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Several risk prediction algorithms have been developed to guide antiviral therapy initiation among patients with chronic hepatitis B (CHB). This study assessed the cost-effectiveness and budget impact of three risk prediction algorithms among patients with CHB in Thailand. A decision tree with a Markov model was constructed. Three risk prediction algorithms were compared with current practices including HePAA, TREAT-B and REACH-B. PubMed was searched from its inception to December 2022 to identify inputs. Tenofovir alafenamide and best supportive care were selected for antiviral-eligible patients, and incremental cost-effectiveness ratios per quality-adjusted life year (QALY) were calculated. Our base case analysis showed that HePAA and REACH-B could provide better QALY (0.098 for HePAA and 0.921 for REACH-B) with decreased total healthcare costs (−10909 THB for HePAA and −8,637 THB for REACH-B). TREAT-B provided worse QALY (−0.144) with increased total healthcare costs (10,435 THB). The budget impacts for HePAA and REACH-B were 387 million THB and 3,653 million THB, respectively. HePAA and REACH-B algorithms are cost-effective in guiding antiviral therapy initiation. REACH-B is the most cost-effective option, but has a high budget impact. Policymakers should consider both cost-effectiveness and budget impact findings when deciding which algorithm should be implemented.

Unchalee Permsuwan,1 Arintaya Phrommintikul,2 Voratima Silavanich1 1Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 2Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Voratima SilavanichDepartment of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Suthep Road, Muang District, Chiang Mai 50200, ThailandTel +66 89-430-6510Fax +66 5-322-2741Email voratima.silavanich@gmail.comBackground: Cardiac resynchronization therapy (CRT) improves symptoms and survival in patients with heart failure (HF). However, the CRT devices are costly and can impose a significant burden to the relatively constrained health budgets of middle-income countries such as Thailand. The aim of this study was to analyze the cost-effectiveness of CRT in combination with optimal medical therapy (OMT) relative to patients with OMT alone.Methods: A two-component model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from a healthcare perspective. Clinical inputs were mostly obtained from meta-analysis of landmark trials. All cost-related data, risk of non-cardiovascular death and readmission rate were based on Thai HF data. Costs and QALYs were discounted at 3%. Findings were reported as an incremental cost-effectiveness ratio (ICER). A variety of sensitivity analyses were also performed.Results: CRT plus OMT costs more than OMT (123,279 vs 11,165 THB or 3,972.90 vs 359.81 USD), and is more effective (3.57 QALYs vs 2.49 QALYs), yielding an ICER of 104,325 THB per QALY (3,362.07 USD per QALY). CRT was cost-effective at the Thai willingness to pay threshold of 160,000 THB per QALY (5,156.30 USD per QALY). The results were sensitive to cost of CRT maintenance.Conclusion: The use of CRT was associated with a cost-effectiveness ratio below generally accepted benchmarks for therapeutic interventions of 160,000 THB per QALY (5,156.30 USD per QALY). This suggests that the clinical benefits of CRT can be achieved at a reasonable cost in Thai HF patients.Keywords: cost-effectiveness, quality-adjusted life-years, cardiac resynchronization therapy, heart failure, Thailand

Suwaporn Songsermlosakul, Unchalee Permsuwan, Wanchana Singhan Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, ThailandCorrespondence: Wanchana Singhan Email swnaice@gmail.comAim: To estimate direct medical treatment costs in patients with pre-dialysis chronic kidney disease (CKD) in a district hospital and to analyze the factors that affected the treatment costs.PatientsandMethods: Data were retrospectively retrieved from the hospital database in the period from January 2015 to December 2017. Patients who were diagnosed with CKD and had visited ambulatory care services at least two times during the index year (January to December 2015) were included. Patients’ data were excluded if they had cancer, had received renal replacement therapy, or had been referred to receive treatment at other hospitals. Treatment costs based on the providers’ perspectives in the first and second years after the index year were assessed. Descriptive statistics were used to analyze patients’ characteristics, and multiple linear regression was used to analyze the factors in the cost model.Results: Data of 212 patients with CKD stage G3a, G3b, or G4 who met inclusion and exclusion criteria were included for analysis. Average costs for treatment in year 1 and year 2 were not statistically different. Total cost was 5701.34 Thai Baht (THB) per year. The total cost for patients with CKD stage G4 was two times greater than for patients with CKD stage G3. Costs were increased for longer hospitalization, more frequent ambulatory visits, having diabetes mellitus or dyslipidemia as a comorbidity, and uncontrolled fasting blood glucose (FBG). A cost model with R2=0.906 was provided. Significant predictors were length of stay, ambulatory visits, diabetes mellitus, dyslipidemia, serum creatinine, FBG, and body mass index.Conclusion: Total annual treatment costs for the 2 years were not different. A more advanced stage of CKD, having diabetes mellitus or dyslipidemia as comorbidities, and uncontrolled FBG were significantly associated with increased costs for treatment in patients with pre-dialysis CKD.Keywords: cost, chronic kidney disease, district hospital, multidisciplinary

Rungroj Krittayaphong,1 Jirawit Yadee,2 Unchalee Permsuwan2 1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Unchalee PermsuwanDepartment of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Suthep Road, Muang District, Chiang Mai 50200, ThailandTel +66 89-635-9268; +66 5-394-4351Fax +66 5-322-2741Email unchalee.permsuwan@gmail.comBackground: The benefit of ivabradine as an adjunctive therapy to conventional treatment in patients with heart failure (HF) with reduced ejection fraction (HFrEF) is a reduction in both cardiovascular death and HF hospitalization. This study aimed to analyze the cost-effectiveness of ivabradine plus standard treatment compared with standard treatment alone.Methods and results: An analytical decision model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from a healthcare perspective. The study cohort comprised HFrEF patients with left ventricular ejection fraction (LVEF)