Impact of COVID-19 on patterns of drug utilization: A case study at national hospital.

BACKGROUND: The Coronavirus disease of 2019 (COVID-19) pandemic and the corresponding mitigation measures have had a discernible impact on drug utilization among outpatients. However, limited research exists on the prescription trends in the elderly population during the pandemic period in Viet Nam. OBJECTIVES: This study aims to analyze the effects of COVID-19 on outpatient drug utilization patterns at a national geriatric hospital in Ho Chi Minh City before and after the early onset of the pandemic. METHODS: Data was collected from the prescriptions and administration claims, encompassing the period from January 2016 to December 2022. The dataset was divided into two periods: Period 1: January 2016 to December 2020 and Period 2: January 2021 to December 2022. The drug utilization was measured using DDD/1000P (defined daily doses-DDD per 1000 prescriptions) on a monthly basis. The analysis employed interrupted time series using Autoregressive Integrated Moving Average (ARIMA) to detect changes in drug use levels and rates. RESULTS: A total of 1,060,507 and 644,944 outpatient prescriptions from Thong Nhat Hospital were included in Period 1 and Period 2, respectively. The median age of the patients were 58 in Period 1 and 67 years old in Period 2. The most common comorbidities were dyslipidemia, hypertension, and diabetes mellitus. In terms of medication utilization, cardiovascular drugs were the most frequently prescribed, followed by drugs active on the digestive and hormonal systems. The study observed significant surges in the number of prescriptions and the average number of drugs per prescription. However, there were no significant changes in the overall consumption of all drugs. Among the drug groups related to the cardiovascular system, three subgroups experienced a sudden and significant increase: cardiac therapy, beta-blocking agents, and antihypertensives, with increasing consumption levels of 1,177.73 [CI 95%: 79.29; 2,276.16], 73.32 [CI 95%: 28.18; 118.46], and 36.70 [CI 95%: 6.74; 66.66] DDD/1000P, respectively. On the other hand, there was a significant monthly decrease of -31.36 [CI 95%: -57.02; -5.70] DDD/1000P in the consumption of anti-inflammatory and antirheumatic products. Interestingly, there was a significant increase of 74.62 [CI 95%: -0.36; 149.60] DDD/1000P in the use of antigout preparations. CONCLUSION: COVID-19 resulted in a sudden, non-significant increase in overall drug consumption levels among outpatients. Notably, our findings highlight significant increases in the utilization of three drug groups related to the cardiovascular system, specifically cardiac therapy, beta-blocking agents, and antihypertensives. Intriguingly, there was a statistically significant increase in the consumption of antigout preparations, despite a decline in the monthly consumption rate of non-steroidal anti-flammatory drugs (NSAIDs). Further studies in the following years are necessary to provide a more comprehensive understanding of the impact of COVID-19 on outpatient drug utilization patterns.

Evaluation of the impact before and after the application of an antimicrobial stewardship program at Dong Thap General Hospital, Vietnam, from 2017 to 2021.

Background: Vietnam has one of the highest rates of antibiotic resistance in Asia. In 2020, the Vietnam Minister of Health introduced new legislation for the implementation of an antimicrobial stewardship program (ASP). The evidence for the effectiveness of ASP in small hospitals and hospitals located in provinces was limited compared with larger-scale and central city hospitals. Aim: Evaluation of the impact before and after the introduction of an antimicrobial stewardship program at Dong Thap General Hospital, from 2017 to 2021. Methods: Retrospective data was collected from June 2017 to June 2021. The impact of the ASP on changes in antibiotic use and the clinical outcome associated with the implementation of the ASP was evaluated using autoregressive integrated moving average modelling of controlled interrupted time-series analysis. Results: There was a significant and sustained decrease in antibiotic consumption level (step change) in 2 indicators, DOT/1000PD (129.55; P<0.01) and LOT/1000PD (99.95, P<0.01), immediately after the ASP intervention. There were no statistically significant changes identified in terms of consumption with DDD/1000PD, or in the clinical outcomes. The results showed no statistically significant change in consumption trend (ramps) in all evaluated indicators. No statistically significant changes in consumption levels and trends were observed in the control group. Conclusion: The ASP implemented in Dong Thap General Hospital from 2017 to 2021 showed a considerable influence on antibiotic consumption as indicated by the DOT/1000 PD and LOT/1000 PD during the initial stages. Moreover, controlling antibiotic consumption did not negatively impact patient outcomes.

Optimal forest management for carbon sequestration, timber, and bioenergy production in Vietnam using an extended full-cycle carbon accounting method.

Using an extended full-cycle carbon model from the Faustmann framework, which allows for management strategies of several uses concurrently implemented in the same area of forest, this paper investigates the selection of management objectives that are beneficial and optimal for forest plantations in Vietnam. Three scenarios are considered: Scenario 1 investigates the management objective of maximizing the land economic value (LEV) of timber as a single production. Scenario 2 investigates the joint production of timber and bioenergy sources. Scenario 3 analyzes the joint production of timber, bioenergy production, and carbon sequestration. The findings reveal that if growers pursue a timber management objective (Scenario 1), the farming business only provides considerable benefits under the government-subsidized credit scheme of 8.4%. For a higher non-subsidized interest rate of 15.24% of commercial banks, such gains reduce substantially and become negative value under the mean interest rate of 19.08% of private credit sources. Altering the management objective to a joint production of timber and raw bioenergy production (Scenario 2) will boost the LEV by a moderate level, but at the expense of timber production and thus carbon stock. However, the reduction tendency of timber and carbon balance is not substantial due mainly to the relatively small proportion of bioenergy production compared to timber production; therefore, decision-making frameworks targeting carbon uptake may be capable of incorporating such levels of confliction. Further internalizing the carbon value of the forest into management objectives generally leads to a longer rotation length, thus improving both carbon sequestration and income gains. Shifting the current timber-dominant management objective to a joint production of timber and bioenergy sources, or, alternatively, a joint production of timber, bioenergy production, and carbon sequestration when the carbon market is emerging, is a good alternative strategy for forest management in Vietnam.

Genetic diversity of the oipA gene among Helicobacter pylori isolates and clinical outcome in Vietnam.

Outer inflammatory protein A (OipA), which is encoded by the oipA gene, can induce interleukin-8 secretion in gastric epithelial cells. The functional status of the oipA gene is regulated by the slipped-strand mispairing mechanism based on the CT dinucleotide repeat number in the 5' region. This study aimed to investigate the oipA functional status ("on/off") of Helicobacter pylori (H. pylori) and its association with gastroduodenal diseases in southwestern Vietnam. The cross-sectional study was conducted on 173H. pylori isolates from 173 patients with gastroduodenal diseases. Sanger sequencing was used to determine the functional status of oipA. Multivariable logistic regression analysis was performed to identify the association between oipA status and gastroduodenal diseases. The oipA "on" status accounted for 96% of H. pylori isolates. Twenty-five CT repeat patterns of the oipA 5' signal region were observed, five of which were novel CT repeat patterns. The oipA "on" status was found in 100%, 97.8%, and 86.8% of H. pylori isolates from patients with peptic ulcer, precancerous lesions, and chronic gastritis, respectively (p < 0.01). The oipA "on" status was related to gastric precancerous lesions versus chronic gastritis (adjusted OR = 7.39, 95% CI: 1.35-40.59, p = 0.021) and peptic ulcers versus chronic gastritis (adjusted OR = 12.79, 95% CI: 1.19-1760.32, p = 0.033). Our data show a high prevalence of the oipA "on" status, which was associated with precancerous gastric lesions and peptic ulcers. Moreover, genetic diversity in the number and pattern of CT dinucleotide repeat of oipA among Vietnamese H. pylori strains was identified.

Telepharmacy: A Systematic Review of Field Application, Benefits, Limitations, and Applicability During the COVID-19 Pandemic.

Introduction: Telepharmacy is widely known as the delivery of pharmacy care offered by registered pharmacists and pharmacies using telecommunication technologies to patients at a distance. We conducted a systematic review of the reported usages, benefits, and limitations of telepharmacy models worldwide to further clarify the pros and cons of a telepharmacy model. Methods: A total of 39 relevant articles was included after searching for articles with a fixed term on four databases, including PubMed, Virtual Health Library (VHL), Global Health Library (GHL), and Google Scholar, as of April 2021. Results: Our review suggested that telepharmacy has played an essential role in addressing pharmacist shortages and helping patients both safely and effectively administer medications in underserved areas. During the COVID-19 pandemic, remote dispensing and counseling are effective measures to avoid infection. Conclusion: Telepharmacy could potentially replace or complement pharmaceutical-related activities, facilitating future innovation in the health care industry.

Two new steroidal saponins from the roots of Cordyline fruticosa (L.) A. Chev.

Two new steroidal saponins, 26-O-ß-D-glucopyranosyl-22α-methoxy-5α-furost-25(27)-ene-1ß,3ß,26-triol 1-O-ß-D-glucopyranoside (1), and 26-O-ß-D-glucopyranosyl-22α-methoxy-furosta-5,25(27)-diene-1ß,3ß,26-triol 1-O-α-L-rhamnopyranosyl-(1→2)-ß-D-fucopyranoside (2) were isolated and elucidated from the roots of Cordyline fruticosa (L.) A. Chev. Their structures were established by interpretation of spectroscopic data (1 D and 2 D NMR) and mass spectrometry (HR-ESI-MS).

Pharmacists' Perspectives on the Use of Telepharmacy in Response to COVID-19 Pandemic in Ho Chi Minh City, Vietnam.

Introduction: Telepharmacy, the application of information and communication technologies in healthcare services, has been adopted in many countries to provide patients with pharmaceutical care. However, it has yet to be widely used in Vietnam. This study was conducted to assess the current status of use and the factors associated with the willingness to use telepharmacy of pharmacists in Vietnam. Methods: A descriptive cross-sectional study was conducted from February to July 2021; 414 pharmacists were recruited to fill in an online survey. Results: Overall, 86.7% of participants have used telepharmacy application and 87.2% of them were willing to apply telepharmacy in pharmacy practice. According to our multivariate analysis, the level of readiness was associated with positive attitude (odds ratio [OR] = 4.67; 95% confidence interval [CI]: 2.26-9.66), and a good behavior (OR = 11.34; 95% CI: 3.84-33.45). Discussion: Developing a telepharmacy system with appropriate features is essential to meet the requirements of pharmacy practice amid the spread of the COVID-19 pandemic.

Assessment of Knowledge, Attitude, and Practice in Adverse Drug Reaction Reporting of Healthcare Professionals in Vietnam: A Cross-Sectional Study.

Background: Under-reporting is a major issue of ADR spontaneous reporting system. This study assesses the knowledge, attitude, and practice of healthcare professionals in Children's Hospital in Vietnam and suggests solutions to enhance ADR reporting rate based on findings. Methods: A cross-sectional study was conducted and 397 self-administered structured questionnaires were distributed to all potential HCPs working in surveyed hospital within 2 weeks from June 03 to June 20, 2020. Results: Overall response rate was 97% with 384 responses. A majority answered correctly ADRs' knowledge apart from form supplier (1.6%) and possible causes (2.6%). The need to focus on patient care (33.3%) and the trivia of reaction (31.5%) reduced HCPs' attention. About 61.7% reported once in their career, 49.7% had training. Having trained group had numbers of practice significantly higher than their counterparts. Major reason for not reporting was lack of information and instruction. Preferred solutions were regularly training, updating, and collaboration of HCPs in reporting ADR. Conclusion: Healthcare professionals had adequate knowledge, positive attitude, and moderate practice. Training significantly raised the number of practices in reporting ADR. Preferred solutions were regular training, updating, and collaboration of healthcare professionals in ADR reporting.

Multipole resonance and Vernier effect in compact and flexible plasmonic structures.

Spoof surface plasmons in corrugated metal surfaces allow tight field confinement and guiding even at low frequencies and are promising for compact microwave photonic devices. Here, we use metal-ink printing on flexible substrates to construct compact spoof plasmon resonators. We clearly observe multipole resonances in the microwave frequencies and demonstrate that they are still maintained even under significant bending. Moreover, by combining two resonators of slightly different sizes, we demonstrate spectral filtering via the Vernier effect. We selectively address a target higher-order resonance while suppressing the other modes. Finally, we investigate the index-sensing capability of printed plasmonic resonators. In the Vernier structure, we can control the resonance amplitude and frequency by adjusting a resonance overlap between two coupled resonators. The transmission amplitude can be maximized at a target refractive index, and this can provide more functionalities and increased design flexibility. The metal-ink printing of microwave photonic structures can be applied to various flexible devices. Therefore, we expect that the compact, flexible plasmonic structures demonstrated in this study may be useful for highly functional elements that can enable tight field confinement and manipulation.

Re-Identification of Patient Subgroups in Uveal Melanoma.

Uveal melanoma (UM) is a comparatively rare cancer but requires serious consideration since patients with developing metastatic UM survive only for about 6-12 months. Fortunately, increasingly large multi-omics databases allow us to further understand cancer initiation and development. Moreover, previous studies have observed that associations between copy number aberrations (CNA) or methylation (MET) versus messenger RNA (mRNA) expression have affected these processes. From that, we decide to explore the effect of these associations on a case study of UM. Also, the current subtypes of UM display its weak association with biological phenotypes and its lack of therapy suggestions. Therefore, the re-identification of molecular subtypes is a pressing need. In this study, we recruit three omics profiles, including CNA, MET, and mRNA, in a UM cohort from The Cancer Genome Atlas (TCGA). Firstly, we identify two sets of genes, CNAexp and METexp, whose CNA and MET significantly correlated with their corresponding mRNA, respectively. Then, single and integrative analyses of the three data types are performed using the PINSPlus tool. As a result, we discover two novel integrative subgroups, IntSub1 and IntSub2, which could be a useful alternative classification for UM patients in the future. To further explore molecular events behind each subgroup, we identify their subgroup-specific genes computationally. Accordingly, the highest expressed genes among IntSub1-specific genes are mostly enriched with immune-related processes. On the other hand, IntSub2-specific genes are highly associated with cellular cation homeostasis, which responds effectively to chemotherapy using ion channel inhibitor drugs. In addition, we detect that the two integrative subgroups show different age-related risks and survival rates. These discoveries can influence the frequency of metastatic surveillance and support medical practitioners to choose an appropriate treatment regime.

The Economic Burden of Chronic Kidney Disease in Vietnam.

Our objective is to analyze the economic burden of chronic kidney disease (CKD) in Vietnam, particularly in District 2 Hospital at Ho Chi Minh City in 2019. This is a descriptive cross-sectional study. The data source is the medical records of the patients. Encoding the data, analyzing treatment cost, regression modeling, and verification were performed using Stata 15 software. Patients with stage 3 CKD account for the highest proportion of the CKD patient population. CKD comorbidities include hypertension, diabetes, cardiovascular disease, and anemia, which increase the treatment fees of patients. Approximately half of the patients with CKD have diabetes or cardiovascular disease. Treatment costs increase as the condition of the patient worsens (except for stage 1 and 2 CKD). The total expenses of all CKD patients in District 2 Hospital were USD 916 423 988.60. Five main factors that affect the treatment fee of a patient: CKD stage, age, gender, and the presence of diabetes, cardiovascular disease, and anemia. The regression model correctly predicts 96% of cases and can explain 64.15% of the fluctuations in costs. The cost of CKD treatment was higher than Vietnam's per capita GDP in 2019, and the primary factors affecting costs are comorbidities and dialysis.

Effect of Additives during Interfacial Polymerization Reaction for Fabrication of Organic Solvent Nanofiltration (OSN) Membranes.

Thin film composite (TFC) membranes is the dominant type of desalination in the field of membrane technology. Most of the TFC membranes are fabricated via interfacial polymerization (IP) technique. The ingenious chemistry of reacting acyl chlorides with diamines at the interface between two immiscible phases was first suggested by Cadotte back in the 1980s, and is still the main chemistry employed now. Researchers have made incremental improvements by incorporating various organic and inorganic additives. However, most of the TFC membrane literature are focused on improving the water desalination performance. Recently, the application spectrum of membrane technology has been expanding from the aqueous environment to harsh solvent environments, now commonly known as Organic Solvent Nanofiltration (OSN) technology. In this work, some of the main additives widely used in the desalination TFC membranes were applied to OSN TFC membranes. It was found that tributyl phosphate (TBP) can improve the solubility of diamine monomer in the organic phase, and sodium dodecyl sulfate (SDS) surfactant can effectively stabilize the IP reaction interface. Employing both TBP and SDS exhibited synergistic effect that improved the membrane permeance and rejection in solvent environments.

Impact of Antimicrobial Stewardship Program on Vancomycin Usage: Costs and Outcomes at Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.

BACKGROUND: Nowadays, with the emergence of vancomycin-resistant strains, the clinical use of vancomycin has been followed closely by applying the antimicrobial stewardship program (ASP) to enhance effectiveness in treatment and reduce cost burden for patients. METHODS: A descriptive cross-sectional study at the Hospital for Tropical Diseases was conducted to assess the inpatient status assigned to intravenous vancomycin and factors associated with the cost of treatment during two periods of implementing ASP, which were i) from April 1, 2016 to March 31, 2018 (previous ASP-pASP) and ii) from June 1, 2018 to March 31, 2020 (new ASP-nASP). RESULTS: Among 1375 patients who met the sampling criteria, there were 601 and 774 patients in pASP and nASP, respectively. The rate of no improvement/mortality in the pASP was higher than that in nASP (37.10% vs 25.98%, p <0.05). The proportion of patients with two or more infection episodes in nASP is lower than that in pASP (9.83% vs 18.64%, p<0.05). Besides, nASP has higher length of therapy (LOT) and higher day of therapy (DOT). The average treatment cost in the pASP is higher than that in the nASP, 1891.22 (95% CI, 1713.46-2068.98) USD vs 1775.55 (95% CI, 1576.22-1974.88) USD. There are seven factors (p<0.05) that associate with the total cost of treatment (age, number of infection episodes, length of stay, discharge status, clinical department, LOT, DOT) in pASP. On the other hand, the nASP has five factors (p<0.001), in which the log(LOT) and age are not as statistically significant (p=0.5127 and 0.3852, respectively) as in the pASP model. CONCLUSION: The implementation and improvement of the ASP at the Hospital for Tropical Diseases have initially shown benefits for patients using intravenous vancomycin. Specifically, the ASP helps to reduce treatment costs, improve patient outcomes, reduce length of stay and decrease the average daily dose of vancomycin.

Assessment of Job Stress of Clinical Pharmacists in Ho Chi Minh City, Vietnam: A Cross-Sectional Study.

Objectives: The official implementation of clinical pharmacy in Vietnam has arrived relatively late, resulting in various stressors. This study aims to evaluate job stress level and suggest viable solutions. Methods: A cross-sectional study was conducted on clinical pharmacists (CPs) in 128 hospitals in Ho Chi Minh City (HCMC). Job stress questions were derived from the Healthcare Profession Stress Inventory (HPSI). Results: A total of 197 CPs participated, giving a response rate of 82.4%. Participants were found to have moderate job stress with an overall mean stress score of 1.5 (0.4) and stress rate of 52.8%. The sample size was statistically adequate and the HPSI was valid and reliable. Patient care responsibility was the main stressor, especially in public hospitals, followed by job conflicts. Lack of experience, low income, and inability to participate in clinical ward rounds caused significant stress to CPs regarding job recognition and job uncertainty. More practice-oriented training programs in bachelor curricula and clinical practice should be applied to help CPs gain more experience, self-confidence, and diminish job stress. Conclusion: CPs in HCMC have moderate stress. More practice-oriented training programs should be prioritized to lessen stress for CPs.

Recyclable waste collection by informal sector in Vietnam: Dataset from Vinh, Nha Trang, Buon Ma Thuot, Da Nang, Ho Chi Minh and Hanoi Cities.

Even though the matter was not widely acknowledged, informal recycling plays a vital role in waste treatment in many developing countries. In Vietnam, the management of waste collection and treatment faces many difficulties, as there is no statistical data or description of the informal sector in waste collection and recycling to clarify their role, their scale, and their capacity. This paper presents the preliminary data processed by informal waste collectors and aggregators in six Vietnamese cities, namely, Vinh, Nha Trang, Buon Ma Thuot, Da Nang, Ho Chi Minh, and Hanoi. The surveys were conducted from January 2017 to December 2019 by the JEAI Recycurbs Viet project [1] and then from August 2019 to December 2020 in the framework of the COMPOSE project (2019-2021) [2]. Geographical and sociology data of aggregators will demonstrate the overall background of the presence, spatial allocation, and the establishment process of aggregators in the surveyed cities to find the patterns of establishment and operations of these aggregators. The data will be the basis for the development of policy making on Extended Producer Responsibility (EPR) in Vietnam.

The Roles of Membrane Technology in Artificial Organs: Current Challenges and Perspectives.

The recent outbreak of the COVID-19 pandemic in 2020 reasserted the necessity of artificial lung membrane technology to treat patients with acute lung failure. In addition, the aging world population inevitably leads to higher demand for better artificial organ (AO) devices. Membrane technology is the central component in many of the AO devices including lung, kidney, liver and pancreas. Although AO technology has improved significantly in the past few decades, the quality of life of organ failure patients is still poor and the technology must be improved further. Most of the current AO literature focuses on the treatment and the clinical use of AO, while the research on the membrane development aspect of AO is relatively scarce. One of the speculated reasons is the wide interdisciplinary spectrum of AO technology, ranging from biotechnology to polymer chemistry and process engineering. In this review, in order to facilitate the membrane aspects of the AO research, the roles of membrane technology in the AO devices, along with the current challenges, are summarized. This review shows that there is a clear need for better membranes in terms of biocompatibility, permselectivity, module design, and process configuration.

Proposal for a neurotoxic classification for chemicals at work.

Many neurotoxic chemicals are used in the workplace but there is currently no database dedicated to neurotoxicity. We aimed to develop a classification method for neurotoxicity based on a weight-of-evidence approach, similar to the IARC classification for carcinogenicity. Human and animal lines of evidence were collected from recent toxicological profiles and a literature search and were combined into six groups from neurotoxic to potentially not neurotoxic. The method was tested on 26 chemicals, mixtures or group of products used in the workplace in France: 31% were considered neurotoxic, 31% probably and 11% possibly neurotoxic, and 27% not classifiable because of insufficient data. This operational method suggests that many chemicals used in the workplace are neurotoxic and that questionnaires used to collect data on occupational chemical exposure should propose items with more targeted compounds that have common chemical or toxic properties to improve risk assessment.

Job satisfaction of clinical pharmacists and clinical pharmacy activities implemented at Ho Chi Minh city, Vietnam.

Ho Chi Minh City (HCMC) in Vietnam pioneered the practice of clinical pharmacy; however, hospitals in HCMC have faced numerous challenges that might influence the job satisfaction of clinical pharmacists (CPs). Additionally, there have been no official statistics about clinical pharmacy activities that have been reported so far. Therefore, this study was conducted to examine the current status of the clinical pharmacy profession and to analyze the key factors affecting job satisfaction of CPs in HCMC. This was a cross-sectional study. Self-administered questionnaires were distributed to all the CPs in all the 128 hospitals in HCMC via an online survey tool from May to June 2020. Only about 30% of the respondents were full-time CPs. The percentage of CPs participating in clinical wards was relatively low (52.79%). "Provide drug information for patients and medical employees" was the most common clinical pharmacy activity, with the percentage of CPs participating in it being nearly 90%. Overall, 74.1% of the 197 CPs surveyed were satisfied with their current job. The factors that they were satisfied with the most and the least were "Inter & Intra professional relationships" (95.9%) and "Income" (59.9%), respectively. The only demographic and work-related characteristic that had a statistically significant association with overall job satisfaction was "Ward round participation". Most clinical pharmacy tasks noted a high rate of participation from the CPs. Nevertheless, hospitals in HCMC was found to be experiencing a shortage of CPs and low levels of participation of CPs in ward rounds, and most CPs were unable to completely focus on clinical pharmacy tasks. Regarding CPs' job satisfaction-related aspects, income and ward round participation appear to be the two factors that should be increased, in order to enhance CPs' job satisfaction.

Sustainable Fabrication of Organic Solvent Nanofiltration Membranes.

Organic solvent nanofiltration (OSN) has been considered as one of the key technologies to improve the sustainability of separation processes. Recently, apart from enhancing the membrane performance, greener fabricate on of OSN membranes has been set as a strategic objective. Considerable efforts have been made aiming to improve the sustainability in membrane fabrication, such as replacing membrane materials with biodegradable alternatives, substituting toxic solvents with greener solvents, and minimizing waste generation with material recycling. In addition, new promising fabrication and post-modification methods of solvent-stable membranes have been developed exploiting the concept of interpenetrating polymer networks, spray coating, and facile interfacial polymerization. This review compiles the recent progress and advances for sustainable fabrication in the field of polymeric OSN membranes.

Cost-Effectiveness of Gliclazide-Based Intensive Glucose Control vs. Standard Glucose Control in Type 2 Diabetes Mellitus. An Economic Analysis of the ADVANCE Trial in Vietnam.

Introduction: ADVANCE was a large, multinational clinical study conducted over 5 years in type 2 diabetes mellitus (T2DM). In all, 11,140 patients were randomly assigned to receive gliclazide-based intensive glucose control (IGC) or standard glucose control (SGC). IGC was shown to significantly reduce the incidence of major macrovascular and microvascular events (composite endpoint) or major microvascular events compared with SGC, primarily by enhancing renal protection. We assessed the cost-effectiveness of IGC vs. SGC, based on the ADVANCE results, from a Vietnamese healthcare payer perspective. Materials and Methods: A partitioned survival times model across five health states (no complications, myocardial infarction, stroke, end-stage renal disease [ESRD], and diabetes-related eye-disease) was designed. Time-to-event curves were informed by the cumulative incidence of events and corresponding hazard ratios from the ADVANCE study. Health outcomes were expressed in terms of ESRD avoided and quality-adjusted life years (QALYs). Costs (in US $) comprised treatment costs and health state costs. Utility weights and costs were documented from literature reporting Vietnamese estimates. For sensitivity analyses, all parameters were individually varied within their 95% confidence interval bounds (when available) or within a ±30% range. Results: Over a 5-year horizon, IGC avoided 6.5 additional ESRD events per 1,000 patients treated compared with SGC (IGC, 3.5 events vs. SGC, 10.0 events) and provided 0.016 additional QALYs (IGC, 3.570 QALYs vs. SGC, 3.555 QALYs). Total costs were similar for the two strategies (IGC, $3,786 vs. SGC, $3,757). Although the total drug costs were markedly higher for IGC compared with SGC ($1,703 vs. $873), this was largely offset by the savings from better renal protection with IGC (IGC, $577 vs. SGC, $1,508). The incremental cost-effectiveness ratio (ICER) of IGC vs. SGC was $1,878/QALY gained, far below the threshold recommended by the World Health Organization (i.e., 1-3 × gross domestic product per inhabitant ≈$7,500 in Vietnam). The ICER of IGC vs. SGC per ESRD event avoided was $4,559/event. The findings were robust to sensitivity analysis. Conclusion: In Vietnam, gliclazide-based IGC was shown to be cost-effective compared with SGC from a healthcare payer perspective, as defined in the ADVANCE study.