Browsing by Author "Yadee J."

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    An Updated Economic Evaluation of HLA-B*58:01 Genotype Testing in Gouty Patients for Preventing Severe Allopurinol Hypersensitivity in Thailand
    (2025-08-01) Dilokthornsakul P.; Louthrenoo W.; Yadee J.; Siripaitoon B.; Jatuworapruk K.; Vannaprasaht S.; Rerkpattanapipat T.; Chungcharoenpanich A.; Iamsumang W.; Upakdee N.; Dechanont S.; Lawanaskol S.; Butthum B.; Chevaisrakul P.; Towiwat P.; Dilokthornsakul P.; Mahidol University
    Objective: Human Leukocyte Antigen (HLA), specifically HLA-B*58:01, testing before allopurinol initiation in patients with gout in Thailand was previously shown to be cost-effective. However, several drugs are available in the treatment of gout in Thailand, so the updated cost-effectiveness analysis is warranted. This study aimed to update the cost-effectiveness of HLA-B*58:01 testing before allopurinol initiation in patients with gout in Thailand. Methods: A hybrid model consisting of a decision tree and a Markov model with a lifetime horizon from a societal perspective was undertaken. The HLA-B*58:01 testing was compared to the standard of care as no testing. Total health care costs and quality-adjusted life years (QALYs) were assessed. A comprehensive literature review along with retrospective data analysis and prospective data collection were conducted to determine inputs to inform the model. The incremental cost-effectiveness ratio analysis was calculated. Results: HLA-B*58:01 testing could avoid 1.554 Stevens-Johnson syndrome and toxic epidermal necrosis cases, resulting in a saving of 0.140 patients’ lives per 1,000 patients. It could gain 0.002 life-years and 0.004 QALYs compared to no testing. However, it required a higher lifetime cost of 4,690 Thai baht (THB), resulting in an incremental cost-effectiveness ratio of 1,093,068 THB/QALY (31,404 US dollars per QALY). Conclusion: HLA-B*58:01 testing was not cost-effective before allopurinol initiation in Thai patients with gout at the current price of 1,000 THB per test. However, HLA-B*58:01 testing would be cost-effective if only probenecid was the alternative treatment for patients with positive HLA-B*58:01 results. This result would be useful for health authorities, policy decision-makers, and physicians’ organizations in providing the recommendation for HLA-B*58:01 testing before initiation of allopurinol.
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    Cost-utility analysis of sutureless and rapid deployment versus conventional aortic valve replacement in patients with moderate to severe aortic stenosis in Thailand
    (2024-01-01) Permsuwan U.; Singhatanadgige S.; Boonpipattanapong K.; Slisatkorn W.; Chartrungsan A.; Nitayavardhana P.; Luangthong N.; Porapakkham P.; Yadee J.; Permsuwan U.; Mahidol University
    BACKGROUND: Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alternative to conventional aortic valve replacement (CAVR) for aortic stenosis (AS) treatment due to its advantages in reducing surgery time and improving outcomes. This study aimed to assess the cost-utility of SUAVR vs. CAVR treatment for patients with moderate to severe AS in Thailand. METHODS: A two-part constructed model was used to estimate the lifetime costs and quality-adjusted life years (QALYs) from both societal and healthcare perspectives. Data on short-term mortality, complications, cost, and utility data were obtained from the Thai population. Long-term clinical data were derived from clinical studies. Costs and QALYs were discounted annually at 3% and presented as 2022 values. The incremental cost-effectiveness ratio (ICER) was calculated to determine additional cost per QALY gained. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: SUAVR treatment incurred higher costs compared with CAVR treatment from both societal (THB 1,733,355 [USD 147,897] vs THB 1,220,643 [USD 104,150]) and healthcare provider perspectives (THB 1,594,174 [USD 136,022] vs THB 1,065,460 [USD 90,910]). In addition, SUAVR treatment resulted in lower health outcomes, with 6.20 life-years (LYs) and 4.95 QALYs, while CAVR treatment achieved 6.29 LYs and 5.08 QALYs. SUAVR treatment was considered as a dominated treatment strategy using both perspectives. Sensitivity analyses indicated the significant impact of changes in utilities and long-term mortality on the model. CONCLUSION: SUAVR treatment is not a cost-effective treatment strategy compared with CAVR treatment for patients with moderate-severe AS in Thailand, as it leads to higher costs and inferior health outcomes. Other important issues related to specific patients such as those with minimally invasive surgery, those undergoing AVR with concomitant procedures, and those with calcified and small aortic root should be taken into account.
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    Cost–Utility Analysis of Transcatheter Aortic Valve Implantation versus Surgery in High-Risk Severe Aortic Stenosis Patients in Thailand
    (2022-01-01) Permsuwan U.; Yoodee V.; Buddhari W.; Wongpraparut N.; Thonghong T.; Cheewatanakornkul S.; Meemook K.; Sakiyalak P.; Duangpakdee P.; Yadee J.; Mahidol University
    Background: Transcatheter aortic valve implantation (TAVI) has been shown to be effective in treating patients with severe symptomatic AS who are high-risk population for conventional surgical aortic valve replacement (SAVR). This study aimed to evaluate the cost–utility of TAVI compared with SAVR for severe aortic stenosis with high surgical risk in Thailand. Methods: Lifetime costs and quality-adjusted life years (QALYs) from societal and healthcare perspectives were estimated using a two-part constructed model. The study population consisted of 80-year-old severe AS patients with high surgical risk. Mortality and complication rates were obtained from landmark trials. All cost–related and utility data were based on Thai population. Costs and QALYs were discounted at a rate of 3% annually and presented as 2021 values. Incremental cost-effectiveness ratios (ICERs) were computed. Sensitivity analyses were performed both deterministically and probabilistically. Results: The findings from a societal perspective revealed that TAVI treatment was associated with higher cost (THB 1,551,895 [USD 47,371.64] vs THB 548,438 [USD 16,741.09] and higher QALYs than SAVR treatment (3.15 vs 2.31 QALYs). The estimated ICER was THB 1,196,191/QALY (USD 36,513.78 QALY). For the healthcare system perspective, TAVI treatment resulted in a higher total cost than SAVR treatment (THB 1,451,317 [USD 44,301.49] vs THB 432,398 [USD 13,198.95]) with comparable gains in LY and QALYs from a societal perspective. The ICER was calculated to be THB 1,214,624/QALY (USD 37,076.42/QALY). TAVI was not cost-effective at the Thai willingness to pay (WTP) threshold of THB 160,000/QALY (USD 4884/QALY). The model was the most sensitive to changes in TAVI valve cost and TAVI or SAVR treatment utilities. Conclusion: TAVI is not a cost-effective strategy in patients with severe AS who are at high surgical risk when compared to SAVR at the WTP of THB 160,000/QALY (USD 4884/QALY) from the perspectives of society and the healthcare system.
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    Trends in Economic Burden and Mortality of Hospitalized Patients With Aortic Stenosis in Thailand
    (2023-10-15) Yadee J.; Slisatkorn W.; Singhatanadgige S.; Porapakkham P.; Permsuwan U.; Mahidol University
    This study aimed to assess the temporal trends in aortic stenosis (AS)–related hospitalizations, in-hospital mortality, and economic burden in Thailand. The study cohort was derived from the electronic claim system of the National Health Security Office, which serves as a reimbursement database for all Thai beneficiaries under the Universal Health Coverage Scheme, covering ∼70% of the entire population. Hospitalization, mortality, and costs were estimated by year, with the primary diagnosis for AS-related hospitalizations identified using code I350. The Cochrane Armitage test was used to examine trends in AS-related hospitalization and in-hospital mortality, whereas a nonparametric trend test was used to analyze the trend of hospitalization costs. Of the 8-year period, 10,406 adults were admitted with a primary diagnosis of AS. AS-related hospitalizations increased from 1,274 in 2015 to 1,945 in 2022 (p = 0.251), with the most significant observed in the age group 60 to 79 years (p <0.001). In-hospital mortality increased from 4.8% to 6.1%. Hospitalization cost significantly increased from $2,879 to $3,443 (p <0.001), with an average length of stay of 6.6 ± 9.2 days. The trend of patients admitted with primary diagnosis of AS in Thailand has significantly increased in the age group 60 to 79 years. In-hospital admission is found at older age and is likely to have high mortality rate. The increased hospitalization cost may impose a substantial economic burden on the Thai health care system.