From Research to Policy Implementation: Trastuzumab in Early-Stage Breast Cancer Treatment in Thailand.

OBJECTIVES: To evaluate the adjuvant therapy of trastuzumab cost and quality-adjusted life-years (QALYs) in lifetime horizon and describe the use of an economic evaluation in supporting policy-making decisions in the treatment of early-stage breast cancer in Thailand. METHODS: A Markov model was used to evaluate the cost effectiveness of 1-year adjuvant trastuzumab for patients with early-stage breast cancer who were considered human epidermal growth factor receptor 2/neu-positive with a societal perspective and lifetime horizon. The research variables were probability of health state change, health utility, and cost of treatment. A sensitivity analysis was conducted using probabilistic methods. A budget impact analysis was also performed. RESULTS: The results revealed that the treatment cost and QALYs in the trastuzumab group yielded 4.59 QALYs. The incremental cost-effectiveness ratio was $3387 (THB 118 572; THB = Thai baht) per QALY. On the basis of the willingness-to-pay threshold in Thailand, a 1-year adjuvant trastuzumab treatment for breast cancer was a cost-effective therapy. CONCLUSIONS: A combination therapy that includes trastuzumab is a preferable choice and should be used in early-stage breast cancer treatment. The Thai government has listed trastuzumab on the National List of Essential Medicines to be used for the early stages of breast cancer since 2014.

Evaluation of sleep profile in schizophrenia patients treated with extended-release paliperidone: an open-label prospective study in Southeast Asia.

OBJECTIVE: To evaluate the effect of 6 months of treatment with paliperidone extended-release (ER) tablets on the sleep profile of patients with schizophrenia. METHODS: A total of 984 patients meeting the The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia who switched their antipsychotic to paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We recorded patient demographics and assessed sleep quality and daytime drowsiness using visual analog scales. RESULTS: Approximately 70% of patients completed the 6-month study. After the use of paliperidone ER, patients reported significantly better sleep quality (76.44 vs 65.48; p<0.001) and less daytime drowsiness compared with their baseline value (23.18 vs 34.22; p<0.001). Factors predicting sleep profile improvement were completion of the study and higher baseline Positive and Negative Syndrome Scale scores. CONCLUSION: Paliperidone ER can help schizophrenia patients to improve sleep quality and reduce daytime drowsiness; this was seen especially in the patients who completed the 6-month treatment period and had higher baseline Positive and Negative Syndrome Scale scores.

Effects of paliperidone extended release on hostility among Thai patients with schizophrenia.

OBJECTIVE: This open-label prospective study investigated the effects of paliperidone extended release (ER) on hostility in Thai patients with schizophrenia. BACKGROUND: Patients diagnosed with schizophrenia may be hostile or exhibit aggressive behavior, which can occasion their admission to psychiatric hospital. Antipsychotic medications are often used to treat hostility and aggression in such patients. Paliperidone ER is effective and well tolerated in the treatment of schizophrenia. However, there are no data available for paliperidone ER with regard to its efficacy on hostility and aggression among Thai patients. This study was a part of the PERFEcT study, a 6-month, open-label, multicenter, multicountry, prospective trial to explore the safety, efficacy, and functionality of paliperidone ER tablets. The current study included only the data obtained from Thai participants. MATERIALS AND METHODS: Flexible dosing of paliperidone ER in a range of 3-12 mg/day was used, allowing investigators to adjust the dosage of each subject individually. The 199 Thai patients had a stable Clinical Global Impression - severity score before enrollment. Demographic data were collected at enrollment, and assessments took place at 1, 2, 3, and 6 months postbaseline. The Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) scale were used to evaluate efficacy. In this analysis, we report the findings for the specific PANSS factor P7 (hostility) and the PSP subscale disturbing and aggressive behavior. Data were analyzed using paired t-test method to investigate changes in mean PANSS and PSP total and subscale scores. The significance level was set at P<0.05. RESULTS: From a total of 199 Thai patients, 148 patients (74.4%) participated in all visits. There was a significant reduction in mean scores for all total PANSS measures from 1 month onward compared with baseline, as well as ongoing significant reductions in scores from visit to visit. There was a significant reduction in mean hostility score at 2 months (P<0.05), 3 months (P<0.05), and 6 months (P<0.01) (n=148). For the PSP scale, there was a significant across-the-board reduction of mean scores from 3 months onward, including in the disturbing and aggressive behavior subscale (P<0.001) (n=148). CONCLUSION: Switching from previously unsuccessful antipsychotic treatments to paliperidone ER may be a useful option to reduce hostility and disturbing behavior in patients with schizophrenia. This study in Thai patients is in line with findings in other countries and cultures concerning the management of hostility in patients with schizophrenia.

Hospitalization and cost after switching from atypical to typical antipsychotics in schizophrenia patients in Thailand.

BACKGROUND: Several clinical practice guidelines suggest using atypical over typical antipsychotics in patients diagnosed with schizophrenia. Nevertheless, cost-containment policy urged restricting usage of atypical antipsychotics and switching from atypical to typical antipsychotics. OBJECTIVE: This study aimed to evaluate clinical and economic impacts of switching from atypical to typical antipsychotics in schizophrenia patients in Thailand. METHODS: From October 2010 through September 2013, a retrospective cohort study was performed utilizing electronic database of two tertiary hospitals. Schizophrenia patients aged 18 years or older and being treated with atypical antipsychotics were included. Patients were classified as atypical antipsychotic switching group if they switched to typical antipsychotics after 180 days of continual atypical antipsychotics therapy. Outcomes were schizophrenia-related hospitalization and total health care cost. Logistic and Poisson regression were used to evaluate the risk of hospitalization, and generalized linear model with gamma distribution was used to determine the health care cost. All analyses were adjusted by employing propensity score and multivariable analyses. All cost estimates were adjusted according to 2013 consumer price index and converted to US$ at an exchange rate of 32.85 Thai bahts/US$. RESULTS: A total of 2,354 patients were included. Of them, 166 (7.1%) patients switched to typical antipsychotics. The adjusted odds ratio for schizophrenia-related hospitalization in atypical antipsychotic switching group was 1.87 (95% confidence interval [CI] 1.23-2.83). The adjusted incidence rate ratio was 2.44 (95% CI 1.57-3.79) for schizophrenia-related hospitalizations. The average total health care cost was lower in patients with antipsychotic switching (-$64; 95% CI -$459 to $332). CONCLUSION: Switching from atypical to typical antipsychotics is associated with an increased risk of schizophrenia-related hospitalization. Nonetheless, association with average total health care cost was not observed. These findings can be of use as a part of evidence in executing prospective cost-containment policy.

Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region.

Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.

Effects of medication adherence on hospitalizations and healthcare costs in patients with schizophrenia in Thailand.

BACKGROUND: This study was conducted to determine the impacts of medication adherence on hospitalization and direct healthcare cost in patients with schizophrenia in Thailand. METHODS: A retrospective study was undertaken. Patients with schizophrenia aged 18-65 years who visited a University hospital and received antipsychotics from April 2011 to October 2011 were included. Propensity score-adjusted logistic regression was used to determine the impacts of medication adherence on schizophrenia-related and all-cause hospitalizations. RESULTS: A total of 582 patients were included. Three out of 224 patients (1.3%) were hospitalized with schizophrenia in optimal adherence group, while 10 of 140 (7.1%) were hospitalized in under-adherence group, and 7 of 218 (3.2%) were hospitalized in over-adherence group. Based on propensity score-adjusted multivariate logistic regression, the adjusted odds ratio was 5.86 (95% confidence interval = 1.53-22.50) for schizophrenia-related hospitalization and 8.04 (95% confidence interval = 2.20-29.40) for all-cause hospitalization. The average annual direct healthcare costs in patients with optimal adherence, under-adherence, and over-adherence were US$371 ± US$836, US$386 ± US$734, and US$508 ± US$2168, respectively. CONCLUSION: An initiation of interventions to maintain optimal adherence in patients with schizophrenia would significantly impact the healthcare system.

Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains?

This study aimed to examine symptoms/demographic characteristics as predictors for psychosocial functioning among individuals with schizophrenia. The Personal and Social Performance (PSP) scale was used to assess psychosocial functioning. Other measures of interest included were the Clinical Global Impression, Severity scale, and the Marder's five-factor model of the Positive and Negative Syndrome Scale. This study included 199 participants with non-acute stage schizophrenia. Spearman correlation coefficients and stepwise multiple linear regression analyses were applied to determine the correlates and predictors of PSP domain/total scores. Younger age, earlier age of schizophrenia onset, severe illness, positive symptoms, negative symptoms, disorganized thought, hostility/excitement, and anxiety/depression were found to significantly correlate with poor functioning. Severe illness and negative symptoms are the main predictors of greater impairment of socially useful activities, personal and social relationships, and self-care. Further prospective studies in other settings, which would include an increased number of variables such as neurocognitive function and social support, are warranted.

Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry.

BACKGROUND: The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR). METHODS: The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery-Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. RESULTS: Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01). CONCLUSION: A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our results underscore how SUD within the family significantly contributes to the risk of an AD comorbidity.

Cost-Utility Analysis of Home-Based Care for Treatment of Thai Hemophilia A and B.

OBJECTIVE: This study aimed to evaluate the cost-utility of the home-based care policy versus the no home-based care policy of factor VIII and factor IX concentrate in Thai patients with hemophilia A and B who had no inhibitor or less than 5 Bethesda units. METHODS: A Markov model was used to evaluate the cost utility of the two policies. The first policy was "no home-based care" in which patients were treated with blood components only when admitted at the hospital but without home treatment. The second policy was "home-based care" in which factors were prescribed and infused for treatment of early bleeding episodes at home. Input parameters related to clinical and cost were obtained from primary data collection at the National Health Security Office, while patients' quality of life was surveyed from mailed questionnaires. Both costs and health outcomes were discounted at 3%. One-way analysis and probabilistic sensitivity analysis were performed to assess uncertainty surrounding model parameters. RESULTS: Based on governmental perspective, the "home-based care" policy had cost saving in patients with moderate and severe hemophilia when compared with the "no home-based care" policy; in patients with mild hemophilia, the incremental cost-effectiveness ratio was 80,542 Thailand baht (THB) or US $2,684.73 (US $1 = 30 THB). CONCLUSIONS: At the ceiling threshold of one time of gross domestic product per capita (120,000 THB per quality-adjusted life-year gained), the "home-based care" policy was cost-effective when compared with the "no home-based care" policy.

Time to relapse and remission of bipolar disorder: findings from a 1-year prospective study in Thailand.

BACKGROUND AND METHODS: This study aimed to determine time to relapse and remission of mood episodes in Thai patients with bipolar disorder (BD). The Thai Bipolar Disorder Registry was a multicenter, prospective, naturalistic, observational study conducted in Thailand. Participants were adult inpatients or outpatients with Diagnostic and Statistical Manual of Mental Disorders bipolar disorder. The diagnosis of bipolar disorder, current psychiatric comorbidity, mood relapse, and mood remission were determined by using the Mini International Neuropsychiatric Interview. Relapse and remission were assessed every 2 months. RESULTS: Of 424 BD participants, 404 (95.3%) were BD I, and 258 (60.8%) were female. At entry, 260 (61.3%) had recovered, and 49 (11.6%) were recovering. During 1-year follow-up (381.7 person-years), 92 participants (21.7%) had 119 relapses or 0.31 (95% confidence interval 0.25-0.35) episodes per person-year. Among 119 relapses, 58 (48.7%), 39 (32.7%), and 21 (17.6%) of them were depressive, hypomanic, and manic episodes, respectively. Using the Kaplan-Meier method, we found that 25% of the participants relapsed in 361 days. Of the 400 participants who reached remission, 113 (28.2%) had mood relapses. Of 173 mood events accountable for remission analysis, the median time to remission was 67.5 days (72.5 days for depressive episodes versus 58.0 days for manic episodes, log rank P = 0.014). CONCLUSIONS: The 1-year relapse rate in Thai patients with BD was 21.7% or 0.31 episodes per person-year. About one-fifth of recovered patients had mood relapses within 371 days. On average, a mood episode would remit in 67.5 days.

Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited.

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.

Quality of life among the navies and their spouses survivors, six months after the tsunami disaster in Phang-Nga Naval Base, Thailand.

OBJECTIVE: Identify the consequences for the survivors of the tsunami disaster on health related quality of life among members of the Navy and their spouses, six months after the disaster. MATERIAL AND METHOD: Using a structured questionnaire modified from the MOS SF-36. Four hundred thirty four subjects participated in the present study. The sample was male (77%), married (67%) and mean age was 34 years old. RESULTS: The quality of life scores among member of the Navy or their spouses were lower than the 2006 Thailand normative data in almost all subscales except physical functioning, bodily pain, and social functioning subscales. The major consequence of the Tsunami was mental health problems. A majority of the survivors who seriously experienced mental problems were female, low education, decreased income, loss of one's family members/loved ones, or property. CONCLUSION: To improve their quality of life, these people required appropriate social support and physical and mental health care. Bodily pain was the only an indicator subscale of QOL that was statistically significantly associated with tsunami exposure. The QOL measures provided essential data and information that helped healthcare providers identify survivors' needs and outcomes and therefore, knowledge of the changes in QOL over the time after tsunami might help guide health programs to efficiently allocate resources at different times.

Quality of life, needs and the mode of coping of the health personnel at Naradhiwasrajanagarindra Hospital in terrorism influence area in Thailand.

The present study was to identify the quality of life (QOL), the needs of help and the mode of coping among the health personnel of Naradhiwasrajana garindra Hospital in a terrorism situation, the first research in Thailand. The chaos of separatist insurgency in the southern part of Thailand has been re-emerged since 2004. The present study was seeking for ways the health personnel coped with the situation while their quality of life and needs that were affected how they had handled the events were explored. General questionnaire, quality of life rand 36 SF-36 questionnaires, help seeking questionnaire and Mode of coping with the terrorism questionnaire were sent to all health personnel in the hospital in November 2007. 392 (65.3%) complete questionnaire were received from 600 distributed papers. They were female 328 (83.7%) and male 64 (16.3%), at the age of 21-59 years old (the mean age of 39.05 SD +/- 9.82), with three different religions, Buddhist 269 (68.6%), Muslim 122 (31.1%) and Christian 1 (0.30%). Thirty nine responses (9.9%) had been directly exposed to a terrorist attack, while 353 responses (90.1%) had a family member or friends who had been exposed. The results revealed that the overall mean scores of QOL were 73.1 +/- SD 15.5. Mean scores of male were significantly lower than female in general health, social functioning and role-emotional subscales. QOL mean scores of those with no terrorism exposure were significantly higher than those with terrorism exposure in role-physical, social functioning and mental health subscales. The most need of help for the personnel was safety of life and belongings (30.6%) followed by the need of money (23.0%). To cope with the terrorist attack, people (81.7%) would always resort to religious beliefs (72.0%) talk it out with coworkers, friends about their feelings, and (68.7%) inquire about the safety of their families and friends after the incident. Certainly, terrorism affected QOL and the most need of people in violent areas was life safety which agrees with Maslow's hierarchy of needs.

Comparisons of methamphetamine psychotic and schizophrenic symptoms: a differential item functioning analysis.

The concept of negative symptoms in methamphetamine (MA) psychosis (e.g., poverty of speech, flatten affect, and loss of drive) is still uncertain. This study aimed to use differential item functioning (DIF) statistical techniques to differentiate the severity of psychotic symptoms between MA psychotic and schizophrenic patients. Data of MA psychotic and schizophrenic patients were those of the participants in the WHO Multi-Site Project on Methamphetamine-Induced Psychosis (or WHO-MAIP study) and the Risperidone Long-Acting Injection in Thai Schizophrenic Patients (or RLAI-Thai study), respectively. To confirm the unidimensionality of psychotic syndromes, we applied the exploratory and confirmatory factor analyses (EFA and CFA) on the eight items of Manchester scale. We conducted the DIF analysis of psychotic symptoms observed in both groups by using nonparametric kernel-smoothing techniques of item response theory. A DIF composite index of 0.30 or greater indicated the difference of symptom severity. The analyses included the data of 168 MA psychotic participants and the baseline data of 169 schizophrenic patients. For both data sets, the EFA and CFA suggested a three-factor model of the psychotic symptoms, including negative syndrome (poverty of speech, psychomotor retardation and flatten/incongruous affect), positive syndrome (delusions, hallucinations and incoherent speech) and anxiety/depression syndrome (anxiety and depression). The DIF composite indexes comparing the severity differences of all eight psychotic symptoms were lower than 0.3. The results suggest that, at the same level of syndrome severity (i.e., negative, positive, and anxiety/depression syndromes), the severity of psychotic symptoms, including the negative ones, observed in MA psychotic and schizophrenic patients are almost the same.

Risperidone long-acting injection (RLAI): the 12-week efficacy and tolerability in Thai patients with chronic schizophrenia.

BACKGROUND: Although oral atypical antipsychotics have improved the outcomes in schizophrenia, the patient medication adherence plays role as the important factor to clinical potential of the drugs. Therefore, the long-acting formulations of antipsychotics have been developed to improve the treatment compliance in patient with schizophrenia and risperidone long-acting injection (RLAI) is the first long-acting injectable drug since then. OBJECTIVE: To evaluate the efficacy and tolerability of long-acting risperidone injection in Thai patients with chronic schizophrenia for 12 weeks treatment. MATERIAL AND METHOD: This was a non-randomized, open-label, single-arm study, performed at 5 centers in Thailand. The eligible patients with schizophrenia diagnosed by DSM-IV criteria were enrolled. Patients received long-acting risperidone injection 25, 37.5 or 50 mg every 2 weeks. Efficacy assessments were measured by Manchester Psychiatric Rating Scale (MPS), CGI-S and SF-36 at baseline, week 6 and week 12 or endpoint visit. Tolerability assessments were measured by Yale Extrapyramidal Symptoms Rating Scale (YESS), Visual analogue scale 10-cm for pain at injection site, body weight (BW) and incidence of adverse events. RESULTS: Of 184 patients recruited, 160 patients (87%) completed the study. RLAI produced a significant improvement (p < 0.001) in MPS positive score from baseline to endpoint, 4.4 +/- 3.7 to 1.6 +/- 2.6. There was also significant reduction in MPS negative score, from 3.06 +/- 2.68 to 0.93 +/- 1.61 at endpoint (p < 0.001). The CGI-S score improved significantly from baseline to endpoint (p < 0.001), as reflected by the increase the proportion of patients rated as "not ill" or "borderline ill" from 5.9% at baseline to 53.2% at endpoint. Quality of life measured on the SF-36 scale was improved in all domains except bodily pain. Movement disorders, measured by YESS, were significantly reduced following RLAI introduction. Treatment with this drug was well tolerated and no significant weight gain occurred during the study. CONCLUSION: This study suggests that RLAI produces symptomatic improvement in chronic schizophrenia patients, along with improvement of movement disorders and had a good tolerability and adherence to treatment.

Efficacy of valproate versus lithium in mania or mixed mania: a randomized, open 12-week trial.

The objective of this study was to compare the efficacy and safety of valproate and lithium in bipolar I patients experiencing a manic or a mixed episode. This international, randomized, open-label, parallel-group, equivalence study included 268 patients with bipolar I disorder. The starting dose of valproate was 20 mg/kg/day and that of lithium was 800 mg/day. Treatment duration was 12 weeks. The primary outcome measure was mean change in Young Mania Rating Scale score between baseline and study end. Secondary outcome measures were response and remission rates, change in Montgomery and Asberg Depression Rating Scale and Clinical Global Impression Bipolar Disorder instrument score, and occurrence of adverse events. The mean change from baseline in Young Mania Rating Scale score was 15.8+/-5.3 in the lithium group and 17.3+/-9.4 in the valproate group. The 90% confidence interval of the intergroup difference (-0.69; 3.31) was within prespecified equivalence limits. Response rates were 72.6% in the lithium group and 79.5% in the valproate group. Remission rates were 58.5 and 71.9%, respectively. No intergroup differences were observed in median time to treatment response (21 days) or change in Clinical Global Impression Bipolar Disorder instrument or Montgomery and Asberg Depression Rating Scale scores. Adverse events were reported in 42.8% of patients in the lithium group and 41.5% in the valproate group. Valproate and lithium showed comparable efficacy and tolerability in the treatment of acute mania over 12 weeks.

The treatment of major depressive disorders (MDD) in Thailand using escitalopram compared to fluoxetine and venlafaxine: a pharmacoeconomic evaluation.

A decision analytical model was used to compare expected health outcomes and costs of treating patients with major depression using new selective serotonin reuptake inhibitor (SSRI) escitalopram versus the other SSRI fluoxetine and the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine. The primary health outcome measure was an overall treatment success, defined as a remission (Montgomery-Asberg Depression Rating Scale (MADRS) < or = 12), achieved over the 6 months of treatment. Estimated costs consisted of those directly related to treatment (drug acquisition costs, costs of psychiatric visits, hospital outpatient visits, hospitalization, and electroconvulsive therapy) and indirect costs associated with productivity lost due to depression. Clinical input parameters for the economic analyses were derived from published literatures. Resource utilization estimates were obtained from a survey of psychiatrists, while medical treatment patterns were determined from focus groups participated consisting from both general and family practitioners and psychiatrists. Unit costs (including daily cost of patient's absence from work due to depression) were obtained from the standard sources. The unit cost of hospitalization was derived based on the average of factual service rates charged by the local hospital. The results show that escitalopram is more effective and less costly compared to fluoxetine and venlafaxine. Treatment using escitalopram produced the best-expected success rate and the lowest expected per patient cost. Escitalopram earned a savings of Baht 2,002 and Baht 1,768 compared to fluoxetine and venlafaxine respectively over a six-month period.

Health-related quality of life in Thai bipolar disorder.

BACKGROUND: Bipolar disorder (BPD) affects both patients 'functioning and well-being. Quality of life (QoL) has gained increasing attention as an important functional outcome in BPD. The present study was conducted to assess QoL of Thai BPD patients. MATERIAL AND METHOD: The authors obtained cross-sectional demographic, clinical, and functional ratings from 285 BPD outpatients. SF-36 and Thai Mania Rating Scale (TMRS) were used to assess QoL and severity of symptoms respectively. RESULTS: The mean TMRS was 4.42 +/- 5.87. Compared with the Thai general population, SF-36 scores of study population were significantly lower, except for bodily pain and social functioning domains. Sodium valproate treated group's SF-36 scores was better than lithium carbonate treated group' (p = 0.02). CONCLUSION: The present study is one of the pioneers in assessing the impact of co-morbidity on health-related QoL in Thai BPD patients. Even in the stable phase, patients were less functioning than the normal Thai population.