Comparing the cost­effectiveness of a new hospital­based health technology in a low­middle­income country (Vietnam) with a high­income country (Germany) Vorgelegt von MD. MBA Duong Anh Vuong aus Phutho Von der Fakultät VII - Wirtschaft und Management der Technischen Universität Berlin zur Erlangung des akademischen Grades Doktor der Gesundheitswissenschaften / Public Health Dr. P.H. Genehmigte Dissertation Promotionsausschuss:ionsauschuss:ProVorsitzender: Vorsitzender: Prof. Dr. Jacqueline Müller-Nordhorn Gutachter: Prof. Dr. Reinhard Busse Gutachter: Prof. Dr. Jonas Schreyögg Gutachter: Prof. Dr. Dirk Rades Tag der wissenschaftlichen Aussprache: 28.06.2011 Berlin 2011 D83 i TABLE OF CONTENT List of figures .............................................................................................................................. v List of tables .............................................................................................................................. vi Acknowledgement .................................................................................................................. viii Summary ..................................................................................................................................... x Zusammenfassung .................................................................................................................. xiii Abbreviation .......................................................................................................................... xvii Part I. Introduction ................................................................................................................... 1 Explosion of new health technology ........................................................................................... 1 Health technology assessment .................................................................................................... 3 Diffusion of new health technology in high- and low-middle-income countries ....................... 6 Aims of this thesis ....................................................................................................................... 8 Outline of this thesis ................................................................................................................... 9 Part II. Epidemiology and therapeutic management of brain metastasis .......... 10 Chapter 1. Temporal trends of cancer incidence in Vietnam, 1993-2007 ..................... 10 Abstract ..................................................................................................................................... 11 Introduction ............................................................................................................................... 12 Methods .................................................................................................................................... 13 Results ....................................................................................................................................... 14 Discussion ................................................................................................................................. 18 Conclusion ................................................................................................................................ 21 Chapter 2. Brain Metastases: Epidemiology and therapeutic management ................. 22 Epidemiology ............................................................................................................................ 22 Signs and symptoms ................................................................................................................. 23 Prognostic factors ..................................................................................................................... 25 Diagnosis and treatment ............................................................................................................ 33 Appendix: Primary brain tumors .............................................................................................. 49 Chapter 3. Extracranial metastatic patterns at the occurrence of brain metastases ... 53 Introduction ............................................................................................................................... 55 Material and methods ................................................................................................................ 55 Results ....................................................................................................................................... 57 Discussion ................................................................................................................................. 61 ii Conclusion ................................................................................................................................ 63 Part III. Health care services and Hospital finance ............................................................. 65 Chapter 4. Mental health in Vietnam: Burden of disease and availability of services 65 Abstract ..................................................................................................................................... 66 Introduction ............................................................................................................................... 67 Methods .................................................................................................................................... 67 Results ....................................................................................................................................... 68 Discussion ................................................................................................................................. 74 Conclusion ................................................................................................................................ 76 Chapter 5. Determining the impacts of hospital cost-sharing on the uninsured in Vietnam ........................................................................................................................... 77 Abstract ..................................................................................................................................... 78 Introduction ............................................................................................................................... 79 Background ............................................................................................................................... 79 Methods .................................................................................................................................... 82 Results ....................................................................................................................................... 86 Discussion ................................................................................................................................. 89 Conclusion ................................................................................................................................ 91 Chapter 6. Health care system in Germany ..................................................................... 92 Introduction ............................................................................................................................... 92 Demography and health status .................................................................................................. 93 Organizational structure and personnel resources .................................................................... 94 Health care personnel resources ............................................................................................... 98 Patient empowerment ............................................................................................................. 101 Health care financing .............................................................................................................. 102 Health care service provision .................................................................................................. 112 Quality management ............................................................................................................... 121 Conclusion .............................................................................................................................. 124 Part IV. Cost-effectiveness of a new hospital-based health technology in a low-middle- income country and a high-income country ....................................................................... 126 Chapter 7. The cost-effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of brain metastasis in Vietnam from the perspective of patients and families ............................................................................................................. 126 iii Abstract ................................................................................................................................... 127 Introduction ............................................................................................................................. 128 Material and methods .............................................................................................................. 128 Results ....................................................................................................................................