Diabetes is a common metabolic disorder with increasing burden in Thailand. The chronic nature along with associated complications makes the disease very costly. In Thailand, there exist some studies on cost of diabetes; however, those studies estimated the cost either from provider or from patient perspective. In order to capture the complete picture of economic burden caused by diabetes, using prevalence‐based approach; the present study estimated the cost of illness of diabetes from societal perspective, the broadest viewpoint covering all costs irrespective of who incur them. Data were collected from 475 randomly selected diabetic patients who received treatment from Waritchaphum hospital in Sakhon Nakhon province of Thailand during 2007–2008 with a response rate of 98%. A micro‐costing approach was used to calculate the cost. The direct medical cost was calculated by multiplying the quantity of medical services consumed by their unit costs while indirect cost was calculated by using human capital approach. The total cost of illness of diabetes for 475 study participants was estimated as USD 418,696 for the financial year 2008 (1 USD = 32 THB). Of this, 23% was direct medical cost, 40% was direct non‐medical cost and 37% was indirect cost. The average cost of illness per diabetic patient was USD 881.47 in 2008 which was 21% of per capita gross domestic product of Thailand. Existence of complications increased the cost substantially. Cost of informal care contributed 28% of total cost of illness of diabetes. Therefore, the disease not only affected the individual but also the family members, friends and neighbours. The economic and social burden of the disease therefore emphasises the need for initiatives to prevent the disease prevalence and counselling to the diabetic patients to prevent the progression of the disease and its devastating complications.
Cordocentesis with placenta penetration carries a higher risk for fetal loss, preterm birth, and low birth weight. This information may be helpful in prenatal diagnosis counseling, and it may encourage performers to avoid placenta penetration, if possible.
Chemotherapy is the primary treatment for advanced and recurrent cervical cancer. To evaluate the survival outcomes of chemotherapy and the prognostic factors in this setting, we conducted a retrospective study by reviewing the medical records of advanced and recurrent cervical cancer patients treated with systemic chemotherapy at our institute between January, 2008 and December, 2014. One hundred and seventy-three patients met the criteria with a mean age of 50.9 years. 4.1% of them were HIV positive. The most common initial stage was stage IVB (30.1%) and the most common histology was squamous cell carcinoma (68.6%). Ninety-two (53.2%) patients were previously treated with concurrent chemoradiation with 53% developing combined sites of recurrence. The median recurrence free interval was 16.7 months. Cisplatin + 5 fluorouracil (5FU) (53.2%) was the most frequent first line chemotherapy followed by carboplatin + paclitaxel (20.2%) with an objective response of 39.3%. Seventy-two patients received subsequent chemotherapy. The median overall survival of all studied patients was 13.2 months. Only a recurrence free interval of less than 12 months was an independent prognostic factor for survival outcome. In conclusion, chemotherapy treatment for advanced and recurrent cervical cancer patients showed modest efficacy with a shorter recurrence free survival less than 12 months as a significant poor prognosis factor.
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