BackgroundOver 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.MethodsThe 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.ResultsThe 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).ConclusionsObesity 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.

Objective: The first five years of a child's life is a golden period of their development, contributing to their future learning skills and social and emotional abilities due to rapid gains in physical and development. This study aimed to estimate the prevalence of delays in development and growth among children aged 1-5 years and to explore their association with maternal age. Methods:A cross-sectional survey was conducted in the Northeast of Thailand during April-September 2014. Seventy Thai mothers aged less than 34 years who were admitted to the postpartum ward of a regional hospital and their first child were included. Developmental delay among their first children was assessed by the Denver II, Thai version.Results: Among the 70 children, 22.9% were suspected to have delayed development with delays in language (14.3%), gross motor (10.0%), personal-social (5.7%) and fine motor (2.9%) skills being the most common domains detected. A higher prevalence of language delay was found in boys (21.4%) compared to girls (9.5%) but the difference was not statistically significant. Children aged 36-62 months showed a higher delayed development, especially in the gross motor domain. The prevalence of underweight and stunting were common among children aged 12-35 months (6.2% and 15.6%, respectively) and wasting was higher among those aged 36-62 months (5.3%). Hyperactivity and showing anger when displeased were common. Conclusion:A high prevalence of suspected delay was found among children aged 36-62 months. Suboptimal growth was common among those 12-35 months. Early identification of developmental delay and early interventions may have a substantial impact on financial, educational, and social costs in the future.

Introduction Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy. Methods A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown. Results The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates. Conclusion The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.

Background Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region. Methods This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017–2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces. Results Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631–0.819) and 11% (RR 0.890, 95% CI: 0.811–0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320–0.527), while the number of visits for non-communicable diseases (ICD-10: E00–E90, I00–I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups. Conclusions Thailand’s OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.

The current program for prevention of mother-to-child HIV transmission in Thailand recommends a 2-drugs regimen for HIV-infected pregnant women with a CD4 count >200 cells/mm(3). This study assesses the value for money of 3 antiretroviral drugs compared with zidovudine (AZT)+single-dose nevirapine (sd-NVP). A decision tree was constructed to predict costs and outcomes using the governmental perspective for assessing cost-effectiveness of 3-drug regimens: (1) AZT, lamivudine, and efavirenz and (2) AZT, 3TC, and lopinavir/ritonavir, in comparison with the current protocol, AZT+sd-NVP. The 3-drug antiretroviral regimens yield lower costs and better health outcomes compared with AZT+sd-NVP. Although these 3-drug regimens offer higher program costs and health care costs for premature birth, they save money significantly in regard to pediatric HIV treatment and treatment costs for drug resistance in mothers. The 3-drug regimens are cost-saving interventions. The findings from this study were used to support a policy change in the national recommendation.

ObjectivesThe study aims to identify high-cost users (HCUs) in the inpatient departments of hospitals in Thailand including their common characteristics, patterns of healthcare utilisation and expenditure compared with low-cost users, and to explore potential factors associated with HCUs so the healthcare system can be prepared to support the HCUs including those who have increased chances of becoming HCUs.Design and settingA retrospective secondary data analysis using hospitalisation data from Thailand’s Universal Coverage Scheme (UCS) obtained from the National Health Security Office over a 5-year period from October 2014 to September 2019 (fiscal year 2014–2018).ParticipantsStudy participants included Thai citizens who had at least one inpatient admission to hospitals under the UCS over the study period.ResultsOver the 5-year period, the top 5% of the hospitalised population (or HCUs) consumed almost 50% of the health expenditure each year. HCUs were more likely to have longer hospital stays, a higher annual number of visits and be admitted to multiple hospitals each year when compared with the low-cost users (the bottom 50% of the hospitalised population). The study further reported that the chance of becoming an HCU is associated with several factors such as increasing age, being male, having a comorbidity and being admitted to hospitals in Bangkok.ConclusionsThis study confirmed that the HCU phenomenon existed in Thailand, where a majority of inpatient care spending is concentrated in the top 5% of the hospitalised population. The study findings call attention to potential initiatives that can help monitor the magnitude and trend of HCUs and develop policies to prevent HCUs.

Background The consumption of health-related products has been increasing continuously. Information on health-related products can make it difficult for some people with limited health literacy to use. This study investigated the extent to which health literacy competencies in the aspect of consumer protection related to demographic and socio-economic factors, using data from the Thai Health Literacy Survey (THL-S) among Thai citizens aged 15 years and above (2019). Methods The THL-S used a stratified three-stage-sampling to draw a sample of Thais aged 15 years and above. Participants were interviewed with a questionnaire of 34 items measuring health literacy and 8 items measuring behavioural practices. Proportions of responses (the 6-Likert scales) in accessing, understanding, communicating and making decisions related to the consumer protection aspect were performed. Logistic regression models were used to explore the association between health literacy competencies and participant’s socioeconomic, demographic, health and social characteristics.Results Levels of difficulties in the consumer protection aspect varied among health competencies, with the most difficult in communicating and the least difficult in understanding. Half of Thais (around 42%) felt difficult to ask for information from healthcare providers. One-third of Thais (38%) experienced difficulties in accessing reliable information about medicine, cosmetic products, herbal products and food supplements. Participants who had a lower level of education, cannot read, did not have health screenings, were living in poverty, did not hold leading roles in the community, were male, had hearing impairment, or were at an older age, experienced more difficulties in practising health literacy competencies.Conclusions Vulnerable consumers face significant barriers in accessing, understanding, communicating and making decisions in the consumer protection aspect. Health literacy programs that aim to build competencies and empower vulnerable consumers should be developed. There is also a need to adapt current information on health related products to be as clear an accessible as possible but reliable to meet health literacy needs.

Background The consumption of herbal and food supplements attributing to health expenditures in Thailand has been increasing over the years. However, information on herbal and food supplement products can make it difficult for some people with limited health literacy to use. Evidence from previous studies outside Thailand shows that SES disadvantaged groups are more likely to have limited health literacy compared with their counterparts with advantaged SES. The present study adds to this body of knowledge through an exploration of health literacy competencies related to herbal and food supplement consumption to determine what competency would be most problematic among Thai people. The study also investigated the influences of demographic and socio-economic factors on the most problematic health literacy competency on herbal and food supplements. Methods The THL-S used a stratified three-stage-sampling to draw a sample of Thais aged 15 years and above. Participants were interviewed with a questionnaire of 34 items measuring health literacy and 8 items measuring behavioural practices. Responses to questions on accessing, understanding, communicating, and making decisions related to herbal and food supplement consumption were analysed. A logistic regression model was used to explore the association between having difficulties in accessing information and participant’s socio-economic factors. Results Levels of difficulties the participants experienced varied among their health literacy competencies. Accessing reliable information was found to be the most problematic health literacy competency faced by respondents (48%), followed by asking healthcare providers about herbal products and food supplements (41%). Significant differences in the ability to access reliable information on herbal and food supplements were found to be based on differences in: education, income levels, occupation, insurance scheme coverage, age, sex, reading ability, writing ability, chronic diseases, wearing eyeglasses or lenses, hearing impairment, and having a community leading role. Conclusions Accessing reliable information on herbal and food supplements has been found to be the most difficult health literacy competency among respondents to the survey, particularly vulnerable consumers in the society such as people with hearing impairment or having limited overall literacy competencies. Therefore, health literacy programs might be developed to build health literacy competencies and empower vulnerable consumers for reasonable use of herbal and food supplements.