Abstract
This research project is part of the process of developing Thailand health benefit package (Universal Coverage Benefit Package: UCBP) under the Universal Coverage Scheme. In 2019, Radiofrequency Ablation ( RFA) , a therapeutic intervention for chronic low back pain ( CLBP) , was nominated by a stakeholder group of medical experts to be included in the benefit package. Following the prioritisation process, the RFA topic has been selected to have an assessment to examine the value of money and the budget impact of the intervention, prior to presenting to relevant decisionmakers including the Sub- Committee and the Board of National Health Security Office (NHSO) for further decisions. The cost- utility analysis using a Markov model was performed in following the Thai HTA guideline. RFA was compared with current conservative treatment (e. g. , medications – oral/ injection, physical therapy, pain education etc. ) from a social perspective, using 16, 28 month time horizons in the base case and 52 months in the scenario case where RFA can be repeated once. Budget impact was analysed, as well as assessing the feasibility of providing RFA treatment for CLBP patients in Thailand. With the cost- effectiveness threshold of 160,000 Baht/QALY, RFA for chronic low back pain from facet joints was not cost- effective in the Thai context, yielding the incremental cost effectiveness ratios (ICER) of 537,394 and 318,536 THB/QALY in 16-, 28-month time horizons, respectively. In the scenario case, the RFA procedure had an ICER of 282,484 THB/QALY. With an average price of RFA, 22,388 THB/ time, this resulted in a budget impact for only the intervention of 3,466 million THB in the first year and 1,558 million THB in the following years, if considering all patients who are eligible for RFA. Thailand currently has 17 hospitals, both public and private, that have RFA machines with 112 pain specialists who can perform the procedures. However, this is largely concentrated in central region of Thailand. While the relative cost- effectiveness of Radiofrequency Ablation (RFA) in the Thai context remains less favorable compared to conventional or conservative treatments, various stakeholders have advocated for the incorporation of RFA in the health benefit package. The rationale behind this proposition lies in the potential of RFA to mitigate the existing discrepancies in patient access to pain relief services between health insurance schemes. This strategic incorporation not only holds promise in developing the capacity of the pain relief service in the health system, but also promoting more distribution of pain management infrastructure and accessibility beyond Bangkok and some other major provinces. The inclusion of RFA within the benefits package also bears implications for the eventual mitigation of prospective expenditures associated with back pain surgery for chronic back pain patients, which is beyond the scope of this study to examine. Furthermore, if price negotiation is conducted for RFA procedure to be cheaper, this will increase the cost effectiveness of the procedure even more, as well as lowering overall budget impact. Considering all of the above, it is proposed to incorporate RFA in the Universal Coverage Scheme (UCS), with an add-on/ontop reimbursement tariff approximating 12,000 baht/service provision for outpatient settings.
