Search

Despite remarkable efforts from the Ministry of Public Health (MOPH) to promote access to health services among migrants, there remains an important gap about equity in utilizing health services among migrants residing in different economic status areas. This study aims to explore the equity in health service utilizations of migrants registered with Health Insurance Card Scheme. A cross-sectional quantitative design using provincial-level data was employed. Claim data of antiretroviral therapy (ART) and high-cost outpatient services, namely, vaccination and chemotherapy, in 2015 and 2016, and Gross Provincial Product per capita were analyzed by descriptive statistics, Spearman’s rank correlation and concentration index (CI). Significant negative Cis were found in the claims for ART in both years, which indicates that migrants residing in poor provinces access to ART more than migrants in rich provinces. However, the distribution of claims for children’s vaccinations across provincial income was relatively equal showing that access to vaccination is quite equal across different geographical location as vaccinations were provided regardless of children's nationality. While the claims for chemotherapy had positive significant CIs in both years indicating better access to chemotherapy was observed in richer provinces because resources needed are relatively pooled in urbanized cities. This study suggests that access to health care services are not equal among migrants residing in rich and poor provinces. The most concern was on access to chemotherapy which is heavily concentrated among the economically well-off provinces. Thus, it is worth exploring whether and to what extent there are hindrances against access to care for such services, especially in the economically deprived areas. The non-reported claims for children’s vaccinations in half of the provinces should also be explored. If there was a case of low coverage, a strategy to support and promote vaccinations to migrants is recommended.

Background This study aims to assess the cost-effectiveness and budget impact of adopting sildenafil to the benefits package for the indication of pulmonary arterial hypertension (PAH), compared to beraprost. Methods Based on a societal perspective, a model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years (LYs) and quality-adjusted life years (QALYs). Results The economic model calculated the incremental cost-effectiveness ratio (ICER) per QALY gained for using sildenafil as first-line therapy compared to beraprost for the patient in functional class (FC) II and III, i.e. USD 3098 and USD 2827, respectively. The results indicated that in spite of sildenafil being more expensive than beraprost, generic sildenafil could potentially be a good value for money since ICER per QALY is below one times gross domestic product (GDP) per capita in Indonesia. Furthermore, budget impact analysis estimated that the incremental budget needed within 5 years for including sildenafil compared to beraprost for PAH patients starting in FC II and FC III was USD 436,775 and USD 3.6 million, respectively. Conclusions Compared to beraprost, sildenafil would be preferable for the treatment of PAH patients in FC II and FC III in Indonesia. The additional budget for adopting sildenafil compared to beraprost as the treatment of PAH in the benefits package was estimated at around USD 4.0 million. Electronic supplementary material The online version of this article (10.1186/s12913-019-4422-5) contains supplementary material, which is available to authorized users.

Data collection form for direct medical cost, Data collection form for collecting direct medical cost from hospital billing data. (DOC 119 kb)

© 2019 The Author(s). Background: Many patients develop tumour recurrence within a few years after undergoing surgical resection of gastrointestinal stromal tumours (GIST). Adjuvant imatinib treatment is recommended for patients with high risk of GIST recurrence as it can improve recurrence-free survival and overall survival of patients. This study aims to assess the cost-utility of adjuvant imatinib in patients with high risk of GIST recurrence after surgery compared with no adjuvant therapy in Thailand. Methods: A Markov model was developed to estimate lifetime costs and outcomes of using adjuvant imatinib treatment and other treatment alternatives if recurrence occurred compared with the current situation of no adjuvant therapy in high-risk patients after surgery. A 1-month cycle length was deployed in the model. Transition probabilities were derived from literature review. Costs were collected and calculated for the year 2014 from a societal perspective. Future costs and outcomes were discounted at 3% per year. One-way and probabilistic sensitivity analyses were conducted to assess parameter uncertainties. Results: Three years of adjuvant imatinib treatment followed by imatinib treatment and best supportive care if recurrence occurred after or during adjuvant therapy, respectively, was the best option as it produced more health outcomes (1.23 life years (LYs) and 1.16 quality-adjusted life years (QALYs)) compared to no adjuvant therapy while yielding the lowest incremental cost-effectiveness ratio (ICER) of 1,648,801 Thai Baht (THB) per QALY gained. Three years of adjuvant imatinib treatment followed by sunitinib treatment if recurrence occurred had an ICER of 2,608,264 THB per QALY gained compared to the best option, while other options were dominated. A one-way sensitivity analysis showed that the utility of patients receiving adjuvant imatinib had the greatest effect on the model, followed by the discount rate and probability of GIST recurrence. Conclusions: Adjuvant imatinib treatment improved the health benefits of patients with high risk of GIST recurrence. However, in the Thai context, it was not cost-effective at the current price.

This study aims to compare the lifetime costs and health outcomes of both first-line and sequential combination treatments with standard treatment for pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) (PAH-CHD) patients.A cost-utility analysis was performed using a Markov model based on a societal perspective. One-way and probabilistic sensitivity analyses were performed to investigate the effect of parameter uncertainty.As first-line treatments, both beraprost (incremental cost-effectiveness ratio (ICER) = 192,752 and 201,308 Thai baht (THB) per quality-adjusted life year (QALY) gained) and sildenafil (ICER = 249,770 and 226,802 THB per QALY gained) seemed cost-effective for PAH-CHD patients aged ≤30 years in functional classes II and III, respectively, while no treatment was cost-effective for the sequential combination therapy.Sildenafil should be included in the National Drug List of Essential Medicines as the first-line treatment for PAH-CHD, and its price per dose should be negotiated to be reduced by 43-57%.