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Fulltext Comparison of health care utilization and costs for patietns with asthma by severity and health insurance in Thailand: using generalized linear regression model. [Abstract]

Dilokthornsakul P, Lee TA, Dhippayom T, Jeanpeerapong N, Chaiyakunapruk N

Value Health, 2014 Nov;17(7):A778.
PMID: 27202883 DOI: 10.1016/j.jval.2014.08.360
Comparative Analysis of Calendar Time-Specific and Conventional Propensity Score Analysis for Thiazolidinedione Use in Diabetes

Dilokthornsakul P, Chaiyakunapruk N, Jeanpeerapong N, Lee TA

Value Health Reg Issues, 2014 May;3:222-228.
PMID: 29702931 DOI: 10.1016/j.vhri.2014.04.013

OBJECTIVES: To evaluate whether there are differences in propensity score (PS) and treatment effects estimated using conventional and calendar time-specific PS (CTS-PS) approaches.
METHODS: A retrospective database analysis at a university-affiliated hospital in Thailand was used. Diabetic patients receiving glucose-lowering medications from July 2008 to June 2011 were included. Patients were categorized into those exposed and not exposed to thiazolidinediones (TZDs). PSs were estimated by using conventional PS and CTS-PS. In the CTS-PS, PS was separately estimated for three specific calendar time periods. Patients were matched 1:1 using caliper matching. The outcomes were cardiovascular and all-cause hospitalizations. The TZD and non-TZD groups were compared with Cox proportional hazard models.
RESULTS: A total of 2165 patients were included. The average conventional PS was 0.198 (95% confidence interval [CI] 0.195-0.202), while the average PS in the CTS-PS approach was 0.212 (0.206-0.218), 0.180 (0.173-0.188), and 0.205 (0.197-0.213) for July 2008 to June 2009, July 2009 to June 2010, and July 2010 to June 2011, respectively. The average difference in PS was 0.012 (P < 0.001), -0.009 (P ≤ 0.002), and 0.000 (P = 0.950) in the three calendar time periods. The adjusted hazard ratios of the conventional PS-matched cohort were 0.97 (95% CI 0.39-2.45) and 0.97 (95% CI 0.78-1.20) for CVD-related and all-cause hospitalizations, while the adjusted hazard ratios of the CTS-PS-matched cohort were 1.11 (95% CI 0.43-2.88) and 1.12 (95% CI 0.91-1.39), respectively.
CONCLUSION: CTS-PS is different from PS estimated by using the conventional approach. CTS-PS should be considered when a pattern of medication use has changed over the study period.
Comparison of Health Care Utilization and Costs for Patients with Asthma by Severity and Health Insurance in Thailand

Dilokthornsakul P, Lee TA, Dhippayom T, Jeanpeerapong N, Chaiyakunapruk N

Value Health Reg Issues, 2016 May;9:105-111.
PMID: 27881251 DOI: 10.1016/j.vhri.2016.03.001

BACKGROUND: To compare health care utilization and cost by asthma severity and type of health insurance in Thailand.

METHODS: A retrospective cohort study using an electronic database was conducted in patients with asthma. Patients who were diagnosed with asthma from 2009 to 2011, had at least two subsequent health care encounters for asthma during the first six months after the first asthma diagnosis, and had at least 90 days of follow-up were included. The primary outcome was direct health care costs of inpatient and outpatient care. We compared outcomes between groups on the basis of a proxy of severity (mild/moderate severe asthma vs. high severe asthma) and type of health insurance using a multivariable generalized linear model. Covariates such as Patients' demographic characteristics, comorbidities, and concurrent medications were included in the model.

RESULTS: Among 1982 patients included, the average age was 40.3 ± 24.0 years, with 60.7% being males. A total of 1936 patients had mild/moderate severe asthma, whereas 46 patients had high severe asthma. There were 1293 patients under the Universal Coverage Scheme, 264 patients under Social Security Insurance, and 626 patients under the Civil Servant Medical Benefit Scheme (CSMBS). The average annual cost per patient was $598 ± $871. In adjusted analyses, the health care cost of patients with high severe asthma was $71 higher than that of patients with mild/moderate severe asthma (95% confidence interval $-131 to $274). The cost of patients under the CSMBS was $110 (95% confidence interval $29-$191) higher than that of patients under Universal Coverage Scheme.

CONCLUSIONS: Health care costs of patients with asthma were substantial and were higher in patients with high severe asthma and patients under the CSMBS.

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