Pudtan Phanthunane

Schizophrenia in Thailand: Prevalence and burden of disease

BackgroundA previous estimate of the burden of schizophrenia in Thailand relied on epidemiological estimates from elsewhere. The aim of this study is to estimate the prevalence and disease burden of schizophrenia in Thailand using local data sources that recently have become available.MethodsThe prevalence of schizophrenia was estimated from a community mental health survey supplemented by a count of hospital admissions. Using data from recent meta-analyses of the risk of mortality and remission, we derived incidence and average duration using DisMod software. We used treated disability weights based on patient and clinician ratings from our own local survey of patients in contact with mental health services and applied methods from Australian Burden of Disease and cost-effectiveness studies. We applied untreated disability weights from the Global Burden of Disease (GBD) study. Uncertainty analysis was conducted using Monte Carlo simulation.ResultsThe prevalence of schizophrenia at ages 15-59 in the Thai population was 8.8 per 1,000 (95% CI: 7.2, 10.6) with a male-to-female ratio of 1.1-to-1. The disability weights from local data were somewhat lower than the GBD weights. The disease burden in disability-adjusted life years was similar in men (70,000; 95% CI: 64,000, 77, 000) and women (75,000; 95% CI: 69,000, 83,000). The impact of using the lower Thai disability weights on the DALY estimates was small in comparison to the uncertainty in prevalence.ConclusionsPrevalence of schizophrenia was more critical to an accurate estimate of burden of disease in Thailand than variations in disability weights.

Improving mental health policy in the case of schizophrenia in Thailand: evidence-based information for efficient solutions

Materials and methods This study was conducted at a national level, using the government, patients and family’s perspectives. Both primary and secondary data were used. A cross-sectional survey was conducted in the year 2008. Data were also obtained from both national and international literature and databases. The concepts of Disability Adjusted Life Year, Cost of Illness estimation and Generalized CostEffectiveness Analysis were adopted to estimate burden of schizophrenia and cost-effective interventions.

Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

BackgroundInformation on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand.MethodsA Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken.ResultsGeneric risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita.ConclusionsThere are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious side effects, treating severe patients with clozapine is advisable only for patients who do not respond to risperidone and only in the presence of a stricter side effect monitoring system than currently exists.

Public expenditure on road safety policy and programmes: right or wrong direction to achieve the decade of action on road safety goal in Thailand

Materials and methods The government budget documents from 5 ministries including Ministry of Transport, Education, Interior, Public Health and Royal Thai Police were reviewed. Two researchers identified budget used in road safety projects with 5-E strategies independently; the kappa analysis was used to test inter-rater reliability. Information from Thai Health Promotion Foundation and Road Safety Fund was also gathered using a developed excel-based template. Semi-structured interviews were conducted among road safety experts. Some mathematical and statistical analyses were applied to evaluate the efficiency of road safety policy.

Health outcomes of schizophrenia in Thailand: Health care provider and patient perspectives

BACKGROUND Patient views are considered an important measure in schizophrenia. There are no studies of the association between patient and clinician perspectives in Thailand. The objectives of this study were to (a) describe the patterns of clinician-rated psychiatric symptoms and patient ratings of health related quality of life and (b) quantify the association between clinician and patient-rated measures. METHOD The cross-sectional study included a stratified representative sample of 307 patients with schizophrenia or schizoaffective disorder in treatment at mental health services during the survey period. Clinicians measured illness severity using the Brief Psychiatric Rating Scale-Expanded while patients rated their health-related quality of life using a six-dimensional EuroQoL instrument. Pearson correlation coefficient and hierarchical regression analyses were used to quantify the association between schizophrenia outcomes elicited from patients and health care providers. RESULTS There was only a modest association between patient-rated and clinician-rated outcomes. In a regression model clinician-rated symptoms explained 33% of patient satisfaction with their quality of life. Negative, cognitive and mood symptoms but not the positive symptoms were significant predictors of patient-rated quality of life. CONCLUSION Policy makers and clinicians need to be aware that clinician-rated and patient-rated outcomes are very different. Improving quality of life of people with schizophrenia requires greater attention be given to negative, cognitive and mood symptoms.

Activity based costing system of continuous ambulatory peritoneal dialysis under the Universal Coverage Scheme in Thailand

Materials and methods The cost of CAPD per patient was computed using activity based costing (ABC) approach. We collected costs and outcomes data during the period from 1 January to 31 December 2011. One-way sensitivity analysis was adopted to evaluate the effect of factors that changes CAPD cost estimated. These factors included the difference in the hours physicians were available for clinical time; and drugs cost used in patients having diabetes mellitus (DM) and in non-DM patients. In addition to total patients, the survived and compliant patients were taken into account as the study’s outcomes.

Pattern of outpatient utilisation and cost for patients under the Universal Coverage

Materials and methods Outpatient data from the National Health Security Office in 2011 were analysed, 4 provinces were picked to represent the pattern of service utilisation. The selection criteria emphasised on 1) availability of various types of hospitals in the province (health promoting, community, general/ regional, university hospital; and others), and 2) the maximum utilisation rate of people in the province. Descriptive statistical analysis was employed to calculate annual utilisation. One-way analysis of variance was used to calculate the association between the annual costs per person and the pattern of service utilisation (whether rural or urban or both; and the type of hospital).

Cost-effectiveness of care for type 2 diabetes patients in Nopparat Rajathanee hospital and private clinics

Materials and methods This was a retrospective economic evaluation study. Type 2 diabetes patients of the universal coverage scheme who visited and followed up at general practice department of Nopparat Rajatanee hospital and the subcontractor private clinics for at least one year were recruited. The patient data were collected from medical records and from hospital computer systems from 1 January to 31 December 2012. Diabetes patients in five subcontractor private clinics were selected by proportional sampling. Effectiveness of care was based on HbA1c ≤ 7%. The costs were calculated from three parts: overhead cost, medicine and medical supply costs, and laboratory costs.

Hospitalisation by ambulatory care sensitive conditions at Rajavithi hospital, Bangkok

Materials and methods A retrospective study collected data from electronic medical record from Rajavithi hospital and National Health Security Office. ACSCs selected were DM, HT and related diseases based on diagnosis codes (ICD-10) from fiscal year 2007–2011. The outcome measurements were number of patients, inpatient admissions, length of stay and cost from hospitalisation. The referral cases were excluded. Descriptive statistics were expressed as a median, 25th and 75th percentile, and percentage. The rates of ACSC were shown by trend line and R for a perfect linearity. The ACSC rate was calculated by number of admission patients on the condition divided by number of patients of that condition visited ambulatory care.

Improving efficiency in financial process of the National Health Security Scheme

Background The National Health Security Scheme was established 10 years ago with the document finance model in communicating the transfer of budget from payer to providers. This model was found to be inefficient in transferring (17 billion Baht delay) or not knowing the amount transferred (33 billion Baht bad debt). A new ageing account model was developed 3 years ago to improve efficiency in financial process. It is interesting to know whether the change achieved the efficiency. This research also wanted to compare efficiency in financial process of all three government health insurance funds managed by the National Security Health Office (NHSO managing the universal coverage scheme), the Social Security Office (SSO managing insurance for workers in private sector) and the Comptroller General Department (CGD managing insurance for civil servants and dependents).