Mental healthcare in South Korea

Trends in Electroconvulsive Therapy Utilization in South Korea: Health Insurance Review Data From 2008 to 2018

OBJECTIVE

The study aimed to analyze and clinically correlate 10-year trends in the demographic characteristics of patients receiving electroconvulsive therapy (ECT) to provide an overview of ECT utilization in South Korea.

METHODS

Using health insurance claims data from 2008 to 2018 retrieved from Health Insurance Review and Assessment Service database in South Korea, we identified individuals undergoing ECT based on procedural codes. Descriptive analysis evaluated baseline clinical characteristics, and trend analysis used a linear regression model.

RESULTS

The prevalence of ECT increased by 240.49% (0.405/105 inhabitants in 2008 to 0.974/105 inhabitants in 2018). The increasing trend was more pronounced in younger and older patients. The proportion of women consistently exceeded that of men. A rise in the proportion of patients with affective disorders, and a decrease in the proportion of psychotic disorders was observed. More antidepressants and atypical antipsychotics were prescribed to patients undergoing ECT. The proportion of ECT sessions conducted in large hospital inpatient settings also decreased during the observation period. Despite increasing global trends, ECT prevalence in South Korea remains significantly lower than worldwide rates.

CONCLUSION

This study demonstrated an increasing trend of ECT across a wide range of population demographics and in more accessible settings. The comparatively low prevalence of ECT in Korea compared to other countries might be attributed to insufficient mental health literacy and the stigma associated with ECT. Given the elevated suicide rates in Korea, more extensive adoption of ECT appears imperative.

Modeling the cost-effectiveness of galantamine for mild to moderately severe Alzheimer's disease in Korea

OBJECTIVE

The aim of the study was to determine the cost-effectiveness, from the third-party payer viewpoint, of galantamine compared with usual care in the treatment of mild to moderately severe Alzheimer's disease (AD).

METHODS

An existing Markov model was adapted to Korea to predict long-term outcomes over a 5-year time horizon and to estimate the cost-effectiveness of galantamine for the treatment of AD. The model structure is informed by a review of national and international literature on the clinical and cost-effectiveness of galantamine and on the costs and outcomes associated with treatment for AD. The main outcome measure used was the cost per quality-adjusted life year (QALY) gained. All costs were indexed to US$ (2007 value). Multivariate probabilistic sensitivity analysis and scenario analysis were undertaken to assess uncertainty in the results.

RESULTS

The study findings indicate that the clinical benefits on AD progression from galantamine treatment resulted in an incremental cost per QALY gained of US$4939 over 5 years (vs. usual care). Probabilistic sensitivity analysis and cost-effectiveness acceptability curve suggest that the probability of galantamine treatment having an incremental cost per QALY over US$6740 is zero. Incremental cost per QALY gained according to scenario analyses ranged from US$2271 to US$8335.

CONCLUSION

These findings suggest that the use of galantamine may be a cost-effective use of Korean national health-care resources, considering the gross domestic product per capita of US$21,695 in 2007.

Mental health systems in countries: where are we now?

More than 85% of the world's population lives in 153 low-income and middle-income countries (LAMICs). Although country-level information on mental health systems has recently become available, it still has substantial gaps and inconsistencies. Most of these countries allocate very scarce financial resources and have grossly inadequate manpower and infrastructure for mental health. Many LAMICs also lack mental health policy and legislation to direct their mental health programmes and services, which is of particular concern in Africa and South East Asia. Different components of mental health systems seem to vary greatly, even in the same-income categories, with some countries having developed their mental health system despite their low-income levels. These examples need careful scrutiny to derive useful lessons. Furthermore, mental health resources in countries seem to be related as much to measures of general health as to economic and developmental indicators, arguing for improved prioritisation for mental health even in low-resource settings. Increased emphasis on mental health, improved resources, and enhanced monitoring of the situation in countries is called for to advance global mental health.

The economic costs of dementia in Korea, 2002

OBJECTIVE

To estimate the economic costs of dementia in 2002 using an economic evaluation model for dementia care.

METHODS

Data were from the Korea National Survey of the Long-Term Care Need (LTC survey) (n = 5058), two prospective 1-year studies [one clinical trial (n = 234), one naturalistic community cohort study (n = 107)], and two epidemiologic community studies for prevalence of dementia (n = 1037 + 1481). Daily costs and proportions of different levels of institutional service provided were collected from the LTC survey. Resource use in the community included health care services, social care services, out-of-pocket purchase for self-support, caregiver time and missed work of caregiver. Costs in community were calculated based on resource utilization multiplied by the unit costs for each resource.

RESULTS

Total annual costs of dementia were estimated to be over 2.4 billion US dollars for 272,000 dementia sufferers. Costs in community represent 96% of the total annual costs, while costs of informal care and missed work of caregivers were 1.3 billion US dollars, or 55% of total annual cost. Average annual costs of full time care (FTC) and pre-FTC in community LTC were 44 121 US dollars and 13 273 US dollars per person, whereas cost per patient who did not need community LTC was 3,986 US dollars.

CONCLUSION

Given that the number of dementia sufferers is projected to increase in the near future and that larger part of the costs are subsidized by the government, the economic and social costs of dementia is significant not only for dementia sufferers and their caregivers, but also for society.