Evidence to inform decision makers in Thailand: a cost-effectiveness analysis of screening and treatment strategies for postmenopausal osteoporosis.

OBJECTIVES: To 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. METHODS: Decision 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. RESULTS: The 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. CONCLUSIONS: Given 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.

Impact on access to medicines from TRIPS-Plus: a case study of Thai-US FTA.

This study assessed the impact of the Thai-US Free Trade Agreement (FTA) on access to medicines in Thailand. We first interpreted the text of the sixth round of Thai-US negotiations in 2006 on intellectual property rights (IPR). The impact was estimated using a macroeconomic model of the impact of changes in IPR. The estimated impact is based on a comparison between the current IPR situation and the proposed changes to IPR. The FTA text involves the period of patent extension from the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS Agreement). The provisions involve the period of patent extension, which have to do with compensation for delays in patent registration and/or drug registration, data exclusivity that would result in a delay in generic drug entry, and the enforcing role of the Thai Food and Drug Administration of patent linkages. As a worst case scenario for this single provision, a 10 year patent extension would be given to compensate for delays in patent registration and/or drug registration. The impact on access to medicine, in the year 2027, would be: 1) A 32% increase in the medicine price index, 2) spending on medicines would increase to approximately USD 11,191 million, (USD1 = THB 33.9 on September 2, 2009), and 3) the domestic industry could loss USD 3.3 million. These results suggest there would be a severe restriction on the access to medicines under the TRIPS-Plus proposal. IPR protection of pharmaceuticals per the TRIPS-Plus proposal should be excluded from FTA negotiations.

Health promotion integrated into a Thai PharmD curriculum to improve pharmacy practice skills.

OBJECTIVE: To implement and evaluate 5 integrated teaching modules in the fifth-year doctor of pharmacy (PharmD) curriculum to increase students' ability to promote patients' health as part of their pharmacy practice. DESIGN: Activity-based learning was added to each module: (1) a practice experience in which students provided health information and counseling to the public; (2) academic debates on current issues in pharmacy (3) journal clubs on articles from the pharmacy literature; and (4) research projects relating to ongoing faculty research on diabetes. Students on 12-week practice experiences had visits to patients in inpatient wards, outpatient clinics, and either primary care units or community pharmacies. ASSESSMENT: Practice examinations at the end of the first semester, the average student score was above 80% as determined by preceptors in experience sites and from faculty members. Group interviews found that students were positive about the benefits of integrated teaching. CONCLUSION: The integration of the teaching between modules in the same semester is possible and greatly benefits student learning.

The cost-effectiveness analysis of initiating HIV/AIDS treatment with efavirenz-based regimens compared with nevirapine-based regimens in Thailand.

OBJECTIVES: The aim of this study is to evaluate the cost-utility of the treatment, starting with EFZ-based therapy, compared with NVP-based therapy in Thai HIV/AIDS patients. MATERIAL AND METHOD: The study adopted a health care provider perspective. A probabilistic Markov model was applied to Thai HIV/AIDS patients aged 15 to 65 years. Input parameters were extracted from a cohort study of four regional hospitals. The study explored the effects of uncertainty around input parameters. RESULTS: For those patients with a different baseline CD4, initial therapy using EFZ-based regimens was the preferable choice for all subgroups. Given a maximum acceptable willingness to pay (WTP) threshold of 300,000 Baht/DALY averted starting with EFZ-based regimens was cost-effective for patients with a baseline CD4 count less than 250 cells/mm3 and in all patient age groups, except those who were 20 years old. CONCLUSIONS: The results suggest that starting with EFZ-based regimens was the preferable choice and it should be used as the first line regimen for Thai HIV/AIDS patients.