Direct and indirect costs of smoking in Vietnam.

OBJECTIVE: To estimate the direct and indirect costs of active smoking in Vietnam. METHOD: A prevalence-based disease-specific cost of illness approach was utilised to calculate the costs related to five smoking-related diseases: lung cancer, cancers of the upper aerodigestive tract, chronic obstructive pulmonary disease, ischaemic heart disease and stroke. Data on healthcare came from an original survey, hospital records and official government statistics. Morbidity and mortality due to smoking combined with the average per capita income were used to calculate the indirect costs of smoking by applying the human capital approach. The smoking-attributable fraction was calculated using the adjusted relative risk values from phase II of the American Cancer Society Cancer Prevention Study (CPS-II). Costs were classified as personal, governmental and health insurance costs. RESULTS: The total economic cost of smoking in 2011 was estimated at 24 679.9 billion Vietnamese dong (VND), equivalent to US$1173.2 million or approximately 0.97% of the 2011 gross domestic product. The direct costs of inpatient and outpatient care reached 9896.2 billion VND (US$470.4 million) and 2567.2 billion VND (US$122.0 million), respectively. The government's contribution to these costs was 4534.3 billion VND (US$215.5 million), which was equivalent to 5.76% of its 2011 healthcare budget. The indirect costs (productivity loss) due to morbidity and mortality were 2652.9 billion VND (US$126.1 million) and 9563.5 billion VND (US$454.6 million), respectively. These indirect costs represent about 49.5% of the total costs of smoking. CONCLUSIONS: Tobacco consumption has large negative consequences on the Vietnamese economy.

Mortality attributable to smoking in Vietnamese men in 2008.

OBJECTIVE: Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies. METHOD: We used the Peto-Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses. RESULTS: When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24-31%) of all adult male deaths (>35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21-26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23-28%)]. CONCLUSION: Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.

Schizophrenia interventions in Vietnam: primary results from a cost-effectiveness study.

Schizophrenia is a highly disabling mental health disorder that imposes a considerable economic burden on a health care system. This paper aimed to examine the cost and effectiveness of alternative pharmaceutical interventions and the effects of family intervention (FI) for schizophrenia from the government perspective in order to introduce the most cost-effective intervention applicable to Vietnam. A Markov model was developed to estimate costs and health outcome over patients' lifetimes when using typical and atypical antipsychotic drugs, alone or in combination with family intervention. Health outcome was measured in terms of disability-adjusted life years averted. Monte Carlo simulation was used for uncertainty analysis. According to our findings, interventions using typical or atypical drugs combined with FI were found to be the most effective and least costly compared to a 'do-nothing' scenario. Interventions using atypical drugs alone were estimated to be much less favourable due to a considerably higher cost. This is a very first attempt on cost-effectiveness analysis of interventions for schizophrenia in Vietnam, and recommendations are made for future research to determine the most cost-effective intervention.

Estimation of Vietnam national burden of disease 2008.

Burden of disease has been used to assess population health status. This article presents the first estimations of burden of disease in Vietnam in 2008 using disability-adjusted life years (DALYs). DALYs were calculated using the Global Burden of Disease (GBD) methods. Incidence, prevalence of diseases, and causes of death was extracted from Vietnam data. Disability weights were borrowed from GBD and Dutch research. In 2008, the total burden of disease in Vietnam was 12.3 million DALYs. Noncommunicable diseases dominated the total burden of diseases in Vietnam, accounting for 71% of the total burden, and cardiovascular disease was the leading cause group of premature death. While pneumonia was an important cause of burden in Vietnamese children, stroke and depression were the main causes of disease burden among adults. The study provides a snapshot of Vietnamese health status and offers guidance for health policymaking in Vietnam.