Cost-effectiveness of atypical antipsychotics for the treatment of dementia in Thailand

Dementia is a significant global health problem and has become a leading cause of morbidity and a functional decline in elderly people. This syndrome comes together with the behavioural and psychological symptoms of dementia, (BPSD), which more than half of people with dementia tend to encounter behavioural disturbances at any one point during the course of the disease, leading to several problems for those patients, caregivers, family members as well as healthcare systems. Due to a controversy of the management of BPSD at this time, it results in a variety of treatment options for BPSD sufferers. Currently, an economic evaluation of atypical antipsychotic drug use for behaviourally disturbed patients with dementia is not well explored. As a result, it is important to address this lack of knowledge as well as the paucity of economic evaluation studies associated with the cost-utility of atypical antipsychotics for the treatment of dementia patients. This thesis aims to use the cost-utility analysis to assess the economic impact of olanzapine compared with risperidone, for patients with BPSD in Thailand. The main stages applied for this analysis are as follows: firstly, the scope of the health economic evaluation was defined. Secondly, the models were developed in different schemes and justified the most appropriate model to apply for evaluating the treatment with olanzapine in comparison to risperidone, for patients with BPSD within a Thai setting. Then, the estimated monthly costs and utility weights of patients with BPSD and receiving olanzapine or risperidone were calculated from the primary data collected from two hospitals in Thailand. Finally, the cost-utility analysis of atypical antipsychotics for the treatment of patients with BPSD in Thailand was conducted from a societal perspective, over a five-year time horizon using a one-month cycle length. The results suggest olanzapine is more cost-effective than risperidone, in the treatment of a patient with BPSD from a societal perspective (ICER< THB 160,000).