Summary: Background: Thailand was among the early adopters of a sugar-sweetened beverage (SSB) tax in Asia; however, there is scope to strengthen the policy to improve its impact. The current tier-based design includes a relatively high tax-free threshold, allowing beverages with meaningful sugar content to remain untaxed. This study compared the cost-effectiveness, equity, and economic impacts of alternative SSB tax designs in Thailand. Methods: A deterministic individual-level cohort simulation model with annual cycles was developed using an analytical dataset prepared from 49,127 Thai adults aged 25–59 years from the 2021 national Health Behaviour of Population Survey. Tax scenarios including the current Thai tier-based tax (tax-free threshold ≤6 g/100 mL), a 20% ad valorem tax, a sugar-content-based tax (0.03 THB per gram of sugar), and a modified Thai tier-based tax (tax-free threshold ≤4 g/100 mL) were compared with a counterfactual no-tax scenario. Tax effects were applied for 10 years, with lifetime health and economic consequences modelled. Cases of obesity avoided and quality-adjusted life-years (QALYs) gained were estimated, alongside medical cost savings, productivity gains and tax burden. Outcomes were reported overall and by socioeconomic quintile based on equivalized household income. Equity was assessed using the concentration index. Findings: All four tax designs were projected to be cost-saving compared with the no-tax scenario. The sugar-content-based tax produced the largest health gains, avoiding 115,097 (3.3 per 1000 persons) obesity cases and yielding 208,286 QALYs gained (6.0 per 1000 persons), followed by the modified Thai tier-based tax (99,694 obesity cases avoided (2.9 per 1000 persons); 165,838 QALYs gained (4.8 per 1000 persons)), the current Thai tier-based tax (86,821 obesity cases avoided (2.5 per 1000 persons); 141,433 QALYs gained (4.1 per 1000 persons)), and the 20% ad valorem tax (24,330 obesity cases avoided (0.7 per 1000 persons); 48,583 QALYs gained (1.4 per 1000 persons)). The sugar-content-based tax also produced the largest economic gains, with US$33.4 million in medical cost savings and US$224.6 million in productivity gains. QALYs gained were broadly similar across socioeconomic groups under the tier-based and sugar-content–based taxes, but were more pro-poor under the ad valorem tax. The tax burden was regressive for all designs, with lower-income groups bearing a higher burden relative to income; regressivity substantially greater under the ad valorem tax and comparatively mild under sugar-targeted designs. Interpretation: SSB tax design materially influences the balance between health gains, equity, and consumer financial burden. In Thailand, the current tier-based system could be strengthened through more granular thresholds, while a sugar-content–based tax represents a more ambitious option if administrative capacity and political feasibility allow. Funding: This work was supported by the Australian Government Research Training Program. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Summary: Substance use and substance use disorders are growing public health concerns in Pacific Island Countries and Areas (PICs), yet evidence on policies, resources, services, and interventions remains fragmented. This scoping review synthesised evidence across 22 PICs by searching 10 peer-reviewed databases and 13 grey literature sources for English and French publications from 2015 to 2025. Among 407 included publications, evidence was unevenly distributed, with Guam contributing the largest proportion (27.03%). Alcohol and tobacco were the most frequently discussed substances, and most publications focused on legislation and policies. Regional substance use disorder service capacity (22.5%) was below the global average (34.3%). Evidence on intervention effectiveness was identified in only five PICs, and no cost-effectiveness analyses were found. Strengthening surveillance, research capacity, policy implementation, financing, workforce training, primary care integration, intervention evaluation, and regional collaboration is needed to reduce substance-related harm across the Pacific.
Summary: Background: The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggested Chronic Kidney Disease (CKD)-specific and kidney marker-incorporated cardiovascular disease (CVD) prediction models to estimate the risk of CVD in patients with CKD. However, their validation and comparison in the Chinese populations remain limited. Methods: We validated and compared ten KDIGO-suggested CKD-specific and kidney marker-incorporated CVD risk prediction models in two large Chinese CKD cohorts: the tertiary hospital-based Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) study and the community-based China Kidney Disease Network (CK-NET)-Yinzhou study, respectively enrolling 2938 and 47,100 CKD patients. We defined two types of CVD outcomes: algorithm-specific outcomes adhering to each model's original endpoint definitions, and a unified outcome including myocardial infarction, stroke, heart failure, fatal coronary heart disease, fatal stroke and other cardiovascular deaths for cross-model comparisons. Model performance was evaluated by discrimination and calibration. Findings: According to the head-to-head comparison of all models, CKD-specific and kidney marker-incorporated CVD risk prediction models outperformed traditional CVD risk models, such as the Pooled Cohort Equations (PCE) and the Systematic Coronary Risk Evaluation 2 (SCORE2). The Add-urinary albumin-to-creatinine ratio Prediction Risk of CVD EVENTS (Add-uACR PREVENT) model exhibited superior discrimination among all models. In the C-STRIDE study, this model achieved a concordance index (C-index) of 0.753 (95% CI: 0.717–0.786), outperforming other models with C-indices ranging from 0.670 (95% CI: 0.628–0.710) to 0.740 (95% CI: 0.704–0.774); Similarly, in the CK-NET-Yinzhou cohort, the model achieved a C-index of 0.733 (95% CI: 0.725–0.742), surpassing other models with C-indices ranging from 0.676 (95% CI: 0.669–0.683) to 0.731 (95% CI: 0.722–0.742). Interpretation: In general, the CKD-specific and kidney marker-incorporated CVD risk models demonstrated superior discrimination compared to traditional CVD risk prediction models. Among all models, the Add-uACR PREVENT model showed the best discrimination. These findings support the use of CKD-specific models, particularly the Add-uACR PREVENT model, for CVD risk stratification in Chinese CKD populations. Funding: National Natural Science Foundation of China ; National Key Research and Development Program of China .
