Feasibility of ultra-low-volume indoor space spraying for dengue control in Southern Thailand.

OBJECTIVES: To assess the feasibility of conducting standard indoor space spraying using ultra-low-volume (SID-ULV) in terms of willingness to pay (WTP) and ability to pay (ATP) and ability to conduct space spraying by local administrative organisations (LAO) in lower Southern Thailand. METHODS: Cross-sectional study. The executive leaders of each LAO were asked to state their WTP and ATP for SID-ULV. Willingness to pay was measured by the payment card and open-ended question methods. Ability to pay was calculated using the budget allocation for space spraying and estimated expenditure for SID-ULV. Ability to conduct the SID-ULV was assessed by interviewing the spraymen. Average WTP and ATP were calculated and uncertainties were estimated using a bootstrapping technique. RESULTS: Ninty-three percent of executive leaders were willing to pay for SID-ULV. The average WTP per case was USD 259 (95% confidence interval [CI] 217-303). Thirty-eight percent of all LAO had actual ATP and 60% had ideal ATP. The average annual budget allocated for space spraying was USD 2327 (95% CI: 1654-3138). The amount of money LAO were willing to pay did not vary significantly between their different types, but ATP did. Thirty-two percent of spraymen could not complete all nine procedures of SID-ULV. CONCLUSIONS: Although WTP for SID-ULV space spraying was high, ATP was low, which revealed the flexibility of budget allocation for SID-ULV in each LAO. The spraymen require training in SID-ULV space spraying.

Cost-effectiveness of interventions for reducing road traffic injuries related to driving under the influence of alcohol.

OBJECTIVE: To determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand. METHODS: We used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a "do-nothing" scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective. RESULTS: Compared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect. CONCLUSIONS: A greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.

Cost of standard indoor ultra-low-volume space spraying as a method to control adult dengue vectors.

OBJECTIVES: To access the costs of standard indoor ultra-low-volume (SID-ULV) space spraying for controlling dengue vectors in Thailand. METHODS: Resources related to SID-ULV space spraying as a method to control dengue vectors between July and December 2009 were identified, measured and valued taking a societal perspective into consideration. Information on costs was collected from direct observations, interviews and bookkeeping records. Uncertainty of unit costs was investigated using a bootstrap technique. RESULTS: Costs of SID-ULV were calculated from 18 new dengue cases that covered 1492 surrounding houses. The average coverage of the SID-ULV was 64.4%. In the first round of spraying, 53% of target houses were sprayed and 44.6% in the second round, of which 69.2% and 54.7% received entire indoor space spraying. Unit costs per case, per 10 houses and per 100 m(2) were USD 705 (95% Confidence Interval CI, 539-888), 180 (95% CI, 150-212) and USD 23 (95% CI, 17-30). The majority of SID-ULV unit cost per case was attributed to productivity loss (83.9%) and recurrent costs (15.2%). The unit cost of the SID-ULV per case and per house in rural was 2.8 and 1.6 times lower than municipal area. The estimated annual cost of SID-ULV space spraying from 2005 to 2009 using healthcare perspective ranged from USD 5.3 to 10.3 million. CONCLUSIONS: The majority of the cost of SID-ULV space spraying was attributed to productivity loss. Potential productivity loss influences the achievement of high coverage, so well-planned SID-ULV space spraying strategies are needed to reduce costs.

The national burden of road traffic injuries in Thailand.

BACKGROUND: This study quantifies the burden of road traffic injuries (RTIs) in Thailand in 2004, incorporating new Thai data on mortality and the frequency and severity of long-term disability. METHODS: We quantified the uncertainty around national RTI mortality estimates based on a verbal autopsy study that was conducted to correct for the large proportion of ill-defined deaths in the vital registration system. The number of nonfatal RTI victims was estimated using hospital and survey data. We used the proportion and severity of long-term disabilities from a recent Thai study, instead of the standard Global Burden of Disease assumptions, to calculate the burden due to long-term disability. To evaluate changes over time, we also calculated the burden of RTIs in 2004 using the method and assumptions used in 1999, when standard Global Burden of Disease assumptions were used. RESULTS: The total loss of disability-adjusted life years due to RTIs was 673,000 (95% uncertainty interval [UI]: 546,000-881,000). Mortality contributed 88% of this burden. The use of local data led to a significantly higher estimate of the burden of long-term disability due to RTIs (74,000 DALYs [95% UI: 55,400-88,500] vs. 43,000 [UI: 42,700-43,600]) using standard Global Burden of Disease methods. However, this difference constituted only a small proportion of the total burden. CONCLUSIONS: The burden of RTIs in 2004 remained at the same high level as in 1999. The use of local data on the long-term health consequences of RTIs enabled an estimate of this burden and its uncertainty that is likely to be more valid.

Sobriety checkpoints in Thailand: a review of effectiveness and developments over time.

This review describes the legal basis for and implementation of sobriety checkpoints in Thailand and identifies factors that influenced their historical development and effectiveness. The first alcohol and traffic injury control law in Thailand was implemented in 1934. The 0.05 g/100 mL blood alcohol concentration limit was set in 1994. Currently, 3 types of sobriety checkpoints are used: general police checkpoints, selective breath testing, and special event sobriety checkpoints. The authors found few reports on the strategies, frequencies, and outcomes for any of these types of checkpoints, despite Thailand having devoted many resources to their implementation. In Thailand and other low-middle income countries, it is necessary to address the country-specific barriers to successful enforcement (including political and logistical issues, lack of equipment, and absence of other supportive alcohol harm reduction measures) before sobriety checkpoints can be expected to be as effective as reported in high-income countries.