่

หลักการเศรษฐศาสตร ์ทัวไป
บทนาสูเ่ ภสัชเศรษฐศาสตร ์
nattanichcha@go.buu.ac.th
 PRINCIPLE OF ECONOMICS

Source: Health Intervention and Technology Assessment Program (Thailand), (2018)

 สินค้าทัวไป
่ X
D

Y
สินค้าสาธารณสุข
Source: https://www.tutor2u.net.
 DEMAND

Qx = f(Px, Py, I, T)

Source: https://www.economicsonline.co.uk/
 SUPPLY

Qx = f(Px, Py, Pk,L, N, T)

Source: https://www.economicsonline.co.uk/
 DEMAND, SUPPLY AND MARKETING

P2

P1

P3

Q1

Source: https://www.economicsonline.co.uk/
PRINCIPLE OF HEALTH ECONOMICS
➤ Theory of the allocation of scarce resources
➤ What, How, for Whom
➤ What: Prevention, treatment (what ratio)
➤ How: Produce (efficiency, cost), Distribute (Equity and Equality)
➤ For Whom (Equity and Equality)
ระบบการจัดสรรบริการสุขภาพ

➤การจัดสรรบริการสุขภาพแบบกลไกตลาด

➤การจัดสรรบริการสุขภาพแบบรัฐสวัสดิการ

➤การจัดสรรบริการสุขภาพแบบผสม

8
CHARACTERISTIC OF PUBLIC HEALTH

➤Public goods
➤Externality

➤Not related to benefit gain

➤Imperfect knowledge
➤Supplier induced demand
วัตถุประสงค ์ของการศึกษาเศรษฐศาสตร ์สุขภาพ

➤ ่ ้ทราบสัดส่วนทีเหมาะสมระหว่
เพือให ่ างการผลิตบริการสุขภาพ
่
และสินค ้าบริการอืนๆ
➤ ่
บริการสุขภาพประเภทใดบ ้างทีควรผลิ ้
ตขึนมาและควรผลิ
ตเป็ นจานวนเท่าไหร่
➤ ่ ้เกิดการจัดสรรทร ัพยากรทางสุขภาพอย่างเหมาะสม
เพือให
ความสาคัญของการศึกษาเศรษฐศาสตร ์สุขภาพ
 EXAMPLE OF HEALTH TECHNOLOGY EVALUATION IN THAILAND

Source: Health Intervention and Technology Assessment Program (Thailand), (2018)

 Application of HEOR in Thailand
• mFOLFOX6 regimen (Standard treatment of stage III colon cancer
under cancer protocol of NHSO)

• 400 mg/m2/day intravenous (IV) bolus on day 1

5-FU • 2,400 mg/m2/day IV drip in 46 hours

Leucovorin • 400 mg/m2/day IV on day 1

Oxaliplatin • 85 mg/m2/day IV on day 1

• Administration every 14 days for 12 cycles

• Patients needed to hospitalization because of long intravenous
infusion.
13
Clinical practice guideline and protocol of cancer treatment. National Health Security Office (NHSO).2018
Home-based vs hospital-based treatment

14
CUA results (sensitivity analysis)
Scenarios Alternatives Costs (US$) QALYs ICER
Hospital 210,244 0.3362 -
Base case
Home 157,276 0.3598 Dominant

HC were administered Hospital 210,244 0.3362 -

in home for all cycles Home 152,592 0.3598 Dominant
Hospital 106,957 0.1678 -
3-month time horizon
Home 82,893 0.1798 Dominant

Adding the impact of Hospital 509,834 2.6909 -

delay treatment Home 454,286 2.7374 Dominant

15
Budget impact analysis
Total costs saving Total benefits gain
52,968 Baht 2,192 Baht
(Per patient) (Per patient)
Total Cost saving (Hospital perspective)
26.93
Direct Million Baht/year (100%)
medical Patient
13.47 Million Baht/year (50%)
cost saving productivity gain
5.39 Million Baht/year (20%)
51,232 Baht 877 Baht
(Per patient) (Per patient)
Total Cost saving (Societal perspective)
27.84 Million Baht/year (100%)
Travelling Relative
13.92 Million Baht/year (50%)
cost saving productivity gain
1,736 Baht2.78 Million Baht/year (20%) 1,315 Baht
(Per patient) (Per patient)

Prevent patient delay treatment

500-600 person/year 16
Development of reimbursement model for home-
based chemotherapy in Thailand

International
review and
interview
Cost-Utility
Analysis and Stakeholder
Budget impact opinion
analysis
Home-based
chemotherapy
reimbursement
model in
Thailand

17
 Home-based chemotherapy international reviews

UK
France
USA
Canada Japan
Singapore
Korea

HC (not palliative care, not disability patient)

Inclusion criteria
• Publication and non-publication
International Review and
document interview
Exclusion criteria • Government and
• Data from private insurance Publication document Australia
Searching database
• Medline • Expert interview
• Government website
• Reference search

18
 Results of international review
Optional Optional Standard Standard

USA Australia Canada France

National Level National Level National Level National Level
OPD, patient’s home OPD, Patient’s Home OPD, Patient's home OPD, Patient's home
Cancer pt with more Cancer pt with 5-FU 5FU treatment Eligible patient
benefit for AIP (8 hours) Reimbursement: DRG, Reimbursement: HAB, Reimbursement by DRG,
Reimbursement: FFS FFS (Drug) cost sharing ABF, FFS (Drug, pump), no cost sharing
(OPD) 20% cost sharing for drug no cost sharing

AIP, HHP AIP, HITH AIP AIP, HHP

Particular Optional Standard Particular

UK Korea Japan Singapore

National Level National Level National Level
National Level
OPD OPD OPD, Patient's home
OPD, Community
5FU treatment 5FU treatment 5-FU, Velcade,
5FU and eligible pt
Reimbursement by FFS Reimbursement by FFS Azacitidine
Reimbursement
5% Cost sharing 30% Cost sharing Reimbursement by FFS
20% cost sharing

AIP AIP AIP AIP, HITH

19
 Pharmaceutical benefits for anti-cancer medicines
by different health insurance schemes

Patikorn C, Taychakhoonavudh S, Thathong T, Anantachoti P. Patient Access to Anticancer Medicines Under Public Health Insurance Schemes in Thailand: A mixed methods study.
Thai Journal of Pharmaceutical Sciences (TJPS). 2015;43(3). 20
 Summary of financial sources of the HC service in Thailand

SSS/UCS CSMBS
HC Service components
IPD OPD IPD OPD
Drug FFS FFS FFS FFS
Pharmacy service FFS FFS FFS FFS
Laboratory DRG Capitation FFS FFS
Solution DRG Capitation FFS FFS
OPD Doctor service Capitation Capitation FFS FFS
IPD Doctor service DRG - DRG -
OPD Nurse service Capitation Capitation FFS FFS
IPD Nurse service DRG - DRG -
Inpatient service DRG - DRG -
IPD Equipment DRG - DRG -
CV Port DRG Capitation FFS FFS
AIP DRG Capitation None None
Mini Spill Kit DRG Capitation FFS FFS
* Do not exceed 50,000 baht per year
21
Cost: HC treatment/12 cycles = 144,098 Baht, Cost IP treatment/12 cycle 199,314
Current HC reimbursement (NHSO)

IPD
Total financial support 149,932 Baht/12 cycles
reimbursement

OPD
Total financial support 119,520 Baht /12 cycles
reimbursement

HC cost Total cost 144,098 Baht/12 cycles

IP cost Total cost 199,314 Baht/12 cycles

22
Stakeholder meeting

31 Participants from hospital (24), payer (4) and cancer institute (3)
23
Recommendation of HC reimbursement model

Ambulatory infusion
pump at SSS
Financing

Payment by case

Organization Management

Healthcare Equipment
system
Port and pump

24
 APPLICATION OF HEALTH ECONOMIC EVALUATIONS

➤Guiding decisions on healthcare policy and resource allocation.

➤A valuable tool for priority setting and healthcare decision-making

Source: Health Intervention and Technology Assessment Program (Thailand), (2018)

TYPE OF ECONOMIC EVALUATION
STUDY
TYPES OF ECONOMIC EVALUATION STUDIES
➤ Cost-minimization analysis
➤ Cost-effectiveness analysis
➤ Cost-utility analysis
➤ Cost-Benefit analysis
 COST-MINIMIZATION ANALYSIS
➤Comparison between the net costs of two or more therapeutic alternatives
➤The alternatives are equivalent clinical effectiveness
➤ To establish the cheaper alternative

Source: MarksMan Healthcare Communications, (2018), Introduction to Health-economics and Outcomes Research
COST-MINIMIZATION ANALYSIS
➤ Example
➤ A comparison between the cost of two antibiotics having the same
treatment benefits and
adverse effects.
➤ Limitation
➤ Both the alternatives have equal consequences or outcomes
➤ It cannot be used to compare therapies with different outcomes (clinical
outcomes of two interventions are rarely exactly similar)

➤ Not full economic evaluation (Cost analysis)

 COST-EFFECTIVENESS ANALYSIS
➤The relationship between the cost of therapy (monetary units) and clinical
benefits or effectiveness
➤The effectiveness measured in terms of improved health outcomes
➤ Lengthened life span

➤ Number of lives saved

➤ Clinical cures

➤ Days free of symptoms

Source: MarksMan Healthcare Communications, (2018), Introduction to Health-economics and Outcomes Research
COST-EFFECTIVENESS ANALYSIS
➤The form of a ratio that specifies the additional unit cost incurred in order to
obtain an additional unit of clinical benefit
➤To identify the therapeutic option with the lower cost/per unit of clinical
benefit
➤ Limitations
➤Can’t comparing difference intervention type >> Decision making
➤Use only single outcome for evaluation
COST-UTILITY ANALYSIS
➤The relationship between costs of therapy and its benefits to the health-
related quality of life of the patient (QALYs)
➤QALYs = Utility x Life year gain
➤Utility ( อรรถประโยชน์)
➤Utility: 0-1
➤1 หมายถึง “อรรถประโยชน์ในสภาวะทีส่ ข
ุ ภาพสมบูรณ์ทสี ่ ดุ ”
➤Consider clinical and humanistic consequences
 COST-UTILITY ANALYSIS
➤Quality-adjusted life year (QALYs)
➤ “1 ปี ทีอ่ ยูอ่ ย่างแข็งแรงสมบูรณ์ทสี ่ ดุ ทัง้ ด้านร่างกายและจิตใจ”
➤ Utility x Life year gain
➤ Utility 0-1

Source: MarksMan Healthcare Communications, (2018), Introduction to Health-economics and Outcomes Research
 COST-BENEFIT ANALYSIS
➤The relationship between the costs and financial benefits of a treatment
or intervention
➤It measures both costs and consequences of therapeutic alternatives in
monetary terms
➤It may be used to compare the return of resources
➤Example

➤ The costs of a vaccination program and resources generated by reduction of work days lost

Source: MarksMan Healthcare Communications, (2018), Introduction to Health-economics and Outcomes Research
COST-BENEFIT ANALYSIS
➤To assess the economic viability of social projects by comparing various
therapeutic alternatives or programs to determine their ‘social profitability’
➤Limitation

➤ It is very difficult to attribute monetary value to health effects.

THANK YOU