Development of health promotion model for economic evaluation in Thailand: a case study of alcohol control interventions

The evaluation of health promotion interventions has also become increasingly important in Thailand, particularly evaluation of effectiveness and cost-effectiveness (Room et al. 2003). The past evaluations of ThaiHealth were the assessment of intermediate outcome e.g. alcohol consumption per capita, individual alcohol drinking pattern, aggregate alcohol sales, and household expenditure on alcohol (Buasai et al. 2007; Galbally et al. 2012). However, the further expected outcomes of those interventions should be changes in epidemiological measures e.g. mortality, morbidity, and healthrelated quality of life in population, which these are the final outcomes of interest (Martineau et al.2013; Tones 1992). Moreover, for the purposes of economic evaluation of alcohol consumption control interventions, it is still methodological problematic to estimate that decreasing alcohol consumption could estimate the final outcomes of interest, especially measured as life years (LYs), quality-adjusted7life years (QALYs) and lifetime economic cost which are widely recommended for economic evaluation of health interventions, including recommendation of Thai Health Technology Assessment Guidelines (Chaikledkaew and Kittrongsiri 2014; ISPOR 2014; NICE 2013; Teerawattananon and Chaikledkaew 2008).

To operate health promotion programmes and support funded partners, ThaiHealth invested the annual budget around 0.75% of total national health expenditure (3,489 million baht) (Buasai et al.2007; Galbally et al. 2012). Due to ThaiHealth’s investments since 2001, ThaiHealth has been evaluated and monitored by policy makers and public sectors (Buasai et al. 2007; Galbally et al. 2012). Therecommendations from the ThaiHealth’s 10-Year Review referred to the demand for health economics, impact evaluation, action research and social epidemiology to strengthen ThaiHealth’s evaluation efforts overall to prove that its funding decisions offer value for money (Galbally et al. 2012). Therefore, this further methodological research will develop to improve the estimation outcomes of interest, especially cost-effectiveness. The method used has been developed and validated in Scottish setting which is the alcohol policy mathematic model for predicting LYs, QALYs and lifetime health care costs. The further study will transfer the methodology of developing alcohol policy model in Scottish setting to Thai setting using country-specific data. The Thai study will demonstrate cost-effectiveness of existing alcohol policies and interventions in Thailand. To estimate a cost-effectiveness of health promotion intervention which this study is focusing on an alcohol intervention in different levels (e.g. individual and population), the economic evaluation alongside RCTs (for a source of evidence on relative effectiveness) might be limited. As a result, it would be needed the combined approaches to estimate the costs and outcomes of alcohol intervention with avoiding biased estimate. Even though the existing economic evaluation alongside RCTs were conducted to assess the intervention cost-effectiveness (Cowell et al. 2012; Crawford et al. 2014; Crawford et al. 2015; UKATT Research Team 2005), these estimates were measured within follow up period, while the consequences of alcohol intervention often become noticeable many years after implementation. Thus, the extrapolation of costs and outcomes beyond the end of the trial using observational data to link intermediate outcomes to final outcomes should be considered to extend the time horizon analysis (e.g. for the lifetime of different drinking patterns). This study will develop a health promotion policy model which is a model that can evaluate the effectiveness and cost-effectiveness of interventions to inform health policy decision makings (Lewsey et al. 2015).

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