Economic evaluation of hepatitis A vaccines by income level of the country: A systematic review

Background & objectives: Although several reviews of economic evaluation (EE) studies on hepatitis A virus (HAV) vaccine exist, there remains a need to corroborate such data from time to time. This study aimed to systematically review the literature for reports on EE of HAV vaccination by type of population, characteristics of intervention and income level of the country. Methods: PubMed and Scopus were searched to identify relevant studies from inception up to May 2021 using topic-specific key words in various combinaiton. Full EE studies comparing HAV vaccination to no vaccine or immunoglobulin were included. The risk of bias was assessed by using the ECOBIAS checklist. Results: Among the 1984 identified studies, 43 were found eligible. Of these, 27 were from high-income countries (HICs), 15 from middle-income countries (MICs), and one from low income country. Majority of the studies used Markov model and/or decision tree (n=26). Eight studies used a dynamic model. The discount rate, perspective and time horizon varied across the studies. Universal HAV vaccination without screening was cost-effective among children (14/16, 87.5%) and adolescents (1/5, 20%) but not in adults (0/4, 0%). Analysis by the level of income found that universal HAV vaccination among children without screening was cost-effective in 81.8 per cent of the studies conducted in MICs (9/11) as compared to 66.7 per cent in HICs (4/6). About one-third of the studies conducted among children found that screening and HAV vaccination were cost-effective compared to no vaccination. Interpretation & conclusions: The finding of this review suggest that universal vaccination of children without screening was likely to be cost-effective, especially in MICs. Nevertheless, it should be noted that the methodology varied across studies. Several aspects should also be considered in transferring the EE results across jurisdictions.

Economic burden of road traffic injuries: a micro-costing approach.

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.

Presentation of economic evaluation results.

In Thailand, economic evaluation results are being increasingly used for making health care resource allocation decisions. To assess the usefulness of economic evaluation information, users of studies such as policy decision makers or health care providers need to know whether the methods used in the study are appropriate and whether the results are valid. The quality of previous economic evaluation studies, however, was quite poor. The objectives of this article are to review the similarities and differences in reporting formats based on existing reporting formats suggested by published methodological guidelines for economic evaluation, and to provide recommendations for economic evaluation result presentation for Thai Health Technology Assessment guidelines. The article presents a recommended reporting format including ten key elements necessary for economic evaluation techniques. The recommended format will increase the transparency of studies as well as facilitate comparisons between studies. This may eventually lead to high-quality and reliable economic evaluation studies available for policy decision making in Thailand.

Making health technology assessment information available for decision making: the development of a Thai database.

In Thailand, there is an attempt to develop the Thai HTA database in order to improve the accessibility and usefulness of HTA information. At present, the database is available online at www.db.hitap.net. The database includes (1) economic evaluation studies i.e. cost-minimization analysis, cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis, (2) outcome assessment studies i.e. randomized controlled trials, and (3) quantitative measured quality of life studies. All HTA studies related to the Thai context, and published in either Thai or English from 1990 onward, are eligible for inclusion in the database. In addition, there is a quality evaluation for each economic evaluation study which will help readers, who have limited knowledge about the method, to understand and make appropriate use of the information in their own settings. This may also raise awareness among researchers, who will conduct economic evaluation studies in the future, to adhere to the standard methodological guidelines because the quality evaluation was developed based on the national guidelines published in this supplement journal.

Thai health technology assessment guideline development.

Health Technology Assessment (HTA) is a comprehensive form of policy research that provides information on the consequences of the application of health technology. It is used primarily to guide health care resource allocation decisions. In Thailand, there is increasing impetus to use HTA information to allow more explicit and transparent health care priority setting. A previous study indicated that serious attention needed to be given to the quality of reporting and the use of information in the analyses. These problems could be reduced by setting up standard guidelines for conducting HTA to stimulate the provision of standardized, reliable and good quality information for policy makers. Nevertheless, Thailand has not yet set up such guidelines. This may lead to low quality evaluations. Therefore, the objective of this article was to describe the rationale for guideline development, supporting principles, guideline development process, sources of information, and future challenges for HTA.

A determination of topics for health technology assessment in Thailand: making decision makers involved.

This study is to describe experiences and findings from the topic selection process for health technology assessment (HTA) conducted by Health Intervention and Technology Assessment Program. The process comprised of 5 stages namely: (1) determining objectives, scope and involved stakeholders; (2) requesting potential topics for assessment from decision makers at the national health authorities; (3) reviewing related literature on and prioritizing the proposed HTA topics by HITAP researchers; (4) selecting the HTA topics by decisionmakers; (5) analyzing the strengths and weaknesses of the current topic selection processes by HITAP staff The strengths of the topic selection were systematic and transparent. It also required participation from stakeholders; however the limitations were topics prioritization methods and time constraints. Lessons learnt from this procedure can be useful for improving the next HTA topic selection in order to increase the usefulness of the future HTA results.

Cost-utility analysis of recombinant human erythropoietin in anemic cancer patients induced by chemotherapy in Thailand.

OBJECTIVE: To conduct a cost-utility analysis on recombinant human erythropoietin (rHuEPO) for treating anemic cancer patients induced by chemotherapy compared to blood transfusion alone under the Thai health care setting. MATERIALS AND METHODS: A health care provider's perspective was used to examine relevant costs and outcomes using the Markov model. Cost data were estimated based on the reference price set by the Ministry of Public Health. The effectiveness data were obtained from a systematic review of published literature. The results were presented in terms of incremental cost-effectiveness ratio (ICER) in Thai Baht per Quality Adjusted Life Years (QALYs) gained. A probabilistic sensitivity analysis method was performed. RESULTS: The ICERs of rHuEPO compared to blood transfusion alone were 3.7 and 2.7 millions Baht per QALY for patients with hemoglobin less than 8 g/dl and 8-9 g/dl, respectively. The rHuEPO required additional resources (more costly) with less benefit compared to blood transfusion for patients with hemoglobin 9-10 g/dl. CONCLUSIONS: The rHuEPO may be cost-ineffective for the treatment of anemia caused by chemotherapy in cancer patients in Thailand.