optimising the development of effective mobile health behaviour change interventions: text messages to support smoking cessation in Thailand

Background: Tobacco smoking is recognised as a leading threat to global population health. Rigorous evaluations of mobile health (mHealth) behaviour change interventions for smoking cessation were reported to be mixed due to the diverse and complex nature of these interventions. There is a lack of evidence in guiding intervention designs to maximise effects of mHealth interventions. The Multiphase Optimisation Strategy (MOST) is an approach which aims to optimise and evaluate multicomponent interventions consisting of screening, refining, and confirming phases. It can be applied to develop and test complex interventions. Objectives: 1) to systematically identify effective components of mHealth behaviour change interventions (e.g. behaviour change techniques (BCTs), modes of delivery, functionality) associated with improvements in smoking cessation; 2) to design mHealth behaviour change interventions that contain effective components to support smoking cessation among Thai smokers; and 3) to simultaneously test whether effective components in mHealth behaviour change interventions improve smoking cessation rates among Thai smokers. Methods: For the first objective, a systematic review, a meta-analysis, and a meta-regression of randomised controlled trials (RCT) of mHealth interventions for tobacco cessation were conducted to identify the effect sizes of mHealth interventions and to quantify the association of the characteristics of mHealth interventions with effect size. For the second objective, mobile text messages were designed to provide support for smokers aimed at three theory-based behaviour change components, namely: ‘Capability’, ‘Opportunity’, and ‘Motivation’. The development involved three steps: 1) selecting BCTs and constructing text messages; 2) testing for the inter-coder reliability of the BCT-enhanced text messages; and 3) validating the acceptability of BCT-enhanced text messages among stakeholders in Thailand using a structured face-to-face focus group discussion. For the third objective, an RCT employing a 2×2×2 full factorial design was conducted to simultaneously assess the effectiveness of the BCT-enhanced text messages for smoking cessation individually, and in combination, among Thai smokers. Effect sizes are presented using odds ratios (OR) and 95% confidence intervals (CI). Kappa's statistic (k) was used to quantify the level of agreement between the two BCT coders. Results: For the first objective, there were 24 mHealth studies identified from the systematic review with the majority being SMS-based interventions. The effect size (OR) of mHealth intervention for smoking cessation was 1.41 (95% CI: 1.19 to 1.67) at 6-months follow-up. From the meta-regression analysis of 23 studies, interventions reported BCTs in the following BCTTv1 domains: ‘Feedback and monitoring’ (OR 1.39, 95% CI: 1.08 to 1.78), ‘Comparison of behaviour’ (OR 1.36, 95% CI: 1.12 to 1.65), ‘Comparison of outcomes’ (OR 1.37, 95% CI: 1.13 to 1.66), and ‘Antecedents’ (OR 1.29, 95% CI: 1.09 to 1.54), Covert learning’ (OR 1.83, 95% CI: 1.21 to 2.75) were associated with an increased odds of smoking cessation. Interventions reported BCTs mapped onto all three theory-based behaviour change components (OR 1.30, 95% CI: 1.05 to 1.59), use theory to inform an intervention (OR 1.51, 95% CI: 1.14 to 1.99), use theory to develop an intervention (OR 1.42, 95% CI: 1.15 to 1.74), and tailoring interventions to participant’s needs (OR 1.56, 95% CI: 1.26 to 1.94) were also associated with an increased odds of smoking cessation. These results suggest further research to make efficient, causal conclusions about components as well as about packages of components. For the second objective, text messages were designed based on 39 evidence-based BCTs mapped onto three behaviour change components. Inter-coder reliability for BCT coding suggested that there was a substantial level of agreement (k = 0.78) between the two BCT coders and none of the discrepancies fell into different behaviour change components. However, only 32 BCTs were found to be acceptable among the Thai expert panel involved with tobacco control and was included in the final set of text messages. For the third objective, a total of 1,571 smokers were randomised to receive one of the eight combinations of BCT-enhanced text messages (Placebo, C, O, M, CO, CM, OM, and COM) twice a day for 30 days. 1,260 participants (80%) received all 60 text messages as intended and 94% of the participants reported that they had opened and read the text messages. The overall 7-day self-reported smoking abstinence rate was 40% (n = 521) at 1-month follow-up. Providing BCT-enhanced text messages aimed at supporting smokers’ capability to quit (OR 1.20, 95% CI: 0.77 to 1.86), smokers’ opportunity to quit (OR 1.05, 95% CI: 0.67 to 1.64), or smokers’ motivation to quit (OR 1.13, 95% CI: 0.73 to 1.77) did not significantly improve the 7-day smoking abstinence rate at 1-month follow-up. The additional components of BCT-enhanced text messages (two or more) showed a trend of decreasing the odds of quitting, which suggested an antagonistic interaction effect. Conclusion: This study optimised and evaluated multicomponent mHealth behaviour change interventions in a resource-limited country with emerging mHealth technology. Though a meta-regression suggested a promising result of combinations of BCT-contained mHealth interventions, the interventions failed to provide a significant improvement in cessation rates in a trial setting. Moreover, the addition of two or more behaviour change components decreased the effect size suggesting the importance of experimental studies for decision making. Understanding the effects of these fine-grained behaviour change components rather than a whole set of interventions as a ‘black box’ will advance knowledge in this field of research using a factorial design

How international approaches to the regulation and assessment of Digital Health Technologies might be applied in Thailand

The Health Intervention and Technology Assessment Program (HITAP) at the Ministry of Public Health, Thailand recently commissioned landscape analyses from three countries (Australia, Singapore, and the United Kingdom) to inform local policies regarding health technology assessment of digital health technologies. This lecture will highlight key findings from these policy analyses and discuss the applicability of these findings to the regulation and assessment of digital health technologies in Thailand. These findings will be supplemented with a discussion of relevant, current challenges in Australia to assessing the value of digital health technologies

Evidence to Inform Decision Makers in Thailand: A Cost-Effectiveness Analysis of Screening and Treatment Strategies for Postmenopausal Osteoporosis

AbstractObjectivesTo assess value for money of providing systematic screening for osteoporosis among postmenopausal women and medical treatments for those diagnosed with osteoporosis as evidence-based decision making for the revision of the National List of Essential Medicines.MethodsDecision analytic models were constructed, using a societal perspective, to assess the cost per quality-adjusted life-years (QALYs) gained from systematic screening using the Osteoporosis Self-Assessment Tool and dual-energy X-ray absorptiometry or dual-energy X-ray absorptiometry alone compared with no screening. Alendronate, risedronate, raloxifene, and nasal calcitonin were economically evaluated to determine a treatment of choice for the prevention of osteoporosis-related fractures. Most input parameters were obtained from literature reviews, and systematic reviews and meta-analyses, if available. The service costs and related household expenses were based on the Thai setting. Probabilistic and one-way sensitivity analyses were used to incorporate the impact of parameter uncertainty.ResultsThe Osteoporosis Self-Assessment Tool and sequential dual-energy X-ray absorptiometry provided better value for money for osteoporosis screening among young age groups (<60 years old). Although there was no significant difference in cost per QALY for older age groups, alendronate provided the lowest incremental cost-effectiveness ratio while nasal calcitonin presented the highest incremental cost-effectiveness ratio. It was shown that providing medication for a secondary prevention yielded a much higher cost per QALY gained compared with providing medication for a primary prevention.ConclusionsGiven the benchmark set at 100,000 Thai baht per QALY gained, providing systematic screening and treatment for osteoporosis was cost-ineffective in the Thai setting

Evidence-informed policy formulation: the case of the voucher scheme for maternal and child health in Myanmar

AbstrAct Introduction: In 2010, with financial support from the Global Alliance for Vaccine and Immunization&apos;s Health System Strengthening programme, the Government of Myanmar established a scheme to improve coverage of maternal and child health (MCH) services. Employing qualitative approaches, this article reviews the processes through which this scheme was devised, focusing on evidence generation and the use of such evidence to inform policy formulation. To address the problem of high mortality rates among mothers and infants, collaborative research was conducted by Myanmar&apos;s Ministry of Health, the World Health Organization, and a research arm of Thailand&apos;s Ministry of Public Health, between March 2010 and September 2011. In the early phase of this study, key barriers to governmentprovided MCH services were identified. Based on a comprehensive review of the literature, the introduction of a voucher scheme was raised for consideration by ministry of health decision-makers and respective stakeholders. Despite the successful experience of this financing strategy in low-income countries, a series of surveys, an economic evaluation, and focus group discussions were carried out to assess the feasibility and potential health and economic implications of this scheme in the Myanmar context. The research findings were then used to guide the design and adoption of the newly established initiative

Additional file 1: of Identifying effective components for mobile health behaviour change interventions for smoking cessation and service uptake: protocol of a systematic review and planned meta-analysis

PRISMA-P checklist. (DOCX 15 kb

Response of 222 Thai patients with various medical conditions to EuroQol 5D instrument, August to October 2009.

<p>TB_TX, TB patients receiving TB treatment; MDR_TX, MDR-TB patients receiving MDR-TB treatment; _anyTB_C, patients who had been successfully treated for TB or MDR-TB for ≥6 months; _anyHIV, HIV-infected patients at any stage; TB_TX/HIV, HIV-infected TB patients receiving TB treatment; _anyTB_C/HIV, HIV-infected patients who had been successfully treated for TB or MDR-TB for ≥6 months.</p