Schizophrenia in Thailand: prevalence and burden of disease

Background: A 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

Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature.

BACKGROUND: The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities. OBJECTIVE: We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults. METHODS AND FINDINGS: We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities. CONCLUSIONS: Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with respect to the patients' ages

Schizophrenia in Thailand: Enabling better information for efficient solutions

Schizophrenia is one of the most severe, disabling, and expensive mental illnesses with a large impact on not only patients but also families and society. Due to limited resources for patients with schizophrenia and lack of information on schizophrenia, this thesis aims to provide necessary evidence-based information on schizophrenia to policy makers and health planners in order to help them improve mental health services and policy in Thailand. This information includes different perceptions of disease severity between patients and health care providers; the magnitude of schizophrenia in terms of either disease or economic burden; and the best treatment package for schizophrenia. Both primary and secondary data were used in this thesis. A cross-sectional survey was conducted in 2008 to gather information on the severity of schizophrenia, the quality of life of patients, productivity losses of patients and family and treatment patterns. The sample consisted of 307 patients (279 outpatients and 28 inpatients) and 122 family members who were in contract with a participant hospital during the survey period. Secondary data was from national and international studies or databases. Aside from the survey, methods used consisted of Markov modelling, meta analysis, regression analysis, bootstrapping and Monte Carlo simulation. The statistical programs and software used in these studies include Stata, Microsoft Excel, DisMod and Ersatz. We found that the prevalence of schizophrenia in the Thai population in 2005 was 9 per 1,000 (95% CI: 7, 11). The patients with schizophrenia interviewed had low severity and a higher quality of life than is reflected in the average severity weights used in the Global Burden of Disease study. Partly, this is because the survey sampled patients who were in contact with mental health services. On the other hand, the most common drug treatment for schizophrenia in Thailand is with typical antipsychotics which affect the psychotic symptoms rather than the negative, mood and cognitive symptoms that patients consider the most important outcomes. There was only a modest association between patient-rated and clinician-rated severity outcomes indicating that patients with schizophrenia and health care providers differ in their perspective on treatment outcomes. This suggests health planners should take not just clinician but also patient perspectives into account when considering mental health policy. The disease burden in disability adjusted life years (DALY) was similar for males and females. Prevalence was a far more important input variable than the level of disability weights in the measurement of DALYs. For future planning purposes, it is important that the Department of Mental Health regularly conducts a mental health survey. Hospitalization was a more costly component of direct medical costs than outpatient visits or drug and non-drug treatments. The direct cost of 22,000 baht per person is high and begs the question if there are more efficient treatment options available. Indirect costs particularly due to patients’ productivity losses were higher than the direct costs. It is not clear if interventions such as vocational therapy can substantially improve employment possibilities for people with schizophrenia in Thailand; greater attention to evaluating those interventions in both clinical and financial terms is required in Thailand. The optimal treatment package for schizophrenia would be a combination of generic risperidone at a cost less of than 10 baht per 2 mg tablet as the first line treatment, with family interventions, consisting of 10 weekly 2-hr sessions during the first year and 2 booster sessions every year after that, as adjunctive treatment. Clozapine could be prescribed for a third of patients with the most severe disease if they fail to respond to risperidone. However, improvement of the Clozapine Patient Monitoring Service program to detect a rare but serious side effect is imperative before considering increasing clozapine use in Thailand. This study provides critical evidence-based information on schizophrenia in Thailand. However, Thai policy makers still require future work relevant to implementing optimal treatment to all Thai people with schizophrenia. First, the effectiveness of family interventions needs to be verified in the Thai context. Second, the effectiveness and cost-effectiveness of interventions that can reduce the indirect costs to patients and families needs to be investigated. Lastly, although this thesis had the primary aim of helping Thai policy makers by providing information on schizophrenia, this thesis provides an example to researchers in other resource-limited countries that despite data limitations it is possible to carry out policy-relevant research on priority setting

Precision medicine in Asia enhanced by next‐generation sequencing: Implications for Thailand through a scoping review and interview study

Abstract Next‐generation sequencing (NGS) significantly enhances precision medicine (PM) by offering personalized approaches to diagnosis, treatment, and prevention of unmet medical needs. Little is known about the current situation of PM in Asia. Thus, we aimed to conduct an overview of the progress and gaps in PM in Asia and enrich it with in‐depth insight into the possibilities of future PM in Thailand. This scoping review focused on Asian countries starting with non‐cancer studies, including rare and undiagnosed diseases (RUDs), non‐communicable diseases (NCDs), infectious diseases (IDs), and pharmacogenomics, with a focus on NGS. Subsequent in‐depth interviews with experts in Thailand were performed, and a thematic analysis served as the main qualitative methodology. Out of 2898 searched articles, 387 studies were included after the review. Although most of the studies focused on cancer, 89 (23.0%) studies were related to RUDs (17.1%), NCDs (2.8%), IDs (1.8%), and pharmacogenomics (1.3%). Apart from medicine and related sciences, the studies were mostly composed of PM (61.8%), followed by genetics medicine and bioinformatics. Interestingly, 28% of articles were conducted exclusively within the fields of medicine and related sciences, emphasizing interdisciplinary integration. The experts emphasized the need for sustainability‐driven political will, nurturing collaboration, reinforcing computational infrastructure, and expanding the bioinformatic workforce. In Asia, developments of NGS have made remarkable progress in PM. Thailand has extended PM beyond cancer and focused on clinical implementation. We summarized the PM challenges, including equity and efficiency targeting, guided research funding, sufficient sample size, integrated collaboration, computational infrastructure, and sufficient trained human resources

Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

Background: Information 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.Methods: A 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.Results: Generic 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.Conclusions: There 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