The cost-utility analysis of some Thai public health programmes
Somchai Suksiriserekul
Because there are no explicit principles for prioritizing resources for health care, the result is often irrational and obscure decision-making. This leads to inefficient uses of health resources. Cost-utility analysis has been developed to better assess efficiency and health economists and decision makers in many countries are increasingly interested in the technique. This study uses the technique on a small scale and assesses how it could contribute to Thai health sector.A survey was conducted in Thailand which consisted of interviews and postal questionnaires, to collect quality of life validation data. The EuroQol instrument was uses together with the visual analogue scale and time trade-off scaling techniques. The survey acquired 354 interviews and 162 postal responses. The effect of some variables, in particular the respondents’ personal background, on the quality of life valuation data are analysed in the cardinal, ordinal and standardized data forms.Health experience, income and education were found to affect the valuation of most health states. However, only health experience was found to affect the standardized data, which were eventually employed in this cost-utility analysis.Four Thai health care programmes were selected for assessment; measles vaccination, rotavirus vaccination, BCG vaccinaton and anti-TB chemotherapy treatment programmes. In each programme, the key parameters in the computation included health benefits, side effects, clinical features of the diseases involved, and health programme costs. A transformation process turns the clinical features and side effects into the correspondent EuroQol health states. As a result, the health benefits and side effects can be converted into the quality-adjusted-life-year (QALY) unit.The base-case analysis indicates that the anti-TB ambulatory short-course chemotherapy would cost 172.94 baht (US$ 6.85) per QALY, the measles vaccination, 435.53 baht (US$ 17.43), the BCG vaccination, 837.23 baht (US$ 33.23) ; the anti-TB hospitalized short –course treatment, 1,456.17 baht (US$ 57.69) and the rotavirus diarrhea vaccination, 2182.68 baht (US$ 86.63). These results are compared with those of other international cost-effectiveness studies as well as to assess a Thai health policy. The sensitivity analysis suggests that the changes in some crucial parameters could alter the ranking.Also, the study preliminarily investigates some valuation models and tests the results both extensively with the Thai data. Finally, it proposes some criteria to assess the model.
Ph.D. University of York ปี 2537