Potential health impacts of increasing the cigarette tax in Viet Nam.

BACKGROUND: Even after the implementation of MPOWER, Viet Nam's cigarette tax remains only 36% of the retail price. This falls short of the World Health Organization's (WHO's) recommendation that the tax share be 70% of the retail price. OBJECTIVE: To assess the health impact of different levels of cigarette taxation by estimating the impact on reducing tobacco consumption and smoking-attributable deaths (SADs). METHODS: A static model was developed based on a previous study by Jha et al. The model calculates the reduction in tobacco consumption, estimating the number of SADs averted and savings in health-related costs. The scenarios for increasing cigarette taxes were aligned with the Viet Nam Tobacco Tax Simulation Model developed by the WHO and the Vietnamese Ministry of Finance. RESULTS: Four scenarios proposed by the Ministry of Finance and the Ministry of Health would prevent an estimated 63 339-581 165 SADs, equivalent to mortality costs of US$577-5296 million. In the ideal scenario, 6 258 361 SADs would be prevented and would save US$57.0 billion. Future young smokers would see the greatest health benefits of increasing the cigarette tax. CONCLUSION: Increasing the cigarette tax could reduce the substantial health impact of tobacco use, and further result in significant financial savings across society. Viet Nam should support efforts to further increase the cigarette tax following WHO recommendations.

Costs of providing tuberculosis diagnosis and treatment services in Viet Nam.

OBJECTIVE: To estimate the cost of providing tuberculosis (TB) diagnosis and treatment packages at different levels of health facilities in Viet Nam. DESIGN: This was a retrospective costing study from the providers' perspective using a standard costing approach. We included typical services for TB diagnosis and treatment based on standard protocols. RESULTS: The least expensive TB service was the 6-month isoniazid preventive therapy regimen for latent tuberculous infection provided by district health centres (US$7.20-14.30, accounting for 0.3-0.7% of Viet Nam's per capita gross domestic product [GDP] of US$2052.30 in 2014). The cost of diagnosing and treating a patient with drug-susceptible TB (the most common type of TB) ranged between US$51.20 and US$180.70, and represented 2.5-8.8% of Viet Nam's per capita GDP in 2014. The most expensive TB service was the diagnosis and treatment of a multidrug-resistant TB case (US$1568.20-2391.20), accounting for 76.4-116.5% of Viet Nam's per capita GDP in 2014). CONCLUSION: The cost of TB diagnosis and treatment services in Viet Nam varied according to level of health facility, type of TB, different costing options, and different staff cost scenarios.

[Insulin resistance and essential hypertension in Vietnamese subjects]. / Insulinorésistance et hypertension artérielle essentielle chez les Vietnamiens.

Several epidemiological and experimental studies suggest that essential arterial hypertension is associated with hyperinsulinism and insulin resistance in obese subjects and also in subjects with normal body weight. Undernutrition remains frequent in adult Vietnamese people and mean body mass index is around 18.5 kg/m2 in Vietnam. The aim of this study was to look for insulin resistance in hypertensive Vietnamese subjects, despite a markedly lower BMI in Vietnam than in occidental countries. One hundred and eight hypertensive patients (51 men and 57 women) over 40 years (mean = 65.4 years) were compared with 36 healthy subjects (23 men and 13 women) over 40 years (mean = 63.8 years). Hypertensive patients had significantly higher BMI (20.5 +/- 0.3 (SEM) kg/m2 vs 18.4 +/- 0.4 kg/m2; p < 0.01), thicker triceps skinfold (1.26 +/- 0.07 cm vs 0.71 +/- 0.07 cm; p < 0.001) and not significantly different waist/hip ratio (0.88 +/- 0.01 vs 0.85 +/- 0.01). Blood glucose at fasting and 2 hours after 75 g glucose taken orally were similar in hypertensive and normotensive subjects. Plasma insulin at fasting and 2 hours after glucose were significantly higher in hypertensive patients (44.4 +/- 5.1 pmol/L vs 21.6 +/- 3.2 pmol/L; p < 0.05 and 271.1 +/- 21.6 pmol/L vs 139.1 +/- 15.2 pmol/L; p < 0.001). Thus, despite under-nutrition, hypertensive Vietnamese patients have a moderate but significant increase in BMI and fat mass without predominant abdominal localization, and a state of insulin-resistance, compared with normotensive healthy subjects.