Tạp Chí Khoa học Trường Đại học Quốc tế Hồng Bàng

Develop predictive model for direct treatment cost of acute coronary syndrome using a neural network algorithm

Pho Nghia Van — 2024-12-19

Background: Acute coronary syndrome (ACS) accounts for half the global economic burden. Current models to predict the ACS treatment cost have low accuracy and high complexity. This study aimed to build a more accurate predictive model using a neural network algorithm. Objectives: 1) Survey the cost of treating ACS at research hospitals. 2) Analyze factors associated with total direct cost of treating ACS at research hospitals. 3) Build and assess a model that predicts the total direct cost of treating ACS at research hospitals. Subjects and methods: A cross-sectional descriptive analysis was conducted based on the electronic medical records of 496 ACS inpatients at Cho Ray and Bach Mai hospitals. Factors associated with the total direct cost were used as inputs to build the neural network model. The grid search tool and k-fold cross-validation were used to select the best set of hyperparameters.Results: Mean total direct cost per ACS patient per course was 75,443,006±52,443,599 VND. Gender, health insurance type, course duration, health status at discharge, and number of comorbidities influenced the cost and were used as model inputs. Regarding the best set of hyperparameters, the distribution was Laplace, the transfer function was rectifier with dropout, the loss function was Absolute, the number of neurons in each hidden layer was 40, the number of hidden layers was 2, the lasso value was 1.0E-5, the ridge value was 1.0E-3, and the rho value was 0.999. The training set root mean squared error (RMSE) (25,091,949 VND) was smaller than those of the validation and test sets (33,025,969 and 29,202,777 VND, respectively); the difference between total predicted and actual cost was not significant, indicating that the optimization and regularization criteria were reached. Conclusions: The predictive model has relatively high accuracy and may be applicable in real-world settings. The model should be continuously enhanced to improve predictions and expanded to other patient groups based on big medical data.

Willingness to pay per quality-adjusted life year of Non-Hodgkin Lymphoma patients in Vietnam

Phan Gia Huy — 2024-12-19

Objectives: To estimate Willingness to pay per quality-adjusted life year (WTP/QALY) of patients with Non-Hodgkin Lymphoma (NHL) and analyze related factors to WTP/QALY of NHL patients. Patients and methods: Cross-sectional study has been conducted based on surveying NHL patients, satisfying inclusion and exclusion criteria in 5 specialized hospitals of Vietnam from March to August 2018. The structured questionnaire on socio-demographic and clinical characteristics, EQ-5D-5L and WTP were built to directly interview patients. Regression and correlation analysis have been conducted to estimate the related factors to WTP/QALY. The data were analyzed with relevant statistical tests and simple linear regression using SPSS 20.0 statistical software provided by International Business Machines (IBM) - New York, United State of America. A p-value <0.05 was considered statistically significant. Results: Sample included 516 NHL patients with the ratio of men: women of 1.37:1, the average age of 53.57 ± 14.37 years old, the average time of NHL onset of 1.32 ± 0.63 years. The median value of WTP/QALY was accounted for 45,604,698.96 (0.00 – 187,311,321.74) VND/QALY. With the confidence interval of 95%, the statistically significant differences in LogWTP/QALY have been found between men and women (0.179; 95% CI: 0.023 – 0.335; p = 0.025); fulltime- working patients and non-working patients (0.270; 95% CI: 0.275 – 0.512; p = 0.022), intellectual workers and unemployed/ housewife/ disability patients (0.555; 95% CI: 0.095 – 1.014; p = 0.009); lost-income and unlost-income status (0.267; 95% CI: 0.090 – 0.445; p = 0.003), family income (r = 0.272, p = 0.000) and patient income (r = 0.288, p = 0.000), HR-QoL (r = 0.436; p = 0.000). Linear regression analysis with 95% reliability showed R2= 0.291; p = 0.000 with two related factors to LogWTP/QALY including HR-QoL coefficient (β = 1.339; p = 0.000) and family income (β = 8.50 x 10-9; p = 0.014). Conclusion: The median value of WTP/QALY was accounted for 45,604,698.96 (0.00 – 187,311,321.74) VND/QALY. With the confidence interval of 95%, linear regression analysis showed two related factors to LogWTP/QALY including HR-QoL coefficient and family income.

Direct medical cost of liver cirrhosis in Vietnam

Nguyen Duy Khanh — 2024-12-19

Introduction: Cirrhosis is one of the leading causes of death worldwide and also a substantial economic burden for patients, healthcare system and society. However, research concentrating on cost of cirrhosis treatment in Vietnam are limited. The aim of this study was to estimate the inpatient treatment costs of liver cirrhosis and influencing factors on costs in Vietnam. Methods: Descriptive cross-sectional study has been conducted based on retrospective data of all cirrhosis patient's records in 2015 from two hospitals (HCMC Tropical Hospital and Bach Mai Hospital), satisfied inclusion and exclusion criteria. Descriptive and correlation analysis were performed with relevant statistical test (T-test, one-way ANOVA, correlation) and 95% confidence level. Results: The median cost of treatment per session was 6,064,104 VND (3,246,810 VND – 11,195,492 VND); the drug cost has the highest median value with 3,040,395 VND (843,309 VND – 6,411,334 VND). In the structure of treatment cost, health insurance covered the most and the drug costs accounted for highest proportion with the median value of 3,642,446 VND (1,805,001 VND – 7,326,606 VND). The median values of health insurance rates are comparable. The related factors on costs of treatment included the place of residence, the number of days in hospital, the stage and the complications of cirrhosis. A multiple regression model to forecast treatment cost has been built with R-square=0.460, p=0.000; following which the number of days in hospital is the strongest factor on treatment cost (β=0.31, p=0.000); followed by the Northern living place (β=0.131, p=0.000) and the stage of disease (β=0.038, p=0.000). Discussions: We only assess the treatment cost for cirrhosis but do not evaluate the expense for the whole process including many different treatment courses yet. Secondly, this study does not evaluate the outpatient treatment costs. Furthermore, the multiple regression model can only explain 46.0% of the change of converted cost with 03 factors: the number of days using sick-bed, the Northern area and the disease stage. Conclusions: With the rising trend of liver cirrhosis in Vietnam and the high cost of treatment, national health policies and medical programs should be considered.

Willingness-to-pay per quality-adjusted life year of patients with psoriasis: A study in Vietnam

Dinh Hoang Yen — 2024-12-19

Background: The chronic nature and frequent recurrence of psoriasis reduce patients' quality of life and increase treatment costs. This study aimed to estimate the willingness-to-pay (WTP) per quality-adjusted life-year (QALY) of psoriasis patients in Vietnam. Patients and methods: A cross-sectional study was conducted based on face-to-face interviews with psoriasis patients at Ho Chi Minh City (HCMC) Hospital of Dermato-Venereology. The Euro Quality of Life 5-Dimension 5-Level (EQ-5D-5L) questionnaire was used, and questions about WTP were asked. Factors related to WTP per QALY were analysed statistically. Results: A total of 310 psoriasis patients (58.4% males; mean age of 48.84±16.27 years) were included. The mean disease and treatment durations were 11.51±9.82 and 9.69±8.87 years, respectively. The mean health-related quality of life was 0.787±0.128, and WTP/QALY was 7,726.86±4,506.82 USD (179,100,000±104,463,500 VND). Patients with university/college degrees had a significantly higher WTP/QALY (10,666.60 USD - 247.24 million VND) than patients with high school or under high school education (8,440.44 and 6,638.38 USD - 195.64 million and 153.87 million VND, p<0.05). There was a significant negative correlation between WTP/QALY and age (r=-0.247, p=0.000). Conclusions: The WTP per QALY of psoriasis patients was almost 3 times higher than GDP per capita of Vietnam in 2018. Education level, health-related quality of life and age are associated with WTP/QALY.

Cost of stroke from patients' perspective: A real-world evidence study in Vietnam

Le Thi Ngoc Thanh — 2024-12-19

Introduction: Stroke is the second leading cause of death worldwide, accounting for 10% of all deaths and 17 million new cases annually. Its impact on society is enormous, not only due to the disease burden but also because of the associated medical costs. Studies on the cost of stroke in Vietnam have been limited so far. The aim of this study is to evaluate stroke-related costs from the patients' perspective in Vietnam using hospital data. Methods: A cross-sectional study using a randomized sample of stroke patients from a hospital in Ho Chi Minh City (115-bed hospital) was conducted to evaluate the cost of stroke. Patients who were hospitalized for stroke at the studied hospital, had complete medical records, and agreed to participate in the study were selected. Patients who were foreigners, did not complete their treatment at the research hospital, or died during treatment were excluded from the study. The costs of stroke considered both direct (medical and nonmedical) and indirect expenses. Results: Based on the study sample of 273 patients with ratio of men: women of 1.315:1, mean age of 62.97± 14.3; approximately 85% with ischemic stroke and 15% with hemorrhagic stroke. The mean total cost per stroke patient was VND 8,112,458.7 ± 285.499,16; 77% of which was due to direct cost (VND 6,307,554.5) and the rest (23%) was due to indirect cost (VND 1,804,904.2). In the structure of direct cost, the medical costs were 1,22 times higher than non-medical costs (3,470,583.8 vs 2,836,970.7 VND; respectively). Discussions: This study was conducted on a small scale, involving only one hospital and a limited study period, which led to constraints in sample size. The study demonstrated the treatment costs for stroke inpatients and highlighted the variations in different types of stroke-related expenses. These findings can assist medical centers and physicians in making informed clinical decisions. Additionally, the results provide a basis for shaping policy decisions and developing national medical programs. Conclusions: With an average hospital stay of 6.17 ± 0.18 days, direct medical costs constituted the largest portion of the total expenses. Given the increasing incidence of stroke in Vietnam, healthcare policies aimed at reducing the financial burden on stroke patients should be considered.

Health-related quality of life of patients with psoriasis: A pilot study in Vietnam

Le Thi Kim Ngan — 2024-12-19

Background: Psoriasis is a chronic proliferative skin inflammation associated with an immune-allergic mechanism. Long-term treatment regimen and abnormal recurrences may negatively affect the patients' health-related quality of life (HR-QoL). In Vietnam, the HR-QoL of patients with psoriasis has not been fully and comprehensively researched. Objective: Evaluation of HR-QoL of patients with psoriasis and its related factors. Methods: Cross-sectional descriptive study was conducted using the structured 3-part questionnaire, including socio-demographic and clinical characteristics, Dermatology Life Quality Index (DLQI) and visual analogue scale (VAS). Patients with psoriasis treated at Ho Chi Minh City Hospital of Dermato Venerelogy and satisfying inclusion, exclusion criteria were chosen in the study. Face-to-face interview with patients has been conducted from January to March of 2018. Analyzing related factors was performed with relevant statistical tests using 95% confidence interval by SPSS software. Results: Study sample including 310 patients treated at Ho Chi Minh City Hospital of Dermato Venerelogy with the average age of 48.84 ± 16.27 years and 58.39% male. The mean DLQI score was 6.92 ± 3.89 points. Among 6 dimensions of QoL, symptoms and feeling dimension were affected by psoriasis most with the score of 2.99 ± 1.33 (moderate level), followed by treatment dimension (1.77 ± 1.24). Age, living place, occupation, and marital status were related factors to the overall DLQI scores. Limitations: The study did not clarify the relationship of pathological factors with HR-QoL of psoriasis patients. Conclusion: Psoriasis had moderate effect on Vietnamese patient's HR-QoL. Age, living place, occupation, marital status are related factors on the HR-QoL impairment of psoriasis.

Economic value of subcutaneous versus intravenous trastuzumab administration in the treatment of HER2-positive breast cancer: A systematic review

Tran Thi My Duyen — 2024-12-19

Introduction: Trastuzumab is the standard therapy for HER-positive breast cancer, traditionally administered intravenously (T-IV). The subcutaneous trastuzumab (T-SC), introduced in 2013, may may offer cost savings compared to T-IV. While previous studies have examined the economic value of T-SC, no quality assessment of these studies or a currency-standardized comparison across countries has been conducted. This study aimed to address these gaps by systematically reviewing and assessing the quality of economic evaluations comparing T-SC and T-IV. Methods: A systematic review of publications until May 31, 2021, was performed using databases like MEDLINE, Cochrane, and ScienceDirect, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. The quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. All costs were adjusted to 2019 Euro using World Bank's consumer price index (CPI). Results: There were 14 out of 368 studies included in this systematic review. Most studies were conducted from a hospital perspective, showing cost savings of T-SC ranging from €52.6 to €29,617.3 per patient annually. Quality assessments based on the CHEERS checklist revealed that the number of compliant sections or items in the studies ranged from 11 to 19 out of 24. Conclusion: This systematic review demonstrated that T-SC might offer cost savings compared to T-IV in treating HER2-positive breast cancer. However, the limited number of studies and their methodological heterogeneity highlight the need for further comprehensive research to inform decision-makers on trastuzumab use.

Mapping the cancer-specific EORTC QLQ-BR53 onto the preference-based EQ-5D-5L instrument: A cross-sectional study in breast cancer in Vietnam

To Hue Nghi — 2024-12-19

Introduction: The EQ-5D instrument is highly recommended for health economic evaluations but is considered less practical than the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) QLQ-BR53 in clinical studies with cancer patients. In these cases, cross-walking is recommended to convert the cancer-specific instrument onto the preference-based measures. This study aimed to develop an algorithm for direct mapping the QLQ-BR53 onto the EQ-5D-5L utility index in breast cancer patients. Methods: A cross-sectional study was conducted among patients diagnosed with HER2 breast cancer across six oncology hospitals in Vietnam from July to December 2020. Participants' health-related quality of life was assessed using QLQ-BR53 and EQ-5D. Two mapping algorithms - ordinary least squares (OLS) and generalized linear regression (GLM) - were compared. The best-fit model was selected based on MAE, RMSE, MAPE, and AIC. Internal validation was done using hold-out and cross-validation methods. Results: The study involved 338 participants with a mean age of 53.87 ± 9.97 years. Most were diagnosed early (55.7%) and non-metastatic (76.6%). The mean EQ-5D utility value was 0.863 ± 0.142. The OLS model was the best fit for mapping EQ-5D utility scores from QLQ-BR53, with goodness-of-fit statistics: MAE = 0.786; RMSE = 0.1038; MAPE = 11.68%; and AIC = -524.2398. Key components included global health status, future perspective, pain, and arm symptoms. Conclusion: The developed model allows mapping QLQ-BR53 breast cancer data to EQ-5D-5L utility values, aiding in calculating quality-adjusted life years (QALYs) for cost-utility analyses in breast cancer.

A comparison of Vietnamese, Malaysian, Thai and Indonesian EQ-5D-5L value sets using a Vietnamese sample of HER2 positive breast cancer patients

Vo Ngoc Yen Nhi — 2024-12-19

Background: Vietnamese value set was published in 2019, but so far there has been no assessment comparison of the Vietnamese value set with other value sets. Objectives: To compare the Vietnamese, Malaysian, Thai, Indonesian value sets and evaluate the appropriateness of the Vietnamese value set for Vietnamese people. Methods: A cross-sectional study was conducted on 338 HER2 positive breast cancer patients are treating at 6 hospitals in Vietnam. Data was collected by taking the entire sample from July to December in 2019. The EQ-5D-5L health states ratings were collected through interviews with patients and utility scores were calculated using the Vietnamese, Malaysian, Thai and Indonesian value sets. The difference in the mean values from 4 value sets was verified by the Wilcoxon signed rank test and the consistency between value sets was assessed by using intraclass correlation coefficients (ICCs). Spearman's test was used to evaluate the correlation between the patient's demographic characteristics with EQ-5D score (95% confidence interval). Results: The study was performed on 338 patients with the mean age of 53.870 ± 9.970 and weight of patients of 54.589 ± 7.698 kg. The Thai value set had the highest mean utility score (0.904 ± 0.142), followed by the Indonesian value set (0.881 ± 0.117), Malaysian value set (0.867 ± 0.143) and the Vietnamese value set had the smallest mean utility score (0.863 ± 0.142). There was a very high consistency between the value sets ( intraclass correlation coefficients > 0.900). The forecasting model of EQ-5D VAS utility score based on EQ-5D-5L utility score from the Vietnamese value set had the highest R square (R2 = 0.231). Conclusion: Vietnamese, Malaysian, Thai, Indonesian value sets have an overall high level of correlation and consistency, in which the correlation of Vietnamese and Malaysian value sets is highest. The Vietnamese value set is most suitable for the Vietnamese HER2-positive breast cancer patients, the Malaysian value set is the second-best option to be applied.

Forecasting the cost of diabetes: A systematic review

Nguyen Linh Viet — 2024-12-19

Background: Diabetes poses a significant global health risk and is a leading cause of death and reduced life expectancy. Objective: A systematic review was conducted to collect studies predicting the economic burden of diabetes, offering insights for policymakers and stakeholders. Methods: A preferred reporting item for systematic reviews and meta-analyses (PRISMA)-guided systematic review identified relevant studies through a literature search in databases like Embase, PubMed, and Cochrane. Study quality was assessed using the Cost of Illness (COI) checklist. All costs were converted to 2024 US dollars after analyzing study characteristics and findings. Results: There were 16 of 1,667 studies from the three databases satisfied the selection and exclusion criteria. Studies were conducted in several nations across Asia, Europe, North America and globally with all studies were modeled using a descriptive cross-sectional design. Studies have projected the cost of diabetes over a period of 1–40 years. Incidence-based and prevalence-based methods were used in these studies. In previous studies, costs ranged from US$0.19 billion to US$3.1 trillion (USD 2024), depending on the region and forecast year. Incidence-based studies estimated total costs at US$15.88 billion. When combining both approaches, the cost range was found to be between US$0.007 billion and US$248.98 billion. Conclusion: Diabetes is forecast to create a huge economic burden on national health systems, society, and the economy. A concerted effort is required to prepare for such changes. To gain a more holistic understanding of the future costs of diabetes, it is vital to expand the research in developing countries.

Cost-effectiveness of metformin in the prevention of Type 2 diabetes mellitus: A systematic review

Nguyen Thi Thu Thuy — 2024-12-19

Background and aims: Type 2 diabetes mellitus (T2DM) is a common metabolic disorder with serious complications. Prediabetes treatment with metformin or lifestyle changes has been shown to delay the progression of prediabetes to T2DM, thus alleviating the overall economic burden associated with T2DM. This systematic review was conducted to evaluate the cost-effectiveness of metformin in the treatment of prediabetes. Methods and results: A PRISMA-guided systematic review was performed on databases: Pubmed, Cochrane, and Embase with appropriate keywords and phrases. CHEERS checklist was used to evaluate the studies' quality. Research characteristics and outcomes were examined, and Incremental cost-effective ratio (ICER) was converted to the USD 2020. With 402 articles identified through the search strategies, 16 articles that met the selection criteria were included for analysis in this review. All articles were deemed to be of relatively good quality according to CHEERS checklist. These analyses were conducted in developed countries from different perspectives and time frames. One of 16 studies revealed metformin as cost-saving compared to placebo, while the remaining studies reported metformin to be cost-effective compared to placebo, no intervention, or standard care, with ICERs below the willingness-to-pay threshold (ranging from $457/QALY to $164,621/QALY). However, conclusions regarding the cost-effectiveness of metformin versus lifestyle changes varied depending on different perspectives and program intensity. Conclusion: Metformin was dominant or cost-effective compared to placebo and no interventions in the treatment of prediabetes. However, the question about cost-effectiveness of metformin versus lifestyle change remained a subject of controversy among the studies. Further investigation into the cost-effectiveness of metformin compared to lifestyle change was recommended, particularly in developing countries where there is a high prevalence rate and limited healthcare resources.