title: Cost-Effectiveness Analysis of the Self-Management Program for Thai Patients with Metabolic Syndrome.
abstract: BACKGROUND
  Lifestyle modification programs are partly evaluated for their usefulness.
  
  
  OBJECTIVE
  This study aimed to assess the cost-effectiveness and healthy lifestyle persistence of a self-management program (SMP) for patients with metabolic syndrome (MetS) in Thai health care settings.
  
  
  METHODS
  A cost-effectiveness analysis was performed on the basis of an intervention study of 90 patients with MetS randomly allocated to the SMP and control groups. A Markov model with the Difference-in-Difference method was used to predict the lifetime costs from a societal perspective and quality-adjusted life-years (QALYs), of which 95% confidence intervals (CIs) were estimated by bootstrapping. The cost-effectiveness analysis, along with healthy lifestyle persistence, was performed using the discount rate of 3% per annum. Parameter uncertainties were identified using one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  The lifetime costs tended to decrease in both groups. The SMP could save lifetime costs (-2310 baht; 95% CI -5960 to 1400) and gain QALYs (0.0098; 95% CI -0.0003 to 0.0190), compared with ordinary care. The probability of cost-effectiveness was 99.4% from the Monte-Carlo simulation, and the program was deemed cost-effective at dropout rates below 69% per year as determined by the threshold of 160,000 baht per QALY gained. The cost of macrovascular complications was the most influencing variable for the overall incremental cost-effectiveness ratio.
  
  
  CONCLUSIONS
  The SMP provided by the health care settings is marginally cost-effective, and the persistence results support the implementation of the program to minimize the complications and economic burden of patients with MetS.
authors.affiliation: Department of Pharmacy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Anut
authors.initials: A
authors.lastname: Sakulsupsiri
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand. Electronic address: phantipa.s@pharm.chula.ac.th.
authors.forename: Phantipa
authors.initials: P
authors.lastname: Sakthong
authors.affiliation: Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Win
authors.initials: W
authors.lastname: Winit-Watjana
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D024821:Metabolic Syndrome / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D000073278:Self-Management / Q000191:economics*; D013785:Thailand
keywords: Thailand; cost-effectiveness analysis; metabolic syndrome; self-management program