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Teerawattananon K.,Health Intervention and Technology Assessment Program HITAP | Teerawattananon K.,Samut Prakan Hospital | Myint C.-Y.,Health Intervention and Technology Assessment Program HITAP | Wongkittirux K.,Queen Sirikit National Institute of Child Health | And 6 more authors.
PLoS ONE | Year: 2014

Introduction: As part of the development of a system for the screening of refractive error in Thai children, this study describes the accuracy and feasibility of establishing a program conducted by teachers. Objective: To assess the accuracy and feasibility of screening by teachers. Methods: A cross-sectional descriptive and analytical study was conducted in 17 schools in four provinces representing four geographic regions in Thailand. A two-staged cluster sampling was employed to compare the detection rate of refractive error among eligible students between trained teachers and health professionals. Serial focus group discussions were held for teachers and parents in order to understand their attitude towards refractive error screening at schools and the potential success factors and barriers. Results: The detection rate of refractive error screening by teachers among pre-primary school children is relatively low (21%) for mild visual impairment but higher for moderate visual impairment (44%). The detection rate for primary school children is high for both levels of visual impairment (52% for mild and 74% for moderate). The focus group discussions reveal that both teachers and parents would benefit from further education regarding refractive errors and that the vast majority of teachers are willing to conduct a school-based screening program. Conclusion: Refractive error screening by health professionals in pre-primary and primary school children is not currently implemented in Thailand due to resource limitations. However, evidence suggests that a refractive error screening program conducted in schools by teachers in the country is reasonable and feasible because the detection and treatment of refractive error in very young generations is important and the screening program can be implemented and conducted with relatively low costs. © 2014 Teerawattananon et al.


PubMed | Rangsit University, Lamphun Hospital, Queen Sirikit National Institute of Child Health, Health Intervention and Technology Assessment Program HITAP and 4 more.
Type: Comparative Study | Journal: PloS one | Year: 2014

As part of the development of a system for the screening of refractive error in Thai children, this study describes the accuracy and feasibility of establishing a program conducted by teachers.To assess the accuracy and feasibility of screening by teachers.A cross-sectional descriptive and analytical study was conducted in 17 schools in four provinces representing four geographic regions in Thailand. A two-staged cluster sampling was employed to compare the detection rate of refractive error among eligible students between trained teachers and health professionals. Serial focus group discussions were held for teachers and parents in order to understand their attitude towards refractive error screening at schools and the potential success factors and barriers.The detection rate of refractive error screening by teachers among pre-primary school children is relatively low (21%) for mild visual impairment but higher for moderate visual impairment (44%). The detection rate for primary school children is high for both levels of visual impairment (52% for mild and 74% for moderate). The focus group discussions reveal that both teachers and parents would benefit from further education regarding refractive errors and that the vast majority of teachers are willing to conduct a school-based screening program.Refractive error screening by health professionals in pre-primary and primary school children is not currently implemented in Thailand due to resource limitations. However, evidence suggests that a refractive error screening program conducted in schools by teachers in the country is reasonable and feasible because the detection and treatment of refractive error in very young generations is important and the screening program can be implemented and conducted with relatively low costs.


Wongwai P.,Khon Kaen University | Kingkaew P.,Health Intervention and Technology Assessment Program HITAP | Asawaphureekorn S.,Khon Kaen University | Kolatat T.,Siriraj Hospital
Asian Biomedicine | Year: 2015

Background: Prompt diagnosis and treatment of retinopathy of prematurity (ROP) is crucial to prevent blindness. Telemedicine for ROP diagnosis can be applied in regions that lack an expert ophthalmologist. Objectives: To assess the value-for-money of telemedicine in screening for ROP in high-risk infants. Methods: A cost-utility analysis of screening and diagnosis of ROP using telemedicine was compared with the current process for ROP screening (Thai Clinical Trials Registry Identification No. TCTR20130911001). We used decision analytical models to compare costs and outcomes in terms of quality-adjusted life years (QALY) to the health provider and society. We used one-way sensitivity analysis and probabilistic sensitivity analysis to consider parameter uncertainty. Results: The total capital cost for telemedicine to the health provider was 951,000 THB per year. With the base case analysis of 400 children screened per year per RetCam, the performance of screening and diagnosis of ROP using telemedicine (100% sensitivity and 97.8% specificity) was higher compared with the current method (88.9% sensitivity and 93.4% specificity). We therefore expect that blindness can be prevented in 3 children per 400 screening cases. The incremental cost to society of telemedicine compared with the current practice was 837 THB. Preventing just one child from becoming blind can save around 146,000 THB throughout their lifetime based on savings to welfare costs for disabled people. The incremental cost-effectiveness ratio of this telemedicine was 259 THB per case of prevented blindness and 17,397 THB per QALY saved. Conclusions: Store and forward telemedicine for ROP screening is cost-effective.


PubMed | Health Intervention and Technology Assessment Program HITAP, Health Intervention and Technology Assessment Program HITAP International Unit and Phramongkutklao Hospital
Type: | Journal: Health economics | Year: 2016

This study reports the systematic development of a population-based health screening package for all Thai people under the universal health coverage (UHC). To determine major disease areas and health problems for which health screening could mitigate health burden, a consultation process was conducted in a systematic, participatory, and evidence-based manner that involved 41 stakeholders in a half-day workshop. Twelve diseases/health problems were identified during the discussion. Subsequently, health technology assessments, including systematic review and meta-analysis of health benefits as well as economic evaluations and budget impact analyses of corresponding population-based screening interventions, were completed. The results led to advice against elements of current clinical practice, such as annual chest X-rays and particular blood tests (e.g. kidney function test), and indicated that the introduction of certain new population-based health screening programs, such as for chronic hepatitis B, would provide substantial health and economic benefits to the Thais. The final results were presented to a wide group of stakeholders, including decision-makers at the Ministry of Public Health and the public health insurance schemes, to verify and validate the findings and policy recommendations. The package has been endorsed by the Thai UHC Benefit Package Committee for implementation in fiscal year 2016.

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