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.

Legal harm reduction among intravenous drug users.

OBJECTIVE: HIV/AIDS infection in injecting drug users occurs with explosive rapidity and, having occurred, they can form a core group for further sexual and vertical transmission. As HIV transmission among injecting drug users can be extremely rapid, various approaches to intervention and obstructing the spread of HIV infection have been explored. Overall, these have been relatively ineffective so what has emerged, both in the developed and developing world, is harm reduction. MATERIAL AND METHOD: In the light of these general considerations, the authors reviewed the law of Thailand in relation to drug abuse and dependence according to the harm reduction for the prevention of HIV/AIDS infection in injecting drug users. RESULTS: With the review, the authors recommend some changes in the law: 1. Introducing a law that allows IDUs to possess sterile syringes and needles while under supervision of a physician. 2. Introducing a law that allows for testing for HIV in people in custody in whom there are grounds for suspecting drug abuses. 3. Establishing and financing a Multi-disciplinary Coordinating Committee on the Prevention of HIV/AIDS (MCCPH/A). CONCLUSION: It should be emphasized that, as in other countries, drug abuse and dependence should, where appropriate, be decriminalized. A large proportion of people with drug-related problems are ill and in need of treatment rather than criminals requiring harsh penalties handed down by the courts.

Asian outpatients with schizophrenia: a double-blind randomized comparison of quality of life and clinical outcomes for patients treated with olanzapine or haloperidol.

To examine the quality of life (QoL) and clinical outcomes for Asian schizophrenic outpatients treated with olanzapine or haloperidol. Patients were randomized to 24-weeks' treatment with either olanzapine (n = 144) or haloperidol (n = 132) in a double-blind, prospective, multi-country study. The QLS and WHO-BREF were assessed for QoL; the PANSS, BPRS and CGI scales for clinical status; the BAS, AIMS and SAS scales for physical dysfunction. Regardless of antipsychotic, QoL improved significantly at 8 weeks and maintained this improvement at 24 weeks. Compared with haloperidol, olanzapine treatment was associated with significantly better QoL in the WHO-BREF physical and social relationship domains, better improvements in extrapyramidal symptoms in BAS and SAS scores, as well as lower incidence of adverse events. Patients taking haloperidol were more likely to be co-prescribed anticholinergics. The comparatively superior side-effect profile and tolerability of olanzapine may have contributed to enhance domain-specific QoL for these Asian outpatients.

Validity and reliability of the Young Mania Rating Scale: Thai version.

OBJECTIVES: The objective of the present study was to assess the reliability and validity of the Young Mania Rating Scale (YMRS) Thai Version in 76 patients with known manic symptoms. The study was carried out at Outpatient and Inpatient Departments of Psychiatry, Ramatibodhi Hospital, Bangkok, Thailand MATERIAL AND METHOD: Cross-sectional study. A Thai version of the YMRS was developed through forward-backward translation techniques and reviewed by five content-experts using psychometric methods to test the reliability and validity of the version. RESULTS: An eleven-item questionnaire was developed The validity was established with the item coefficient > 0.6for all scales. The reliability of the YMRS Thai Version on a interrater test had a Pearson's correlation of 0.87 and a Cronbach's Alpha coefficient for all scales of > 0.70. The scale's Cronbach's Alpha coefficient for the total number of items was 0.89. CONCLUSION: The present study supports the use of the YMRS Thai Version as a valid measurement for mania in Thai patients.

A 4-week, double-blind comparison of olanzapine with haloperidol in the treatment of amphetamine psychosis.

OBJECTIVE: To compare the efficacy and tolerability of olanzapines and haloperidol in treating patients with amphetamine psychosis. MATERIAL AND METHOD: Fifty-eight patients experiencing episode of amphetamine psychosis were randomly assigned to olanzapine (N=29) or haloperidol (N=29) in 1:1 (olanzapine: haloperidol) ratio. All patients started with 5-10 mg/day of the study drug; after each 7-day period, the study drug could be adjusted in 5-mg increments or decrements within the allowed dose range of 5-20 mg/day during the 4-week double-blind period. RESULTS: Clinical response was seen in both treatment groups since the first week. Ninety three percent of the olanzapine patients (N=27 of 29) and 79.3% of the haloperidol patients (N=23 of 27) were clinically improved at endpoint. These differences were not statistically significant (p=0.25). The Simpson-Angus total score change from baseline to endpoint reflected no extrapyramidal symptoms among the olanzapine-treated patients (median=0.0, range=0.0). In contrast, worsening occurred among the haloperidol-treated patients (median=0.2, range=0.0-3.1). The differences of mean change in Simpson Angus Scale significantly favored olanzapine (p<0.01). Change to endpoint on the Barnes Akathisia Scale showed that olanzapine-treated patients' scores were close to the baseline (median=0.0, range=-1.0-0.0), whereas haloperidol-treated patients' scores worsened from the baseline (median=0.0, range=-1.0-3.0). This difference was statistically significant (p=0.02). CONCLUSION: Both olanzapine and haloperidol were efficacious in the treatment of patients with amphetamine psychosis. Olanzapine was superior to conventional neuroleptic haloperidol in treatment safety with lower frequency and severity of extrapyramidal symptoms.

Cost analysis of the treatment of schizophrenia in Thailand: a simulation model comparing olanzapine, risperidone, quetiapine, ziprasidone and haloperidol.

OBJECTIVES: To compare the annual costs of treating schizophrenia with four atypical antipsychotics-olanzapine, risperidone, quetiapine and ziprasidone and one typical antipsychotic: haloperidol in Thailand MATERIAL AND METHOD: The present study used a cost analysis model. The model simulated treatment of schizophrenics for 12 months with the data from international literature review. A comprehensive search of pharmacoeconomic literature was carried out in order to identify studies to be included in the present review. Model parameter used data from the searches of 1175 publications but merely 31 of them were relevant to the objectives of the present study. Costs associated with olanzapine, risperidone, quetiapine, ziprasidone and haloperidol therapy were calculated over a period of 12-months. This analysis included health care costs and costs associated with productivity losses. RESULTS: The total cost from the cost analysis was as follows: Haloperidol gives the lowest annual cost of THB 86,004, within the atypical antipsychotics, Olanzapine produces an annual cost of THB 103,225 compared to THB 104,564 with risperidone, 118,314 with ziprazidone. The cost ranges up to THB 146,526 for quetiapine therapy. CONCLUSION: Treatment with olanzapine appears to be more cost-effective than that with the other atypical antipsychotics in Thai schizophrenic patients.

The functioning and quality of life of depressive patients with 12 weeks of psychiatric care.

OBJECTIVES: The purpose of this study was to obtain data about the functional status of depressive patients with 12 weeks of psychiatric care and find out if there is any correlation between improvement of clinical and functioning status. MATERIAL AND METHOD: A prospective descriptive study was conducted and quality of life instruments (SF-36) were used to assess 96 depressive patients with 12 weeks follow up. RESULTS: There was prominent functional disability with depressive patients. The response rate of depressive patients with 3-month psychiatric care was 67.7%. The correlation between improvement in clinical status and quality of life of this group of patients did not significantly correlate. CONCLUSION: Depressive disorder is treatable with a very good response rate but no significant correlation between clinical improvement and quality of life. There is limitations in psychological and role functioning of depressive patients after 3 months of care. It is recommended that continuing of care should be considered for quality of life improvement.

Clinical response of depressive patients in a Thai psychiatric care setting.

OBJECTIVE: To obtain data on the clinical outcome of patients with depressive disorders after three months psychiatric care in a Thai psychiatric unit. MATERIAL AND METHOD: A prospective descriptive study of 96 patients followed up for 3 months. The severity of depression was measured with the Thai version of the Hamilton rating scale for depression (HAM-D Thai). RESULTS: The response rate following 3-months psychiatric care was 67.7% (95% CI = 58.18-77.23). Fifty percent of the patients had a HAM-D Thai score of < 7 at week 12. CONCLUSION: The treatment outcome in the Thai psychiatric setting described is comparable to that reported in other countries.

Health-related quality of life after hip fracture in the elderly community-dwelling.

Hip fracture occurs commonly in older individuals and can have a considerable impact on the functional independence and quality of life for older patients living in the community. In a population-based case-control study six months after hip fracture, we investigated the association between functionality and quality of life. The Functional Independence Measure (FIM), the Frenchay Activities of Daily Living Index (FAI), and the Berg Balance Scale (BBS) were used to measure physical function, and quality of life was measured by completing a Short Form-36 (SF-36). With age and gender match, the hip fracture group scores were significantly lower (p < or = 0.05) than the control group in all measurements of physical function (FIM 95.54 vs 103.5; FAI 23.68 vs 30.76; BBS 46.21 vs 54.25). The quality of life was assessed by SF-36, which has eight domains: physical function, physical role, bodily pain, mental health, emotional role, social function, general health and vitality. All eight domains were significantly lower in the hip fracture group compared with the controls (p<0.05). The reduction in function was reflected in a reduction in the quality of life. Thus, clinically reported hip fracture impairs both the functionality and quality of life of these subjects. The adverse impact of hip fracture on quality of life and functionality needs to be recognized by health personnel in the community, so that adequate health resources can be devoted to preventing and treating this debilitating condition.