Multidisciplinary perspective intervention with community involvement to decrease antibiotic sales in village groceries in Thailand.

In Thailand, antibiotics are rampantly available in village groceries, despite the fact that it is illegal to sell antibiotics without a pharmacy license. This study implemented a multidisciplinary perspectives intervention with community involvement (MPI&CI), which was developed based on information obtained from focus groups that included multidisciplinary stakeholders. Community leaders in the intervention group were trained to implement MPI&CI in their villages. A quasi-experiment with a pretest-posttest design was conducted. Data were collected from 20 villages in Mahasarakham Province (intervention group) along with another 20 villages (comparison group). Using a generalized linear mixed model Poisson regression with repeated measures, groceries in the intervention group had 87% fewer antibiotics available at postintervention compared with preintervention (relative rate = 0.13; 95% confidence interval = 0.07-0.23), whereas the control group had only an 8% reduction in antibiotic availability (relative rate = 0.92; 95% confidence interval = 0.88-0.97) between the 2 time periods. Further study should be made to assess the sustainability and long-term effectiveness of MPI&CI.

Drug reimbursement decision-making in Thailand, China, and South Korea.

OBJECTIVE: To provide a comparison of national drug reimbursement decision-making, including an update of economic evaluation roles and barriers, in Thailand, China, and South Korea. METHODS: Documentary reviews supplemented by experiences of policymakers. RESULTS: National health insurance policy in all the three countries has been developed toward coverage for all. It leads to higher health-care expenditures and requires a good reimbursement system for health-care services, including drugs. Drug reimbursement decision-making in these countries is to develop a reimbursement list with the help of various committees having different roles. Primarily, they assess the clinical and safety evidence. Economic evidence, including budget impact and pharmacoeconomic evaluation, has also been very important for their reimbursement decision-making. This evidence is sometimes used in negotiation mechanism, which allows pharmaceutical companies to lower their drug prices and leads to lower overall drug expenditures. Several common barriers, for example, human capacity and data availability, for obtaining economic evidence in all the three countries, however, still exist. CONCLUSIONS: Drug reimbursement decision-making in Thailand, China, and South Korea is in its transition period. It seems to run in the same direction, for example, guideline development and pharmacoeconomic evaluation agency establishment. Pharmacoeconomic evaluation plays important roles in the efficiency of drug reimbursement decision-making, even though there are several barriers to be overcome.

The cost-effectiveness analysis of initiating HIV/AIDS treatment with efavirenz-based regimens compared with nevirapine-based regimens in Thailand.

OBJECTIVES: The aim of this study is to evaluate the cost-utility of the treatment, starting with EFZ-based therapy, compared with NVP-based therapy in Thai HIV/AIDS patients. MATERIAL AND METHOD: The study adopted a health care provider perspective. A probabilistic Markov model was applied to Thai HIV/AIDS patients aged 15 to 65 years. Input parameters were extracted from a cohort study of four regional hospitals. The study explored the effects of uncertainty around input parameters. RESULTS: For those patients with a different baseline CD4, initial therapy using EFZ-based regimens was the preferable choice for all subgroups. Given a maximum acceptable willingness to pay (WTP) threshold of 300,000 Baht/DALY averted starting with EFZ-based regimens was cost-effective for patients with a baseline CD4 count less than 250 cells/mm3 and in all patient age groups, except those who were 20 years old. CONCLUSIONS: The results suggest that starting with EFZ-based regimens was the preferable choice and it should be used as the first line regimen for Thai HIV/AIDS patients.