Schizophrenia in Thailand: Enabling better information for efficient solutions

Pudtan Phanthunane (2010). Schizophrenia in Thailand: Enabling better information for efficient solutions PhD Thesis, School of Population Health, The University of Queensland.

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Author Pudtan Phanthunane
Thesis Title Schizophrenia in Thailand: Enabling better information for efficient solutions
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2010-06-01
Thesis type PhD Thesis
Supervisor Professor Theo Vos
Professor Harvey Whiteford
Dr. Melanie Bertram
Total pages 170
Total black and white pages 170
Subjects 11 Medical and Health Sciences
Abstract/Summary 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.
Keyword schizophrenia

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Created: Thu, 12 May 2011, 22:41:41 EST by Ms Pudtan Phanthunane on behalf of Library - Information Access Service