Piyalamporn Havanond

Prevalence of osteopenia and osteoporosis in Thai women.

ObjectiveTo determine the age-specific and age-adjusted prevalence of osteopenia and osteoporosis in pre-and postmenopausal Thai women. MethodsThis was a descriptive study of 1,935 Thai women ranging in age from 40 to 80 years, with randomly selected strata using multistage sampling and stratifying from six representative provinces of the country. After recruiting, all the women were interviewed by a well-trained interviewer using structured questionnaires. Bone mineral density (BMD) of lumbar spine 1-4 and nondominant hip was measured by a dual energy photon absorptiometer. The investigators were trained and standardized; inter-and intraobserver variations were measured periodically. Every BMD outcome was re-examined by the specialist. Age-specific prevalence of osteoporosis and osteopenia were determined using both Thai and Western standard BMD values. Age-adjusted prevalence of osteopenia and osteoporosis was calculated using the age-adjusted direct method. ResultsUsing the Thai BMD reference, the age-specific prevalence of osteoporosis among Thai women rose progressively with increasing age to more than 50% after the age of 70. The age-adjusted prevalence of osteoporosis also rose progressively. It was 19.8%, 13.6%, and 10% for lumbar spine, femoral neck, and intertrochanteric. The age-adjusted prevalence of osteoporosis indicates the overall magnitude of that condition in the population or country. In our study, using a Western BMD reference resulted in a misleadingly high prevalence of osteoporosis in the population of Asian countries. ConclusionIt is important to calculate the age-adjusted prevalence of osteopenia and osteoporosis to address the overall magnitude of the problem in Thai women. This will allow us to predict the socioeconomic impact of preventable chronic conditions such as osteoporosis. The results obtained from this study are important data for public health policy: maximizing bone mass throughout life as well as detection of important risk factors is essential.

Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries.

BACKGROUND Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year. OBJECTIVES We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18. METHODS We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually. RESULTS Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%. CONCLUSION Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand.

PCN10 ESTIMATION OF THE HEALTH AND COST BURDEN OF HPV-RELATED DISEASES IN THAILAND

PCN5 SOFRAFENIB VERSUS SUNITINIB IN METASTATIC RENAL CELL CARCINOMA: INDIRECT COMPARISON ANALYSIS Leung HW, Chan AL Taipei Medical UniversityShuang Ho Hospital, Taipei, Taiwan; Chi Mei Medical Center, Tainan, Taiwan OBJECTIVES: To evaluate the clinical effectiveness of sorafenib and sunitinib in metastatic renal cell carcinoma (RCC) by using indirect comparison meta-analysis. METHODS: Systematic literature search of Medline, Embase, Cochrane controlled trials register. All randomized clinical trials of sorafenib or sunitinib versus interferon alfa for treating metastatic renal-cell carcinoma were included. Study selection, data extraction and quality assessment were performed by two reviewers with disagreements being resolved by consensus. The effects of sorafenib and sunitinib on progression-free survival were compared indirectly using indirect treatment comparison program, with interferon alfa (IFN) as a common comparator. RESULTS: Two studies were included. Median progression-free survival was prolonged with the treatment of sunitinib (11 months) compared to interferon alfa (5 months). For the comparison of sorafenib and interferon-alfa, the median progression-free survival was similar (median PFS: 5.7 months vs. 5.6 months). Indirect comparison suggests that sunitinib is not superior to sorafenib for prolongation of progress free survival (hazard ratio 0.37; 95% CI: 0.236–0.58, P = 0.0189). CONCLUSIONS: There is no signifi cant evidence to suggest that treatment with sunitinib has clinical advantages over treatment with sorafenib in patients with metastatic RCC.

Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer.

BACKGROUND There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. OBJECTIVE To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. MATERIALS AND METHODS A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variables impact on the uncertainty of the results. RESULTS Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. CONCLUSIONS All of the second-line chemotherapy strategies showed certain benefits due to an increased life- year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

Should we use the shorter Thai‐version quality of life and symptoms questionnaires in women with overactive bladder?

The aim of this study was to test: (i) the validation and reliability of the Thai versions of overactive bladder (OAB) questionnaires (the 8‐item and 3‐item Overactive Bladder Symptoms Score questionnaires [OAB‐v8 and OAB‐v3, respectively] and the Overactive Bladder Questionnaire [OAB‐q]); and (ii) the correlation of the OAB‐v8, OAB‐v3, and the single‐question Quality of Life Questionnaire (1‐QoL) to the OAB‐q in Thai women with OAB.

Cost-Effectiveness Analysis of Different Management Strategies for Detection CIN2+ of Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap Smear in Thailand

BACKGROUND To identify the optimal cost effective strategy for the management of women having ASC-US who attended at King Chulalongkorn Memorial Hospital (KMCH). DESIGN An Economical Analysis based on a retrospective study. SUBJECT The women who were referred to the gynecological department due to screening result of ASC-US at King Chulalongkorn Memorial Hospital, a general and tertiary referral center in Bangkok Thailand, from Jan 2008 - Dec 2012. MATERIALS AND METHODS A decision tree-based was constructed to evaluate the cost effectiveness of three follow up strategies in the management of ASC-US results: repeat cytology, triage with HPV testing and immediate colposcopy. Each ASC-US woman made the decision of each strategy after receiving all details about this algorithm, advantages and disadvantages of each strategy from a doctor. The model compared the incremental costs per case of high-grade cervical intraepithelial neoplasia (CIN2+) detected as measured by incremental cost-effectiveness ratio (ICER). RESULTS From the providers perspective, immediate colposcopy is the least costly strategy and also the most effective option among the three follow up strategies. Compared with HPV triage, repeat cytology triage is less costly than HPV triage, whereas the latter provides a more effective option at an incremental cost-effectiveness ratio (ICER) of 56,048 Baht per additional case of CIN 2+ detected. From the patients perspective, the least costly and least effective is repeat cytology triage. Repeat colposcopy has an incremental cost-effectiveness (ICER) of 2,500 Baht per additional case of CIN2+ detected when compared to colposcopy. From the sensitivity analysis, immediate colposcopy triage is no longer cost effective when the cost exceeds 2,250 Baht or the cost of cytology is less than 50 Baht (1USD = 31.58 THB). CONCLUSIONS In women with ASC-US cytology, colposcopy is more cost-effective than repeat cytology or triage with HPV testing for both provider and patient perspectives.

Impact of Vaccination: Health Impact and Cost-Effectiveness to Make Informed Policy Decision on the Introduction of Human Papillomavirus (Hpv) Vaccine to the National Immunization Program (Nip) in Thailand

• Cervical cancer is the second most common cancer and the second most common cause of death among cancer in Thai women (ASR 24.5 and 12.8 per 100,000 women/year) • Since 2004, VIA test and pap smear have been covered by national UC health scheme as cervical cancer screening tests • Despite the introduction of cervical cancer screening tests, those services have not contributed to a significant health impact • In 2007, two HPV vaccine products were licensed for use in Thailand