Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole

Economic Evaluation of Molecular Testing for Pulmonary Tuberculosis Diagnosis: A Systematic Review

Natthakan Chitpim,1 Panida Yoopetch,2 Jiraphun Jittikoon,3 Wanvisa Udomsinprasert,3 Kornkanok Bunwong,4,5 Surakameth Mahasirimongkol,6 Usa Chaikledkaew2,7 1Social, Economic and Administrative Pharmacy (SEAP) Graduate Program, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 2Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand; 3Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 4Department of Mathematics, Faculty of Science, Mahidol University, Bangkok, Thailand; 5Centre of Excellence in Mathematics, MHESI, Bangkok, Thailand; 6Office of Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand; 7Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, ThailandCorrespondence: Usa Chaikledkaew, Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudhaya Road, Ratchathewi, Bangkok, 10400, Thailand, Email [email protected]: Rapid molecular assays such as Xpert MTB/RIF and TB-LAMP accelerate pulmonary tuberculosis (TB) diagnosis but are more expensive than smear microscopy. This study provided an updated economic synthesis for presumptive adult pulmonary TB in high-burden settings, broadening the evidence from Xpert MTB/RIF to other WHO endorsed tests compared to conventional strategies.Methods: Medline, Embase and Scopus were searched through March 2025. The strategy combined search terms related to molecular diagnostic tests, pulmonary tuberculosis, and economic evaluation study designs. Full economic evaluations comparing molecular tests with smear microscopy, culture or passive case-finding were eligible. Two reviewers independently screened articles, extracted data, and adjusted costs to 2025 US dollars (USD) using average exchange rates. Reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Due to heterogeneity in evaluation criteria, model structures, time horizons, and outcome measures, meta-analysis were not feasible. Therefore, results were synthesized narratively, and incremental cost-effectiveness ratios (ICERs) were contextualized against country-specific cost-effectiveness thresholds to enable meaningful cross-study interpretation.Results: Eight studies conducted in low- and middle-income countries with high TB burdens were included. All evaluated Xpert MTB/RIF and the Thai studies also examined TB-LAMP. Five studies reported cost per disability-adjusted life years (DALYs) averted or quality-adjusted life years (QALYs) gained, while three used TB cases detected or years of life saved (YLS). CHEERS reporting quality was high (median is 23/28 items). Reported ICERs for molecular testing were either cost-saving or highly cost-effective compared with country-specific thresholds. Probabilistic sensitivity analyses (five studies) indicated ≥ 90% probability of cost-effectiveness in four studies and 6% in one.Conclusion: Recent evidence supports the cost-effectiveness and cost-saving of Xpert MTB/RIF and TB-LAMP for diagnosing adult pulmonary TB. Policymakers should prioritize reducing cartridge costs and implementing models that capture patient-level benefits to maximize economic benefits.Keywords: Xpert MTB/RIF, cost-effectiveness, molecular testing, systematic revie

The Burden of Obesity in Saudi Arabia: A Real-World Cost-of-Illness Study

Mouaddh Abdulmalik Nagi,1,2 Ziyad Saeed Almalki,3,* Montarat Thavorncharoensap,4,5,* Sermsiri Sangroongruangsri,4 Saowalak Turongkaravee,4 Usa Chaikledkaew,4,5 Abdulhadi M Alqahtani,6 Lamis S AlSharif,6 Ibrahim A Alsubaihi,7 Abdulaziz I Alzarea,8 Mohammed M Alsultan9 1Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 2Department of Pharmacy, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen; 3Department of Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Riyadh - Al-Kharj, Saudi Arabia; 4Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 5Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand; 6Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia; 7Department of Clinical Trials Support and Development, Saudi National Institute of Health, Riyadh, Saudi Arabia; 8Department of Clinical Pharmacy, Al-Jouf University College of Pharmacy, Sakaka, Saudi Arabia; 9Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia*These authors contributed equally to this workCorrespondence: Ziyad Saeed Almalki, Department of Clinical Pharmacy, Prince Sattam bin Abdulaziz University, P.O. Box: 173, Riyadh - Al-Kharj, 11942, Saudi Arabia, Email [email protected] Montarat Thavorncharoensap, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand, Email [email protected]: The rising prevalence of obesity in the Kingdom of Saudi Arabia (KSA) poses a significant public health challenge. Estimates of the economic cost of obesity are crucial for prioritizing healthcare interventions, guiding policy choices, and justifying budget allocations aimed at reducing obesity prevalence. This study aimed to estimate the cost of obesity in the KSA in 2022.Methods: A prevalence-based cost-of-illness approach was used to determine the cost of obesity. This analysis encompasses 29 diseases, namely obesity and twenty-eight diseases attributable to obesity. Both direct and indirect costs were considered. The annual cost of treatment for each obesity-attributable disease was obtained from the hospital records of one tertiary hospital in the KSA. Data on direct non-medical costs were obtained from the patient survey. The human capital approach was used to estimate the indirect costs of morbidity and mortality.Results: The total economic burden of obesity (2022 values) was estimated at US$116.85 billion from a societal perspective and US$109.67 billion from a healthcare system perspective. From a societal perspective, the total direct medical cost accounted for the largest portion of the total cost (94%). In terms of direct medical costs, the cost of treating diseases attributable to obesity was substantially greater than the cost of treating obesity itself. According to the sensitivity analysis, the total cost ranged from 3.4% of the country’s Gross domestic product (GDP) when the unit cost of treatment was reduced by 74% to 9.5% of the country’s GDP when the prevalence of obesity and its comorbidities was reduced by 5%.Conclusion: Obesity imposes a substantial economic burden on the healthcare system and society in the KSA. Interventions aimed at promoting healthier lifestyles to reduce the prevalence and incidence of obesity and its comorbidities are highly warranted to alleviate the impact of obesity in the country.Keywords: body mass index, cost-of-illness, economic burden, obesity, Saudi Arabi

Factors affecting costs and utilization of type 2 diabetes healthcare: a cross-sectional survey among 15 hospitals in urban China

<p>Abstract</p> <p>Background</p> <p>Type 2 Diabetes mellitus (T2DM) affects persons of all ages, while also placing heavy economic burdens on national economies and healthcare systems. The study aims to investigate the determinants of direct medical cost (DMC), out-of-pocket (OOP) proportion of the cost, and healthcare utilization associated with T2DM.</p> <p>Methods</p> <p>This cross-sectional study was conducted in four major cities in China. Eligible subjects were adult outpatients who received treatment at one of 15 sampled secondary or tertiary hospitals and consecutively enrolled between March 2007 and May 2007. Generalized estimating equations were used to determine impact factors associated with DMC and healthcare utilization.</p> <p>Results</p> <p>Insurance schemes and receiving insulin therapy were significantly associated with a higher annual DMC of T2DM. For each increase in number of complications, there was about 33% increase in annual DMC. Insurance schemes were significantly associated with the proportions of DMC from pocket. A 7% significantly lower proportion of DMC was paid and 23% more clinic visits (AOR = 1.232, P < 0.001) were made by patients admitted at secondary hospitals than tertiary hospitals. The group with higher income (> 2000 CNY/month) paid 23% less from their pocket, compared with the lower income group. The number of complications also significantly increased the outpatient visits (AOR = 1.064, P < 0.001).</p> <p>Conclusions</p> <p>It implies that preventing complications through the use of more effective treatment regimens is important in order to control the healthcare expenditures of the diseases. Healthcare reform needs to be focused on the medical insurance system and redistribution of patients in hospitals of different levels.</p

The economic costs of alcohol consumption in Thailand, 2006

<p>Abstract</p> <p>Background</p> <p>There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006.</p> <p>Methods</p> <p>This is a prevalence-based, cost-of-illness study. The estimated costs in this study included both direct and indirect costs. Direct costs included health care costs, costs of law enforcement, and costs of property damage due to road-traffic accidents. Indirect costs included costs of productivity loss due to premature mortality, and costs of reduced productivity due to absenteeism and presenteeism (reduced on-the-job productivity).</p> <p>Results</p> <p>The total economic cost of alcohol consumption in Thailand in 2006 was estimated at 156,105.4 million baht (9,627 million US$PPP) or about 1.99$ PPP), followed by cost of productivity loss due to reduced productivity (45,464.6 million baht/2,804 million US$PPP), health care cost (5,491.2 million baht/339 million US$ PPP), cost of property damage as a result of road traffic accidents (779.4 million baht/48 million US$PPP), and cost of law enforcement (242.4 million baht/15 million US$ PPP), respectively. The results from the sensitivity analysis revealed that the cost ranges from 115,160.4 million baht to 214,053.0 million baht (7,102.1 - 13,201 million US$ PPP) depending on the methods and assumptions employed.</p> <p>Conclusions</p> <p>Alcohol imposes a substantial economic burden on Thai society, and according to these findings, the Thai government needs to pay significantly more attention to implementing more effective alcohol policies/interventions in order to reduce the negative consequences associated with alcohol.</p