Background: At present, health technology assessment (HTA) guidelines of many countries including Thailand have recommended EQ-5D as the preferred method for assessing utility. This study aims to generate an EQ-5D-5L value set based on societal preferences of Thai population. Methods: A 1,207 representative sample was recruited using a stratified multi-stage quota sampling technique. Face-to-face, computer-assisted interviews using the EuroQol Valuation Technology (EQ-VT) software were employed. To elicit preference score, each respondent was asked to value health states using composite time trade-off (cTTO), and discrete choice experiment (DCE). All data were integrated and analyzed using a hybrid regression model to estimate the value set. Results: Characteristics of 1,207 participants were generally similar to those of Thai general population. The coefficients generated from a hybrid model were logically consistent. The second best value is 0.9436 for health state 11121 and the worst state (55555) value is −0.4212. Mobility shows the greatest impact to utility decrement. Conclusions: Our study developed a Thai value set for EQ-5D using hybrid model. The findings from this study are of important to facilitate health technology assessment studies to inform policy decision-making as well as to promote the use of EQ-5D-5L in various health research in Thailand.

The EQ-5D is a health-related quality of life instrument which provides a simple descriptive health profile and a single index value for health status. The latest version, the EQ-5D-5L, has been translated into more than one hundred languages worldwide - including Thai. This study aims to assess the measurement properties of the Thai version of the EQ-5D-5L (the 5L) compared to the EQ-5D-3L (the 3L). A total of 117 diabetes patients treated with insulin completed a questionnaire including the 3L and the 5L. The 3L and 5L were compared in terms of distribution, ceiling, convergent validity, discriminative power, test-retest reliability, feasibility, and patient preference. Convergent validity was tested by assessing the relationship between each dimension of the EQ-5D and SF-36v2 using Spearman’s rank-order correlation. Discriminative power was determined by the Shannon index (H ′) and Shannon’s Evenness index (J ′). The test-retest reliability was assessed by examining the intraclass correlation coefficient (ICC) and Cohen’s weighted kappa coefficient. No inconsistent response was found. The 5L trended towards a slightly lower ceiling compared with the 3L (33% versus 29%). Regarding redistribution, 69% to 100% of the patients answering level 2 with the 3L version redistributed their responses to level 2 with the 5L version while about 9% to 22% redistributed their responses to level 3 with the 5L version. The Shannon index (H ′) improved with the 5L while the Shannon's Evenness index (J ′) reduced slightly. Convergent validity and test-retest reliability was confirmed for both 3L and 5L. Evidence supported the convergent validity and test-retest reliability of both the 3L and 5L in diabetes patients. However, the 5L is more promising compared to the 3L in terms of a lower ceiling, more discriminatory power, and higher preference by the respondents. Thus, the 5L should be recommended as a preferred health-related quality of life measure in Thailand.

Peer reviewed article authored by (Thavorncharoensap M, Teerawattananon Y, Natanant S, Kulpeng W, Yothasamut J, Werayingyong P). Read article or submit your manuscript for publishing.

This systematic review aimed to comprehensively synthesize cost-effectiveness evidences of bariatric surgery by pooling incremental net monetary benefits (INB). Twenty-eight full economic evaluation studies comparing bariatric surgery with usual care were identified from five databases. In high-income countries (HICs), bariatric surgery was cost-effective among mixed obesity group (i.e., obesity with/without diabetes) over a 10-year time horizon (pooled INB = $53,063.69; 95% CI $42,647.96, $63,479.43) and lifetime horizon (pooled INB = $101,897.96; 95% CI $79,390.93, $124,404.99). All studies conducted among obese with diabetes reported that bariatric surgery was cost-effective. Also, the pooled INB for obesity with diabetes group over lifetime horizon in HICs was $80,826.28 (95% CI $32,500.75, $129,151.81). Nevertheless, no evidence is available in low- and middle-income countries. Graphical abstract

Background: Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m²) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. Methods: The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. Results: The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand’s Gross Domestic Product (GDP). Conclusions: Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority.