Development of reimbursement model forhome-based chemotherapy in Thailand
Notice bibliographique
Résumé
The objectives of the study were (1) to review on HC reimbursement model in other countries (2) to conduct economic evaluation comparing HC with inpatient chemotherapy and hospital-based chemotherapy treatment (IP) from a societal perspective (3) to develop national models and financing and reimbursing of HC services in Thailand. Literature review and semi-structured interviews as the mixed methods had been applied for data collection. The characteristic of HC and reimbursement policies for public payer and service delivery were obtained from eight countries: Australia, Canada (Ontario), England, France, Japan, Korea, Singapore and the United States (US) (Medicare Part B). A cost-utility analysis was conducted for stage III colon cancer patients after resection with a 6-month time horizon. Parameter inputs for the analysis had gathered data from Ramathibodi hospital and literature review. The measuring of health outcomes was in the form of Quality-adjusted life years (QALYs). Result of international review, Thai context literature review and economic evaluation were used to develop the HC reimbursement model in Thailand. A stakeholder meeting was proceeded to summarize opinions to the models. The budget impact analysis was done after the reimbursement model was developed. Comparators of the analysis were hospital-based chemotherapy with the current reimbursement model and HC with proposed reimbursement models. The result found that the HC characteristics are various among countries. There are three types of HC: Ambulatory infusion pump (AIP), Hospital in the home program (HITH) and Home health provider (HHP) where the different service structures are provided under healthcare system organization and governance. Funding mechanisms reflect country-specific context and local variations in care provision, where this depends on the reimbursement mechanism and compliance on the healthcare system of each country. The result of the economic analysis showed that HC was a dominant option that provided 52,968 baht of cost-saving per patient for the episode of treatment. QALYs of HC and IP were 0.3598 and 0.3362, respectively. We recommend the reimbursement models that comply with the Thai context. The models supported hospital management, central venous (CV) port, AIP and mini spill kit that were the important compositions of HC service. The stakeholder meeting was conducted with 31 participants from payers, hospitals and cancer organizations in Thailand. The stakeholders considered AIP HC that would be suitable for the organization, governance, and management of the hospital and payers would support HC management and equipment for more accessibility of the service. The budget impact analysis found total cost saving comparing HC and IP treatment from a societal perspective was 27.84 million baht for 100% patient accessibility rate. The study concluded that HC is a cost-saving strategy comparing with IP. In Thailand, moving chemotherapy into HC could help with cost-saving and increasing patient health outcomes. For HC development, healthcare providers, patients, and relatives must be trained to handle the process of treatment at home. The HC AIP service is optional for a cancer patient in Thailand. The implementation of the service would be supported by the new reimbursement model that appropriate with the Thai healthcare system.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».