Browsing by Author "Sripen Tantivess"

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    Advanced health biotechnologies in Thailand: Redefining policy directions
    (2013-01-02) Román Pérez Velasco; Usa Chaikledkaew; Chaw Yin Myint; Roongnapa Khampang; Sripen Tantivess; Yot Teerawattananon; Thailand Ministry of Public Health; Mahidol University
    Background: Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these-such as diabetes, cancer, and inherited inborn metabolic diseases-have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems.Methods: Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations.Results: Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D), and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E). The establishment of a specialised institution to fill the gaps in this area is warranted.Conclusion: The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended. © 2013 Perez Velasco et al.; licensee BioMed Central Ltd.
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    Economic evaluation of 3-drug antiretroviral regimens for the prevention of mother-to-child HIV transmission in Thailand
    (2015-01-01) Pitsaphun Werayingyong; Nittaya Phanuphak; Kulkunya Chokephaibulkit; Sripen Tantivess; Nareeluk Kullert; Kakanang Tosanguan; Rukmanee Butchon; Nipunporn Voramongkol; Sarawut Boonsuk; Songyot Pilasant; Wantanee Kulpeng; Y. Teerawattananon; Thailand Ministry of Public Health; Thai Red Cross AIDS Research Centre; Mahidol University; Benjalak Hospital
    © 2013 APJPH. The current program for prevention of mother-to-child HIV transmission in Thailand recommends a 2-drugs regimen for HIV-infected pregnant women with a CD4 count >200 cells/mm3. This study assesses the value for money of 3 antiretroviral drugs compared with zidovudine (AZT)+single-dose nevirapine (sd-NVP). A decision tree was constructed to predict costs and outcomes using the governmental perspective for assessing cost-effectiveness of 3-drug regimens: (1) AZT, lamivudine, and efavirenz and (2) AZT, 3TC, and lopinavir/ritonavir, in comparison with the current protocol, AZT+sd-NVP. The 3-drug antiretroviral regimens yield lower costs and better health outcomes compared with AZT+sd-NVP. Although these 3-drug regimens offer higher program costs and health care costs for premature birth, they save money significantly in regard to pediatric HIV treatment and treatment costs for drug resistance in mothers. The 3-drug regimens are cost-saving interventions. The findings from this study were used to support a policy change in the national recommendation.
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    Economic evaluation of policy options for prevention and control of cervical cancer in Thailand
    (2011-08-22) Naiyana Praditsitthikorn; Yot Teerawattananon; Sripen Tantivess; Supon Limwattananon; Arthorn Riewpaiboon; Saibua Chichareon; Nantakan Ieumwananonthachai; Viroj Tangcharoensathien; Thailand Ministry of Public Health; Mahidol University; Prince of Songkla University
    Background: The Thai healthcare setting has seen patients with cervical cancer experience an increasing burden of morbidity and mortality, a stagnation in the performance of cervical screening programmes and the introduction of a vaccine for the prevention of human papillomavirus (HPV) infection. Objective: This study aims to identify the optimum mix of interventions that are cost effective, from societal and healthcare provider perspectives, for the prevention and control of cervical cancer. Methods: A computer-based Markov model of the natural history of cervical cancer was used to simulate an age-stratified cohort of women in Thailand. The strategy comparators, including both control and prevention programmes, were (i) conventional cytology screening (Pap smears); (ii) screening by visual inspection with acetic acid (VIA); and (iii) HPV-16, -18 vaccination. Input parameters (e.g. age-specific incidence of HPV infection, progression and regression of the infection, test performance of screening methods and efficacy of vaccine) were synthesized from a systematic review and metaanalysis. Costs (year 2007 values) and outcomes were evaluated separately, and compared for each combination. The screening strategies were started from the age of 30-40 years and repeated at 5- and 10-year intervals. In addition, HPV vaccines were introduced at age 15-60 years. Results: All of the screening strategies showed certain benefits due to a decreased number of women developing cervical cancer versus 'no intervention'. Moreover, the most cost-effective strategy from the societal perspective was the combination of VIA and sequential Pap smear (i.e. VIA every 5 years for women aged 30-45 years, followed by Pap smear every 5 years for women aged 50-60 years). This strategy was dominant, with a QALY gain of 0.01 and a total cost saving of Baht (Bt)800, compared with doing nothing. From the societal perspective, universal HPV vaccination for girls aged 15 years without screening resulted in a QALY gain of 0.06 at an additional cost of Bt8800, based on the cost of Bt15 000 for a full immunization schedule. The incremental cost-effectiveness ratio, comparing HPV vaccinations for girls aged 15 years with the current national policy of Pap smears for women aged 35-60 years every 5 years, was approximately Bt181 000 per QALY gained. This figure was relatively high for the Thai setting. Conclusions: The results suggest that controlling cervical cancer by increasing the numbers of women accepting the VIA and Pap smear screening as routine and by improving the performance of the existing screening programmes is the most cost-effective policy option in Thailand. © 2011 Adis Data Information BV. All rights reserved.
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    The potential demand for an AIDS vaccine in Thailand
    (2001-06-15) Viroj Tangcharoensathien; Wiput Phoolcharoen; Siriwan Pitayarangsarit; Sukhontha Kongsin; Vijj Kasemsup; Sripen Tantivess; Chutima Suraratdecha; Thailand Health Systems Research Institute; Mahidol University; Sukhothai Thammatirat Open University
    The recent ongoing phase III clinical trial of a preventive vaccine in Thailand has prompted studies on potential demand for the vaccine among public, employers and households. This study aims to demonstrate the impact of HIV/AIDS, estimate the AIDS vaccine budget required and design the vaccination strategies for different population groups. The analysis is based on available secondary data and several assumptions on levels of secondary infections among various risk groups. Among 15 groups, we identified eight groups as potential vaccinees: Direct CSW, IDU in treatment, IDU out of treatment, male STD, transport workers, CSW indirect, conscripts and prisoners. The vaccine budget, excluding other operating expenditure, was estimated based on a single dose regimen ranging from 100 Baht (US$3) to 1000 Baht (US$29) per dose. A total of US$1.8-17.7 million is required for non-infected catch-up population and US$0.2-1.9 million for the maintenance population in the subsequent year. We foresee a relative inefficient and inequitable consumption of AIDS vaccine, which requires proper policy analysis and government interventions. Before vaccine adoption, strong preventive measures must be in place. AIDS vaccine could play an additional, not a substituting, role. A thorough understanding, a wide consultation with stakeholders and public debates are crucial steps for sound policy formulation. Copyright © 2001 Elsevier Science Ireland Ltd.
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    Setting priorities for introducing new vaccines into the national immunization program
    (Mahidol University. Mahidol University Library and Knowledge Center, 2014) Siriporn Pooripussarakul; Arthorn Riewpaiboon; Charung Muangchana; Sripen Tantivess
    This study aimed to develop a tool for policy decision making on prioritization of new vaccines into the national immunization program and assess potential vaccines employing the tool developed. A qualitative study was used to identify attributes and levels for quantitative study. Best-worst scaling method (BWS) is a quantitative method to elicit the preference among different stakeholders for prioritizing new vaccines in Thailand. The survey was conducted between October 2013 and January 2014. A total of seventy questionnaires were completed with a 54% response rate. Data were analyzed from three groups of respondents, policy makers, health professionals, and health administrators. Severity, safety, and burden of disease showed the highest preferences among respondents. Policy makers had high preferences for safety and effectiveness. Health professionals had high preferences for burden of disease and safety. Health administrators had high preferences for budget impact, effectiveness, and cost of vaccine. The result was then used for rank-ordering of both the existing as well as new vaccines to determine potential vaccines that should be prioritized into the national immunization program. From the selected vaccines, Diptheria-Tetanus-Pertussis-Hepatitis B vaccine was ranked first, followed by Pneumococcal Conjugate Vaccine-13 and Haemophilus influenza type B vaccine. This reflected that the new vaccine that could protect people from more severe disease and gain individual health benefits would be ranked as a high priority. This study showed quantitative indicators that could be accounting for priority setting of vaccines including the burden of disease, age group, budget impact, safety, severity, effectiveness, and cost of vaccine. The ranking of vaccines could contribute to transparency and accountability in the decision-making process on new vaccine adoption in Thailand.
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    What criteria do decision makers in Thailand use to set priorities for vaccine introduction?
    (2016-08-02) Siriporn Pooripussarakul; Arthorn Riewpaiboon; David Bishai; Charung Muangchana; Sripen Tantivess; Mahidol University; Johns Hopkins Bloomberg School of Public Health; Thailand Ministry of Public Health
    © 2016 The Author(s). Background: There is a need to identify rational criteria and set priorities for vaccines. In Thailand, many licensed vaccines are being considering for introduction into the Expanded Program on Immunization; thus, the government has to make decisions about which vaccines should be adopted. This study aimed to set priorities for new vaccines and to facilitate decision analysis. Methods: We used a best-worst scaling study for rank-ordering of vaccines. The candidate vaccines were determined by a set of criteria, including burden of disease, target age group, budget impact, side effect, effectiveness, severity of disease, and cost of vaccine. The criteria were identified from a literature review and by in-depth, open-ended interviews with experts. The priority-setting model was conducted among three groups of stakeholders, including policy makers, healthcare professionals and healthcare administrators. The vaccine data were mapped and then calculated for the probability of selection. Results: From the candidate vaccines, the probability of hepatitis B vaccine being selected by all respondents (96.67 %) was ranked first. This was followed, respectively, by pneumococcal conjugate vaccine-13 (95.09 %) and Haemophilus influenzae type b vaccine (90.87 %). The three groups of stakeholders (policy makers, healthcare professionals and healthcare administrators) showed the same ranking trends. Most severe disease, high fever rate and high disease burden showed the highest coefficients for criterion levels being selected by all respondents. This result can be implied that a vaccine which can prevent most severe disease with high disease burden and has low safety has a greater chance of being selected by respondents in this study. Conclusions: The priority setting of vaccines through a multiple-criteria approach could contribute to transparency and accountability in the decision-making process. This is a step forward in the development of an evidence-based approach that meets the need of developing country. The methodology is generalizable but its application to another country would require the criteria as relevant to that country.
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    What criteria do decision makers in Thailand use to set priorities for vaccine introduction?
    (2016) Siriporn Pooripussarakul; Arthorn Riewpaiboon; Bishai, David; Charung Muangchana; Sripen Tantivess; Mahidol University. Faculty of Pharmacy. Department of Pharmacy
    Background: There is a need to identify rational criteria and set priorities for vaccines. In Thailand, many licensed vaccines are being considering for introduction into the Expanded Program on Immunization; thus, the government has to make decisions about which vaccines should be adopted. This study aimed to set priorities for new vaccines and to facilitate decision analysis. Methods: We used a best-worst scaling study for rank-ordering of vaccines. The candidate vaccines were determined by a set of criteria, including burden of disease, target age group, budget impact, side effect, effectiveness, severity of disease, and cost of vaccine. The criteria were identified from a literature review and by in-depth, open-ended interviews with experts. The priority-setting model was conducted among three groups of stakeholders, including policy makers, healthcare professionals and healthcare administrators. The vaccine data were mapped and then calculated for the probability of selection. Results: From the candidate vaccines, the probability of hepatitis B vaccine being selected by all respondents (96.67 %) was ranked first. This was followed, respectively, by pneumococcal conjugate vaccine-13 (95.09 %) and Haemophilus influenzae type b vaccine (90.87 %). The three groups of stakeholders (policy makers, healthcare professionals and healthcare administrators) showed the same ranking trends. Most severe disease, high fever rate and high disease burden showed the highest coefficients for criterion levels being selected by all respondents. This result can be implied that a vaccine which can prevent most severe disease with high disease burden and has low safety has a greater chance of being selected by respondents in this study. Conclusions: The priority setting of vaccines through a multiple-criteria approach could contribute to transparency and accountability in the decision-making process. This is a step forward in the development of an evidence-based approach that meets the need of developing country. The methodology is generalizable but its application to another country would require the criteria as relevant to that country.