Annual relative increased in inpatient mortality from antimicrobial resistant nosocomial infections in Thailand.

Antimicrobial resistance is a major health threat worldwide as it brings about poorer treatment outcome and places economic burden to the society. This study aims to estimate the annual relative increased in inpatient mortality from antimicrobial resistant (AMR) nosocomial infections (NI) in Thailand. A retrospective cohort study was conducted at Ramathibodi Hospital, Bangkok, Thailand, over 2008-2012. Survival model was used to estimate the hazard ratio of mortality of AMR relative to those patients without resistance (non-AMR) after controlling for nine potential confounders. The majority of NI (73.80%) were caused by AMR bacteria over the study period. Patients in the AMR and non-AMR groups had similar baseline clinical characteristics. Relative to patients in the non-AMR group, the expected hazard ratios of mortality for patients in the AMR group with Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were 1.92 (95% CI 0.10-35.52), 1.25 (95% CI 0.08-20.29), 1.60 (95% CI 0.13-19.10) and 1.84 (95% CI 0.04-95.58), respectively. In the complete absence of AMR bacteria, this study estimated that annually, in Thailand, there would be 111 295 fewer AMR cases and 48 258 fewer deaths.

Optimizing national immunization program supply chain management in Thailand: an economic analysis.

OBJECTIVES: This study aimed to conduct an economic analysis of the transition of the conventional vaccine supply and logistics systems to the vendor managed inventory (VMI) system in Thailand. STUDY DESIGN: Cost analysis of health care program. METHODS: An ingredients based approach was used to design the survey and collect data for an economic analysis of the immunization supply and logistics systems covering procurement, storage and distribution of vaccines from the central level to the lowest level of vaccine administration facility. Costs were presented in 2010 US dollar. RESULTS: The total cost of the vaccination program including cost of vaccine procured and logistics under the conventional system was US$0.60 per packed volume procured (cm(3)) and US$1.35 per dose procured compared to US$0.66 per packed volume procured (cm(3)) and US$1.43 per dose procured under the VMI system. However, the findings revealed that the transition to the VMI system and outsourcing of the supply chain system reduced the cost of immunization program at US$6.6 million per year because of reduction of un-opened vaccine wastage. CONCLUSIONS: The findings demonstrated that the new supply chain system would result in efficiency improvement and potential savings to the immunization program compared to the conventional system.

Costs of illness due to endemic cholera.

Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were US$32 and US$47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective.