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.

Background: Acute myocardial infarction (MI) is a leading cause of cardiovascular (CV) mortality and hospitalization. Survivors of acute MI have higher risk of subsequent CV events and death, compared to individuals without MI. Evidences have demonstrated the CV benefits of n-3 polyunsaturated fatty acids (PUFAs) in patients who experienced MI. Objectives:We assessed the cost-effectiveness of highly concentrated n-3 polyunsaturated fatty acids (PUFAs) in addition to standard therapy compared with standard therapy alone in post-MI patients in Thailand. Methods: A Markov model was constructed to assess costs, life years, and quality-adjusted life years (QALYs) with lifetime horizon in post-MI patients, on the basis of provider perspective. Input data were based on information from the Thai Acute Coronary Syndrome (ACS) Registry, a meta-analysis of mortality data and published articles. Outcomes have been presented as incremental cost-effectiveness ratios of life expectancy and quality-adjusted life expectancy. Deterministic and probabilistic sensitivity analyses were performed for key variables in the model. Results: n-3 PUFAs increased life expectancy by 2.34 life-years at an incremental cost-effectiveness ratio (ICER) of 256,199 Thai baht (THB) per life-year gained (LYG), compared to the standard therapy alone in the base case analysis. The quality-adjusted life years (QALY) increased by 2.01 with ICER of 297,193 THB per QALY from n-3 PUFAs supplementation. Both ICER/QALY and ICER/LYG decreased as the age of patients increased. The incremental cost per QALY gained in post-MI patients aged 45 to 85 years old ranged from 216,200 THB to 414,049 THB. Conclusion: Considering the current willingness-to-pay threshold of 160,000 THB/QALY, highly concentrated n-3 PUFAs as secondary prevention of MI appears not to be cost-effective compared to standard treatment alone in Thailand.

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.

The study aimed to compare performance between the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) methods in identifiing serious adverse drug reactions (ADRs) using the Thai FDA spontaneous database. The two methods were retrospectively applied to identifi 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 thefirst signal of a potential ADR. However, the pattern of signaling seems relatively different with each method. Additional analyses of different drugs, AD&, and databases will contribute to increase understanding of methods for postmarketing surveillance using spontaneous reporting system.

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 direciors responded to the survey from April to July 1999. There were no significant differences between respondents and nonrespondents with regard to hospital demographics. One hundred and thirty eight hospitals (83.1%) reported using PE daia. The two most important criteria leading to a P E 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 $25,000 and $I 00,000 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 Ilb/IIla inhibitor; Cox-I1 inhibitor; Low molecular weight heparin). The most important sources of PE data were published literature, pharmaceutical companies, and in-house PE assessments. Hospitals thai 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.