Goto, Rei



Graduate School of Business Administration (Hiyoshi)



Other Affiliation 【 Display / hide

  • Center of Health Economics and Health Technology Assessment, KGRI

  • Graduate School of Health Management

Career 【 Display / hide

  • 1998.05

    Kobe City General Hospital, Resident in Medicine

  • 2005.04

    Konan University, Faculty of Economics, Lecturer

  • 2007.04

    Konan University, Faculty of Economics, Associate Professor

  • 2012.04

    Kyoto University, The Hakubi Institute of Advanced Research, Associate Professor

Academic Background 【 Display / hide

  • 1992.04

    Kyoto University, School of Medicine

    University, Graduated, Other

  • 2000.04

    Kyoto University, Graduate School of Economics

    Graduate School, Completed, Doctoral course

Academic Degrees 【 Display / hide

  • 学士(医学), Kyoto University, Coursework, 1998.03

  • 博士(経済学), Kyoto University, Coursework, 2006.05

Licenses and Qualifications 【 Display / hide

  • Physician, 1998.04


Research Areas 【 Display / hide

  • Humanities & Social Sciences / Economic policy

  • Humanities & Social Sciences / Public economics and labor economics

  • Life Science / Medical management and medical sociology

Research Keywords 【 Display / hide

  • health technology assessment

  • health policy

  • health economics

  • behavioral economics


Books 【 Display / hide

  • Health Economics

    後藤励, 井深陽子, 有斐閣, 2020.03

  • 医療レジリエンス -医学アカデミアの社会的責任-

    FUKUHARA Shunichi,GOTO Rei,NAKAYAMA Takeo,KAWAKAMI Koji,FUKUMA Shingo, 医学書院, 2015

  • 日本のお医者さん研究

    MORI Takeshi,GOTO Rei, 東洋経済新報社, 2012

  • 医療経済学講義

    GOTO Rei, 東京大学出版会, 2011

    Scope: 第10章 生活習慣と行動変容

  • 健康行動経済学

    YODA Takanori,GOTO Rei,NISHIMURA Shuzo, 日本評論社, 2009

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Papers 【 Display / hide

  • Cost-effectiveness Analysis of Nivolumab Plus Ipilimumab Combination Therapy as First-line Treatment for Advanced Renal Cell Carcinoma in Japan

    Maeda T., Moriwaki K., Morimoto K., Mo X., Yoshioka T., Goto R., Shimozuma K.

    Value in Health Regional Issues (Value in Health Regional Issues)  40   118 - 126 2024.03

    ISSN  22121099

     View Summary

    Objectives: The purpose of this study is to examine the cost-effectiveness of nivolumab (NIVO) plus ipilimumab (IPI) combination therapy (NIVO + IPI) compared with the sunitinib (SUN) therapy for Japanese patients with advanced renal cell carcinoma from the perspective of a Japanese health insurance payer. Methods: A lifetime horizon was applied, and 2% per annum was set as the discount rate. The threshold was set as $ 75 000 per quality-adjusted life-year (QALY) gained. For the analytical method, we used a partitioned survival analysis model to estimate the incremental cost-effectiveness ratio (ICER), which is calculated by dividing incremental costs by incremental QALYs. Progression-free survival, progressive disease, and death were set as health states. Additionally, cost parameters and utility weights were set as key parameters. We set the intermediate/poor-risk population as the base case. Scenario analysis was conducted for the intention-to-treat population and the favorable risk population. Furthermore, one-way sensitivity analysis and probabilistic sensitivity analysis were conducted for each population. Results: In the base-case analysis, the QALYs of NIVO + IPI and SUN were 4.32 and 2.99, respectively. NIVO + IPI conferred 1.34 additional QALYs. Meanwhile, the total costs in the NIVO + IPI and SUN were $692 288 and $475 481, respectively. As a result, the ICER of NIVO + IPI compared with SUN was estimated to be $162 243 per QALY gained. The parameter that greatly affected the ICER was the utility weight of progression-free survival in NIVO + IPI. Conclusions: NIVO + IPI for advanced renal cell carcinoma seems to be not cost-effective compared with the SUN in the Japanese healthcare system.

  • Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan

    Honda K., Akune Y., Goto R.

    JAMA Network Open (JAMA Network Open)  7 ( 2 )  2024.02

     View Summary

    IMPORTANCE The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer's perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2%per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1). INTERVENTIONS School urinary screening for IgA nephropathy was compared with no screening. MAIN OUTCOMES AND MEASURES Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093). RESULTS In the base case analysis, the ICERwas ¥4 186 642 (US $39 127)/QALY, whichwas less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Costeffectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, -¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY). CONCLUSIONS AND RELEVANCE This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.

  • Protocol digest of a randomized controlled Phase III study comparing surgery alone versus adjuvant nivolumab versus adjuvant S-1 for locally advanced oesophageal squamous cell carcinoma with no pathological complete response after neoadjuvant chemotherapy followed by curative esophagectomy: Japan Clinical Oncology Group study JCOG2206 (SUNRISE Trial)

    Kita R., Matsuda S., Nomura M., MacHida R., Sasaki K., Kato K., Goto R., Yoshioka T., Yamamoto S., Tsushima T., Fukuda H., Takeuchi H., Kitagawa Y.

    Japanese Journal of Clinical Oncology (Japanese Journal of Clinical Oncology)  54 ( 2 ) 212 - 216 2024.02

    ISSN  03682811

     View Summary

    Although the efficacy of postoperative therapy with nivolumab after preoperative chemoradiotherapy for locally advanced oesophageal cancer has been proven in Western countries, the survival benefits of postoperative therapy after preoperative chemotherapy with docetaxel, cisplatin and 5-FU or cisplatin plus 5-FU as the Japanese standard therapy remain controversial. This randomized Phase III trial was designed to confirm the superiority of postoperative therapy with nivolumab over observation alone and S-1 over observation alone in patients with locally advanced oesophageal squamous cell carcinoma with no pathological complete response after preoperative chemotherapy followed by curative esophagectomy. A total of 450 patients will be enrolled from 56 hospitals in Japan over 5.5 years. The primary endpoint is relapse-free survival, and the secondary endpoints are disease-free survival, overall survival, adverse events and incremental cost-effectiveness ratio. This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031230219 (

  • Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis

    Uno S., Goto R., Honda K., Uchida S., Uwamino Y., Namkoong H., Yoshifuji A., Mikita K., Takano Y., Matsumoto M., Kitagawa Y., Hasegawa N.

    Clinical Infectious Diseases (Clinical Infectious Diseases)  78 ( 1 ) 57 - 64 2024.01

    ISSN  10584838

     View Summary

    Background: An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing. Methods: We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY). Results: The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. The incremental cost-effectiveness ratio fell below 5 000 000 JPY/QALY only when the test-positive rate exceeded 0.739%. However, when the probability of developing a postoperative pulmonary complication among SARS-CoV-2-positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became. Conclusions: Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced.

  • 特集 リハビリテーションの医療経済学 医療政策の経済学的評価

    後藤 励

    総合リハビリテーション (株式会社医学書院)  52 ( 1 ) 35 - 41 2024.01

    ISSN  03869822

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Papers, etc., Registered in KOARA 【 Display / hide

Reviews, Commentaries, etc. 【 Display / hide

  • Health-related quality of life assessment in children for economic evaluation

    HONDA Kimiko, SHIROIWA Takeru, GOTO Rei, FUKUDA Takashi

    Journal of the National Institute of Public Health (National Institute of Public Health)  71 ( 3 ) 264 - 275 2022.08

    ISSN  1347-6459

     View Summary

    <p>The use of quality-adjusted life year (QALY) as a measure of benefit is recommended in economic evaluation, which aims to provide evidence for the appropriate allocation of health care resources. This allows for an easier comparison of interventions' effects in different fields. A QALY value is calculated by weighting the life years (LYs) by the quality of life (QOL) score, which is determined by preference-based measure (PBM) and converted from 0 to 1. The QOL score should be obtained through domestic surveys because it reflects the value in the country's general population. In Japan, the data of the QOL scores for adults have been accumulated in recent years. However, few studies for children have been conducted due to various issues in evaluating pediatric health-related QOL (HRQOL). The PBM process for obtaining the QOL score can be divided into “measurement” and “valuation” of the health state to be evaluated. This process is implemented at once in direct methods, whereas it is carried out separately in indirect methods. Direct methods include the rating scale, the time trade-off, and the standard gamble, but children's feasibility, reliability, and validity must be thoroughly investigated. In indirect methods, which is currently the mainstream in general, multi-attribute utility instruments (MAUIs) are used, consisting of a questionnaire to measure the health state and a value set to value the measured health state. However, most MAUIs are designed for adult use and are not suitable for pediatric use because the questions are inappropriate, and the value set is intended to value adult health. In recent years, some MAUIs for pediatric use have been developed. Nevertheless, due to translations and the value set, these are not available in all countries. Additionally, there are no existing MAUIs available for children aged 3 years. Furthermore, issues concerning “measurement,” such as which domains should be assessed and how, and by whom, and issues concerning “valuation,” such as whose preferences should be reflected in developing the value set, and which perspectives should be used, remain. There have been no MAUIs for pediatric use in Japan, but the Japanese version of the EuroQol 5-dimension Youth version (EQ-5D-Y) and its value set have recently been published. It is necessary to fully understand the challenges and limitations in measuring and interpreting the QOL score in children.</p>

  • 【すぐそこまで来た,医師の働き方改革-課題と実現可能性】医師の働き方改革とお金の問題

    後藤 励

    病院 ((株)医学書院)  81 ( 2 ) 127 - 129 2022.02

    ISSN  0385-2377

  • Comment on “Health and Public Health Implications of COVID-19 in Asian Countries”

    Goto R.

    Asian Economic Policy Review (Asian Economic Policy Review)  17 ( 1 ) 39 - 40 2022.01

    ISSN  18328105

  • 【統計的分析手法と研究デザイン】統計学的分析手法 医療の経済評価

    後藤 励

    小児科診療 ((株)診断と治療社)  84 ( 6 ) 767 - 772 2021.06

    ISSN  0386-9806

     View Summary


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Research Projects of Competitive Funds, etc. 【 Display / hide

  • Platform development of claim data analysis for economic analysis of health policy


    MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Scientific Research (C), Principal investigator


Courses Taught 【 Display / hide











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