Vithaya Kulsomboon

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.

CRITERIA TO REQUEST PHARMACOECONOMIC DATA AND DATA SOURCES FOR HOSPITAL FORMULARY DECISIONS

A national mail survey was designed to study how pharmacoeconomic (PE) data were applied to formulary decisions in teaching hospitals in the United States. The study objectives were to determine the criteria for using PE data for formulary decisions, to describe PE data sources that were used, and to assess the opinions of pharmacy directors regarding the quality of available PE data. One hundred and sixty-six (39.6%) pharmacy directors responded to the survey from April to July 1999. There were no significant differences between respondents and non-respondents with regard to hospital demographics. One hundred and thirty eight hospitals (83.1%) reported using PE data. The two most important criteria leading to a PE analysis were the impact that a new medication may have on institutional cost, and the anticipated annual pharmacy budget for a new medication (the threshold of potential cost was concentrated between

Multidisciplinary Perspective Intervention With Community Involvement to Decrease Antibiotic Sales in Village Groceries in Thailand

25,000 and

Detection of Adverse Drug Reaction Signals in the Thai FDA Database: Comparison between Reporting Odds Ratio and Bayesian Confidence Propagation Neural Network Methods

100,000 per medication). Classes of drugs that frequently “ranked first” in requiring PE data were antiplatelets, systemic anti-infective drugs, and antineoplastics. Drugs that required PE data were those which were recently approved by the Food and Drug Administration (FDA) and that were relatively expensive (eg, Glycoprotein IIb/IIIa inhibitor; Cox-II inhibitor; Low molecular weight heparin). The most important sources of PE data were published literature, pharmaceutical companies, and in-house PE assessments. Hospitals that could identify greater cost-savings used more in-house PE data. Seventy-six percent of pharmacy directors had a moderate to high level of skepticism of PE data derived from PE modeling and 79% of them felt that the use of PE data might expand if the FDA review process incorporated approval of such data.

Impact of COX-2 Inhibitors in Thai Orthopaedic Outpatients

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.

Bridging the Gap in Pharmacoeconomics and Outcomes Research between Researchers, Policymakers, and Practitioners in the Asia-Pacific Region

The study aimed to compare performance between the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) methods in identifying serious adverse drug reactions (ADRs) using the Thai FDA spontaneous database. The two methods were retrospectively applied to identify new, serious ADRs reported with antiretroviral therapy (ART) drugs using the data set between 1990 and 2006. We plotted the ROR and the information component against time to compare the differential timing of signal detection and the pattern of signaling over time between these methods. The ROR and the BCPNN methods identified the associations between ART drugs and serious ADRs at the same time. Both methods were similar in detecting the first signal of a potential ADR. However, the pattern of signaling seems relatively different with each method. Additional analyses of different drugs, ADRs, and databases will contribute to increase understanding of methods for postmarketing surveillance using spontaneous reporting system.

DS3 A COMPARISON OF SIGNAL DETECTION PERFORMANCE BETWEEN REPORTING ODDS RATIO AND BAYESIAN CONFIDENCE PROPAGATION NEURAL NETWORK METHODS ON ADVERSE DRUG REACTION SPONTANEOUS REPORTING DATABASE OF THE THAI FDA

Prescribing of cyclo‐oxygenase ‐2 inhibitors (coxibs) has had an economic impact on patients and overall healthcare costs in Thailand.