Volume 6 - Issue 10 by M. Bertram
In an editorial published in this journal, Baltussen et al argue that information on cost-effecti... more In an editorial published in this journal, Baltussen et al argue that information on cost-effectiveness is not sufficient for priority setting for universal health coverage (UHC), a claim which is correct as far as it goes. However, their focus on the procedural legitimacy of 'micro' priority setting processes (eg, decisions concerning the reimbursement of specific interventions), and their related assumption that values for priority setting are determined only at this level, leads them to ignore the relevance of higher level, 'macro' priority setting processes, for example, consultations held by World Health Organization (WHO) Member States and other global stakeholders that have resulted in widespread consensus on the principles of UHC. Priority setting is not merely about discrete choices, nor should the focus be exclusively (or even mainly) on improving the procedural elements of micro priority setting processes. Systemic activities that shape the health system environment, such as strategic planning, as well as the substantive content of global policy instruments, are critical elements for priority setting for UHC. Citation: Lauer JA, Rajan D, Bertram MY. Priority setting for universal health coverage: we need to focus both on substance and on process: Comment on " Priority setting for universal health coverage: we need evidence-informed deliberative processes, not just more evidence on cost-effectiveness.
Papers by M. Bertram
Value in Health, 2010
High-dose atorvastatin crystalline has been shown to reduce the risk of recurrent stroke among pa... more High-dose atorvastatin crystalline has been shown to reduce the risk of recurrent stroke among patients with a recent stroke/TIA. It was found to be a cost-effective treatment strategy in many countries; however, there is no data available in Thailand. This study examined the cost-effectiveness of atorvastatin crystalline 80 mg/day compared to usual treatment in prevention of recurrent stroke in Thailand. METHODS: A discrete event simulation was used to project long-term results of atorvastatin crystalline reported in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. A clinical course following a stroke or TIA was simulated based on the risks of stroke and cardiovascular events observed from the trial adjusted by baseline demographics and risk factors of Thai patients. Costs and resource use were obtained from Chulalongkorn Stroke Database, life expectancy from Saskatchewan Health Database, and utility weights from a literature. Costs, survival, and quality-adjusted life-years (QALYs) were estimated over lifetime from a health-care provider perspective; discounted 3% annually. RESULTS: Compared to usual care, using atorvastatin crystalline resulted in a decrease in numbers of stroke, TIA, MI, angina and other cardiovascular events which led to an average gain of 0.28 QALYs and 0.27 survival years per patient. A net additional cost of atorvastatin crystalline resulting from higher drug costs and reduction in direct medical costs was 182,910 baht/patient, or 483,800 baht/QALY (US $14,229) gained. Subgroup analyses indicated that lower ICERs (396,000-464,000 baht/QALY or US$11,647-US$12,470) have been shown in high risks patients (e.g., older age, history of stroke/ TIA, diabetes, hypertension). CONCLUSIONS: For patients with prior stroke/TIA, using atorvastatin crystalline comparing to current post-stroke care is clinically effective in Thai stroke patients. ICER is slightly in excess of three times of GDP/capita (US$11,920) as the threshold recommended by WHO, however, it still can be considered economically tolerable as a cost-effective use was found in specifi c patient groups.
South African Medical Journal, 2012
Injury Prevention, 2012
Background Conducting a burden of road traffic injuries (RTIs) in developing countries is difficu... more Background Conducting a burden of road traffic injuries (RTIs) in developing countries is difficult due to the paucity and inconsistency of data.
The Lancet, 2007
Background Swedish snus is a smokeless tobacco product that has been suggested as a tobacco harm ... more Background Swedish snus is a smokeless tobacco product that has been suggested as a tobacco harm reduction product. Our aim was to assess the potential population health effects of snus. Methods We assessed the potential population health effects of snus in Australia with multistate life tables to estimate the difference in health-adjusted life expectancy between people who have never been smokers and various trajectories of tobacco use, including switching from smoking to snus use; and the potential for net population-level harm given different rates of snus uptake by current smokers, ex-smokers, and people who have never smoked. Findings There was little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus (difference of 0•1-0•3 years for men and 0•1-0•4 years for women). For net harm to occur, 14-25 ex-smokers would have to start using snus to offset the health gain from every smoker who switched to snus rather than continuing to smoke. Likewise, 14-25 people who have never smoked would need to start using snus to offset the health gain from every new tobacco user who used snus rather than smoking. Interpretation Current smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus.
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Volume 6 - Issue 10 by M. Bertram
Papers by M. Bertram