Browsing by Author "Siripen Supakankunti"

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    Cost and effectiveness of screening methods for abnormal fasting plasma glucose among Thai adults participating in the annual health check-up at king chulalongkorn memorial hospital
    (2011-07-01) Nipa Srichang; Wiroj Jiamjarasrangsi; Wichai Aekplakorn; Siripen Supakankunti; Chulalongkorn University; Mahidol University
    Background: In Thailand, type 2 diabetes screening was implementing at national level by the Ministry of Public Health (MOPH) recommendation but screening methods have not been fully evaluated. Objective: To compare the performance, cost, and cost-effectiveness of four screening methods in identifying individuals with abnormal fasting plasma glucose among Thai adults participating in the annual health check-up at King Chulalongkorn Memorial Hospital. Material and Method: Individuals aged 35 to 60 years old with no known abnormal fasting plasma glucose (2,977 persons) were recruited. All subjects completed a set of screening questionnaires and were tested for venous fasting plasma glucose (FPG). One-time screening performance and costs were analyzed. Results: Sensitivities of all screening methods ranged from 71 to 92%, while specificities were between 31 and 57%. The total costs of screening per one newly detected case were 59.12 to 69.62 US dollars (2,022 to 2,381 bahts). Compared to the universal FPG test, all screening methods using questionnaires were relatively more cost-effective. Their relative costeffectiveness was, however, not obviously different. Conclusion: Other factors should also be considered in selecting type 2 diabetes screening method for specific population in Thailand.
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    Cost-effectiveness and budget impact analyses of colorectal cancer screenings in a low- and middle-income country: example from Thailand
    (2019-12-02) Pochamana Phisalprapa; Siripen Supakankunti; Nathorn Chaiyakunapruk; Chulalongkorn University; University of Utah; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Objectives: Colorectal cancer (CRC) screening programs have been reported to be cost-effective in many high-income countries. However, there was no such study in low- and middle-income countries. This study aimed to evaluate cost-effectiveness and budget impact of CRC screening modalities for average-risk persons in Thailand. Methods: A decision tree coupled with a Markov model was used to estimate lifetime costs and health benefits of fecal immunochemical test (FIT) and colonoscopy using a societal perspective. The input parameters were obtained from a CRC screening project at a Thai tertiary care hospital, Thai health care costs and databases, and systematic literature review. Results were reported as incremental cost-effectiveness ratios (ICERs) in 2017 US Dollars (USD) per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to assess the influence of parameter uncertainty. Finally, budget impact analysis was conducted. Results: At the Thai ceiling threshold of societal willingness-to-pay of 4,706 USD, the screening colonoscopy every 10 years and annual FIT, starting at age 50, was cost-effective, as compared to no screening resulting in 15.09 and 15.00 QALYs with the ICERs of 600.20 and 509.84 USD/QALY gained, respectively. Colonoscopy every 10 years and annual FIT could prevent 17.9% and 5.7% of early stage cancer and 27.8% and 9.2% of late stage cancer per 100,000 screening over lifetime when compared to no screening, respectively. The colonoscopy screening was cost-effective with the ICER of 646.53 USD/QALY gained when compared to FIT. The probabilities of being cost-effective for the colonoscopy and FIT were 75% and 25%, respectively. Budget impact analysis showed the colonoscopy screening required an 8-times higher budget than FIT. Conclusions: Colonoscopy offers the best value for money of CRC screenings in Thailand. Annual FIT is potentially feasible since it requires less resources. Our findings can be used as part of evidence for informing policy decision making.Key points for decision makers There was a lack of cost-effective study of colorectal cancer screening programs in low- and middle-income countries. This study evaluated lifetime health outcomes and costs, and the cost-effectiveness of colorectal screening options for average-risk persons in Thailand. Colonoscopy screening every 10 years is cost-effective with high probability of being cost-effective as compared with annual fecal immunochemical test. Screening by annual fecal immunochemical test is more feasible in terms of human resource and budgetary burden. Colorectal screening programs provides an opportunity for early diagnosis and treatments to prevent advance colorectal stages and avoid higher consequent costs. This study contributes a new evidence-based knowledge for Thailand and can be used to support policy decision making process.
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    Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand
    (2021-01-01) Pochamana Phisalprapa; Surachat Ngorsuraches; Tanatape Wanishayakorn; Chayanis Kositamongkol; Siripen Supakankunti; Nathorn Chaiyakunapruk; Siriraj Hospital; Chulalongkorn University; University of Utah Health; Prince of Songkla University; Harrison School of Pharmacy
    Aims: Colorectal cancer (CRC) is one of the public health burdens that can be lowered by early detection. This study aims to examine the preferences and willingness-to-pay of a population at risk for CRC screening in Thailand. Understanding the preferences for these individuals at risk would help Thailand, as an example of LMICs, to design effective population-based CRC screening programs. Materials and methods: A discrete choice experiment (DCE) was conducted among screening-naïve adults aged 50–75 years, who were at risk of CRC, in the out-patient department of a tertiary care hospital in Thailand. A DCE questionnaire was developed from six CRC screening attributes. Each questionnaire was composed of six choice sets and each contained two alternatives described by the different levels of attributes and an opt-out alternative. Participants were asked to choose one alternative from each choice set. A multinomial logit model was developed to determine the relative preference of each attribute. The willingness-to-pays for all attributes and screening modalities and the estimated preferred choices of the annual fecal immunochemical test (FIT), 10-yearly colonoscopy, 5-yearly double-contrast barium enema (DCBE), 5-yearly computed tomographic colonography (CTC), 5-yearly flexible sigmoidoscopy (FS), and no screening was calculated and compared. Results: Four hundred participants were included. All attributes, except pain and less bowel preparation, were statistically associated with the participants’ preference (p <.05). They preferred screenings with a high-risk reduction of CRC-related mortality, no complication, 5-year interval, and lower cost. The estimated preferred choices of FIT, colonoscopy, DCBE, CTC, and FS were 38.2%, 11.4%, 14.6%, 9.2%, and 11.4%, respectively. The willingness-to-pays for each screening modality was US$251, US$189, US$183, US$154, and US$142 (8,107, 6,105, 5,911, 4,974, and 4,587 THB) per episode, respectively. Conclusions: The risk reduction of CRC-related mortality, complication, screening interval, and cost influenced the CRC screening preferences of Thai adults. FIT was the most preferred. Policymakers can develop a successful CRC screening campaign using these findings, incorporating the perspective of the population at risk in policy formulation to accomplish their goals.