研究者詳細 - 後藤　励

論文 - 後藤　励

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Efficacy of aqueous olanexidine compared with alcohol-based chlorhexidine for surgical skin antisepsis regarding the incidence of surgical-site infections in clean-contaminated surgery: a randomized superiority trial

Takeuchi M., Obara H., Furube T., Kawakubo H., Kitago M., Okabayashi K., Fujisaki H., Aoyama J., Morimoto Y., Amemiya R., Sano J., Nakadai J., Goto R., Sato Y., Kitagawa Y.

British Journal of Surgery 112 （ 4 ） 2025年04月

ISSN 00071323

Background: Surgical-site antisepsis is used to prevent surgical-site infections (SSIs). Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine, povidone-iodine, and olanexidine, in reducing the SSI rate, an optimal recommendation is still not established. The aim of this study was to evaluate the efficacy of aqueous olanexidine compared with chlorhexidine-alcohol as the optimal antiseptic for preventing SSI in clean-contaminated surgery. Methods: This multicentre randomized trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary-pancreatic surgeries in five hospitals evaluated the efficacy of olanexidine and chlorhexidine-alcohol. The primary endpoint was 30-day SSI. Secondary outcomes included the occurrence of SSI types, intervention-related toxicity, and reoperation caused by SSI. Results: Overall, 700 patients from five institutions underwent randomization; 347 received olanexidine and 345 received chlorhexidine-alcohol in the full analysis set. The 30-day SSI rate was 12.4% (43 of 347) in the olanexidine group and 13.6% (47 of 345) in the chlorhexidine-alcohol group (adjusted risk ratio (aRR) 0.911 (95% c.i. 0.625 to 1.327); P = 0.626). No significant differences were observed between the groups regarding the secondary outcomes, including the occurrence of superficial incisional SSI, deep incisional SSI, organ/space SSI, and reoperation caused by SSI. Overall adverse effects were seen in two patients (0.58%) in the olanexidine group and in three patients (0.87%) in the chlorhexidine-alcohol group (aRR 0.663 (95% c.i. 0.111 to 3.951)). Conclusion: Olanexidine did not significantly reduce the occurrence of overall SSI compared with chlorhexidine-alcohol. Nevertheless, these findings provide valuable insights for developing novel surgical SSI management protocols. Registration number: UMIN 000049712 (University Hospital Medical Information Network Clinical Trials Registry).

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Cost-effectiveness of AI-based diabetic retinopathy screening in nationwide health checkups and diabetes management in Japan: A modeling study

Akune Y., Kawasaki R., Goto R., Tamura H., Hiratsuka Y., Yamada M.

Diabetes Research and Clinical Practice 221 2025年03月

ISSN 01688227

Aims: We evaluated the cost-effectiveness of artificial intelligence (AI)-based diabetic retinopathy (DR) screening in Japan. This evaluation compared the simultaneous introduction of AI in nationwide health checkups, namely “specific health check-ups in Japan” (SHC), and diabetes complication management (AI-case) with the current situation where AI is not being introduced (conventional-case) from the healthcare payer's perspective. Methods: A cost-effectiveness analysis was conducted using a new individual-based state transition model. Model parameters, including the incidence and progression of DR, health utility values, and costs of screening and treatment, were based on literature data and expert opinion. The analysis estimated quality-adjusted life years (QALYs), cumulative costs, and incremental cost-effectiveness ratios (ICER). Results: The ICER comparing the AI-case with conventional-case was estimated to be JPY 1,598,244/QALY (USD 11,375/QALY), which is below the willingness-to-pay threshold of JPY 5 million/QALY (USD 35,584/QALY). Scenario analyses revealed that ICERs for the AI-based DR screening in SHC-only condition was JPY 1,895,226/QALY (USD 13,488/QALY) and JPY 3,960,839/QALY (USD 28,189/QALY) in diabetes management-only condition. Conclusions: The introduction of AI-based DR screening for SHC and diabetes management was cost-effective compared to the current situation in Japan.

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The relationship between long COVID, labor productivity, and socioeconomic losses in Japan: A cohort study

Konishi S., Masaki K., Shimamoto K., Ibuka Y., Goto R., Namkoong H., Chubachi S., Terai H., Asakura T., Miyata J., Azekawa S., Nakagawara K., Tanaka H., Morita A., Harada N., Sasano H., Nakamura A., Kusaka Y., Ohba T., Nakano Y., Nishio K., Nakajima Y., Suzuki S., Yoshida S., Tateno H., Fukunaga K.

IJID Regions 14 2025年03月

Objectives: We examined shifts in labor productivity and their economic ramifications among adult patients with long COVID in Japan. Methods: A total of 396 patients were categorized into three groups based on symptom progression: non-long COVID, long COVID recovered, and long COVID persistent. Patient-reported outcomes were assessed at three time intervals: 3, 6, and 12 months after COVID-19 diagnosis. Labor productivity was gauged through presenteeism and absenteeism, measured using the World Health Organization Health and Work Performance Questionnaire. Results: Long COVID was observed in 52.7% of patients, and 29.3% of all the patients continued to experience long COVID symptoms 1 year after diagnosis. At all three time points (3, 6, and 12 months after diagnosis), the long COVID persistent group showed a statistically significant difference in absolute presenteeism compared with the non-long COVID and long COVID recovered groups (P <0.01). Economic loss owing to decrease in labor productivity was calculated as $21,659 per year in the long COVID persistent group and $9008 per year in the long COVID recovered group (P <0.01). Conclusion: The study's results revealed a notable decline in labor productivity over time, underscoring the importance of early detection and intervention to mitigate the socio-economic repercussions of long COVID, in addition to its health implications.

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Utilisation of outpatient care immediately before emergency admission for ambulatory care-sensitive conditions in Japan: a retrospective observational study

Nagashima R., Kato H., Matsuzaki T., Nagahama T., Goto R.

BMJ Open 15 （ 1 ） 2025年01月

Objective This study assessed whether patients with potentially preventable emergency admissions had limited access to outpatient care immediately before admission and whether they received appropriate outpatient care during their outpatient visits. Design Retrospective observational study. Setting Linked outpatient and inpatient care records obtained from a nationwide claims database in Japan. Participants Patients who experienced emergency admissions for ambulatory care-sensitive conditions between April 2005 and March 2020. Patient and regional characteristics were examined to assess the types of patients who faced difficulties with outpatient visits and receiving outpatient care related to the disease that resulted in admissions (hereafter referred to as admission-related outpatient care). Main outcome measures (1) Whether patients had an outpatient visit during the 2 weeks preceding admission and (2) whether patients received admission-related outpatient care during the 2 weeks before admission. Results This study included 18 449 emergency admissions for ambulatory care-sensitive conditions, representing 16.3% (18 449/113 669) of all emergency admissions in our data. Among patients with emergency admissions for ambulatory care-sensitive conditions, 37.4% did not have an outpatient visit within the 2 weeks preceding admission and 29.9% did not receive admission-related outpatient care despite having an outpatient visit. In total, 67.4% did not receive admission-related outpatient care during the 2 weeks preceding admission. Patients in their 40s and 50s were less likely to have outpatient visits and receive admission-related outpatient care before admission. No evidence associates regional characteristics with outpatient visits and receiving admission-related outpatient care before admission. Conclusion Most patients who underwent emergency admissions for ambulatory care-sensitive conditions did not have an outpatient visit or receive admission-related outpatient care, despite having an outpatient visit immediately before admission. Our findings suggest that emergency admissions may be prevented by improving access to timely and effective outpatient care.

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Health utility value of overactive bladder in Japanese older adults

Yoshioka T., Omae K., Funada S., Minami T., Goto R.

BJUI Compass 6 （ 1 ） 2025年01月

Objectives: To determine the health utility values (HUVs) of overactive bladder (OAB), defined as urinary urgency, usually accompanied by urinary daytime or nocturnal frequency, with or without urinary incontinence, among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity. Methods: This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each sex and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≤5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol five-dimension five-level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB. We selected eight covariates (age, sex, body mass index, education, income, smoking, alcohol use, and comorbidities) as potential confounders based on previous studies. The sample size was determined based on previous studies without statistical power calculations. Results: Among the 998 participants (51.9% male; mean age, 73.2 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs] and p values) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066, p = 0.014) and −0.0591 (−0.0844 to −0.0339, p < 0.001), respectively. Conclusions: Consistent with previous HUV studies on OAB, our results demonstrated that the prevalence of OAB was associated with substantially lower HUV. The results demonstrate that increased OAB severity is associated with greater disutility.

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Research Study on the Cost Structure and Break-Even Point of Mechanical Thrombectomy in Japan

Yamasaki Bumpei, Goto Rei, Imamura Hirotoshi, Sasanuma Jinichi

脳神経血管内治療（一般社団法人日本脳神経血管内治療学会） 19 （ 1 ） n/a 2025年

ISSN 18824072

Objective: Mechanical thrombectomy (MT) is an important procedure in the treatment of acute cerebral infarction, and its effectiveness depends largely on timely intervention after the onset. In the United States, a tiered accreditation system of stoke centers has been established to provide MT efficiently. In Japan, however, despite the large number of medical institutions performing MT, the establishment of a tiered accreditation system has yet to be seen. The low number of cases treated per institution raises concerns about the economic sustainability of MT in Japan because significant capital and human resource investment are required. This study aims to investigate the cost structure of MT procedure and the break-even point in 2 different hospital settings in Japan.Methods: We conducted a detailed cost analysis of MT at 2 distinct hospitals: Hospital A, a large public hospital in a government-designated city, and Hospital B, a private non-profit hospital in the Tokyo metropolitan area. Data collection involved face-to-face interviews with department heads and a structured survey based on the Japanese Hospital Accounting Standards, focusing on material, labor, and facility-related costs. Break-even points were calculated considering both fixed and variable costs, with adjustments made for the shared use of facilities in Hospital B.Results: The total cost per case was 349256 yen in Hospital A and 245150 yen in Hospital B, respectively. The total cost per case was elevated to 559866 yen assuming only MT was performed at Hospital B. This figure was significantly higher than the reimbursement price of MT (331500 yen). The number of procedures needed to exceed the break-even point for MT was approximately 290 cases per year in Hospital A and 125 cases per year in Hospital B, respectively.Conclusion: We conducted a break-even analysis of MT based on an interview survey. The number of cases required to cross the break-even point for MT alone was much higher than the actual number of MT procedures being performed in the 2 hospitals.

Cost-Effectiveness Analysis of SOX Plus Bevacizumab Versus SOX Plus Cetuximab for First-Line Treatment of KRAS Wild-Type Metastatic Colorectal Cancer in Japan

Morimoto T., Fujito K., Goto R.

Clinical Therapeutics 47 （ 5 ） 347 - 354 2025年

ISSN 01492918

Purpose: In this study, we aimed to evaluate the cost-effectiveness of S-1 and oxaliplatin (SOX) plus bevacizumab (Bmab group) compared with SOX plus cetuximab (Cmab group) as a first-line treatment for patients with Kirsten rat sarcoma virus (KRAS) wild-type metastatic colorectal cancer (mCRC) in Japan from the perspective of healthcare payers. Methods: A partitioned survival model was developed using data from the randomized phase II Osaka Multicenter Study Group on Colorectal Cancer-1107 study, which included overall survival, progression-free survival, and treatment regimens for the Bmab and Cmab groups. Treatment costs were estimated from the Japanese medical claims database and the National Health Insurance drug price list. The utilities were derived from the literature. Outcomes were reported as incremental cost, incremental quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) threshold was set at 7.5 million JPY per QALY. The time horizon of the model was set to 20 years. Sensitivity analyses were conducted to assess the uncertainty of the model for various parameters. Findings: Compared with the Cmab group, the Bmab group had an incremental cost of 911,373 JPY (6,528 USD), an incremental effectiveness of 0.79 QALY, and an ICER of 1146,745 JPY (8,215 USD) per QALY. One-way sensitivity analysis showed that the cost of progressive disease treatment in the Bmab group had the greatest impact on the ICER. According to the probabilistic sensitivity analysis, the Bmab group had a 94.9% probability of being cost-effective compared with the Cmab group. Implications: Considering a WTP threshold of 7.5 million JPY (approximately 53,700 USD) per QALY, Bmab might be a cost-effective treatment option for patients with KRAS wild-type mCRC in Japan. Further studies on economic evaluations based on personalized drugs and patient selection based on clinical and genetic information are warranted.

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Reporting Quality in Health Economic Evaluation Studies of Immune Checkpoint Inhibitors: A Systematic Review

Yoshioka T., Azuma S., Funada S., Itaya T., Goto R.

Clinical Drug Investigation 2025年

ISSN 11732563

Background and Objective: The introduction of immune checkpoint inhibitors (ICIs) in oncology presents a critical healthcare policy challenge for resource allocation due to their substantial financial burden. This study assessed the reporting quality of health economic evaluation (HEE) studies of ICIs. Methods: This study conducted a systematic literature search of four databases (PubMed, EMBASE, Cochrane CENTRAL, and the International HTA Database) for studies published between January 1, 2014 and December 31, 2022. All ICIs approved up to December 31, 2022, in the USA, EU, China, and Japan were included. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards published in 2013 (CHEERS 2013), which is the most widely recognised and implemented reporting guideline for HEE studies. Subgroup analyses were also performed based on the risk of sponsorship bias or citation of CHEERS 2013. Results: A total of 5368 records were identified, 252 of which were included after full-text review. The study design, setting, and ICIs most frequently observed were cost-effectiveness and cost-utility analyses (63.5%), the USA (46.0%), and pembrolizumab (38.1%), respectively. Of the 24 items of CHEERS 2013, fully reported items were limited, particularly in the Methods section. Setting and location were not reported in 94.4% of the records. Subgroup analyses also revealed insufficient reporting of items in the Methods section, particularly “Setting and location”. Conclusion: Health economic evaluation studies on ICIs between 2014 and 2022 had limited reporting across the 24 items of CHEERS 2013, regardless of sponsorship bias risk or citations. The items on setting and location in the Methods section were particularly underreported, emphasising the need for transparent reporting in HEE studies of ICIs.

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Analysis of recent changes in treatment options for patients with hepatocellular carcinoma using data from a highly comprehensive Japanese national database: Impact of advances in systemic therapy and minimally invasive surgery

Kokudo T., Yamada Y., Sugiyama T., Goto R., Kokudo N.

Global Health & Medicine （国立研究開発法人国立国際医療研究センター） 6 （ 6 ） 416 - 419 2024年12月

ISSN 24349186

In 2011, the Ministry of Health, Labour and Welfare started providing data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) for research purposes. The NDB is an exhaustive and valuable database for health policymaking and research. It provides an accurate and most recent visualization of the burden of hepatocellular carcinoma (HCC) in Japan. In this study, we analyzed the trend in HCC treatments using data from the NDB. The NDB data were retrospectively analyzed to calculate the number of patients who were diagnosed with HCC (International Classification of Diseases, version 10 code of C22.0) and underwent treatment from fiscal year (FY) 2016 to 2020. We observed the following trends in HCC treatments during the past 5 years: a slight increase in the number of liver resection (LR) cases (+5.4%), a decrease in the number of radiofrequency ablation cases (−15.2%), and a considerable decrease in the number of transarterial chemoembolization/transarterial embolization cases (−38.2%). However, the number of patients who received systemic therapy dramatically increased from 471 in FY 2016 to 1,584 in FY 2020 (+236%). Among LR cases, there was a remarkable increase in the number of laparoscopic procedures from 1,227 in FY 2016 to 2,057 in FY 2020 (+67.6%). This analysis of a national highly comprehensive database revealed a very recent visualization of HCC management in Japan, wherein the impact of recent advances in systemic therapy and minimally invasive surgery was prominent.

Trends in the integration of medical corporation hospitals in Japan: a national wide longitudinal study between 2017 and 2021

Funada S., Luo Y., Kato H., Yoshioka T., Uno S., Honda K., Akune Y., Goto R.

BMC Health Services Research 24 （ 1 ） 2024年12月

Background: Medical corporations, which are non-profit organizations that aim to operate hospitals, clinics, or long-term care facilities, account for more than half of all hospital beds and play a central role in the health care system in Japan. However, limited analysis of hospital integration has been performed. Examining the hospital integration trends of medical corporations can provide valuable insights for optimizing health care delivery and resource allocation in Japan. This study conducted a comprehensive analysis of trends in the hospital integration of medical corporations and market concentration in Japan using nationwide longitudinal data. Methods: This longitudinal study evaluated the hospital integration of medical corporations in Japan between 2017 and 2021 using medical corporation financial data provided by the Neostage Company. The target population was medical corporations that own hospitals in Japan. The primary outcomes were the horizontal and vertical integration of medical corporation hospitals. Horizontal integration was defined as the integration of two or more hospitals within the same corporation, while vertical integration was defined as the integration of a hospital with different types of health care facilities, such as clinics or long-term care facilities, within a single medical corporation. The Herfindahl–Hirschman Index (HHI) was calculated to measure hospital market concentration using hospital bed data for medical corporations in all prefectures. Results: The number of hospitals and hospital beds within medical corporations decreased from 5,670 to 848,174 in 2017 to 5,486 and 814,462 in 2021, respectively. Both horizontal and vertical integration among medical corporation facilities showed a gradual upward trend, increasing from 24.92% to 55.75% in 2017 to 26.92% and 59.42% in 2021, respectively. The mean (standard deviation [SD]) HHI increased slightly from 262.7 (178.6) in 2017 to 275.2 (187.9) in 2021, with rural areas being more concentrated than urban areas, although both remained unconcentrated. Conclusions: This longitudinal study revealed a gradual downward trend in the number of hospitals and hospital beds owned by medical corporations, while horizontal and vertical integration gradually progressed without any particular medical corporation dominating the market. These findings are expected to contribute to policymaking efforts aimed at providing optimal health care services in Japan.

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A cost-effectiveness analysis of three surgical options for treating displaced femoral neck fractures in active older patients in Japan: A full economic evaluation

Yokoyama K., Akune Y., Katoh H., Bito S., Fujita Y., Goto R., Yamauchi K.

PLoS ONE 19 （ 10 October ） 2024年10月

For older patients with displaced femoral neck fractures, in which primary osteosynthesis is usually not indicated, there are three primary prosthetic options—bipolar hemiarthroplasty (BHA), single-bearing total hip arthroplasty (SB-THA), and dual-mobility THA (DM-THA). However, the optimal choice for managing displaced femoral neck fractures remains controversial. Accordingly, this study aimed to evaluate the cost-effectiveness of BHA, SB-THA, and DM-THA in active older patients with displaced femoral neck fractures. A decision tree combined with a Markov model was employed to analyze the cost and quality-adjusted life years (QALYs) of BHA, SB-THA, and DM-THA for the management in the Japanese healthcare system. By simulating the five-year trajectory of a 75-year-old woman treated for a displaced femoral neck fracture, the cost-effectiveness of the three surgical options was evaluated. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to assess parameter uncertainty. Additionally, two scenario analyses were conducted for other settings. The treatment was considered to be cost-effective when the incremental cost-effectiveness ratio (ICER) was below the 5,000,000 yen/QALY threshold. Compared with BHA, SB-THA exhibited higher costs but greater health benefits, resulting in an ICER of 1,499,440 yen/QALY. DM-THA offered additional health benefits compared with SB-THA, with an ICER of 4,145,777 yen/QALY. One-way sensitivity analysis revealed some influential parameters. PSA indicated that the probability of DM-THA, SB-THA, and BHA being cost-effective was 40.1%, 38.5%, and 21.4%, respectively. SB-THA was more cost-effective than BHA in patients aged 65–85 years, while DM-THA was more cost-effective than SB-THA in patients aged 65–75 years. The results suggest that SB-THA is a cost-effective alternative to BHA for displaced femoral neck fractures in active older patients, whereas DM-THA is more cost-effective than SB-THA in relatively younger patients. It is, therefore, recommended that orthopedic surgeons select the most appropriate surgical option based on the individual patient’s physiological age.

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Cost-effectiveness of behavioural counselling intervention compared with non-intervention for adult patients with metabolic syndrome to prevent cardiovascular diseases and type 2 diabetes in Japan: a microsimulation modelling study

Akune Y., Anezaki H., Nakao Y.M., Goto R.

BMJ Open （BMJ Open） 14 （ 4 ） 2024年04月

Objectives Nationwide lifestyle intervention—specific health guidance (SHG) in Japan—employs counselling and education to change unhealthy behaviours that contribute to metabolic syndrome, especially obesity or abdominal obesity. We aimed to perform a model-based economic evaluation of SHG in a low participation rate setting. Design A hypothetical population, comprised 50 000 Japanese aged 40 years who met the criteria of the SHG, used a microsimulation using the Markov model to evaluate SHG’s cost-effectiveness compared with non-SHG. This hypothetical population was simulated over a 35-year time horizon. Setting SHG is conducted annually by all Japanese insurers. Outcome measures Model parameters, such as costs and health outcomes (including quality-adjusted life-years, QALYs), were based on existing literature. Incremental cost-effectiveness ratios were estimated from the healthcare payer’s perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to evaluate the uncertainty around the model input parameters. Results The simulation revealed that the total costs per person in the SHG group decreased by JPY53 014 (US$480) compared with that in the non-SHG group, and the QALYs increased by 0.044, wherein SHG was considered the dominant strategy despite the low participation rates. PSA indicated that the credibility intervals (2.5th–97.5th percentile) of the incremental costs and the incremental QALYs with the SHG group compared with the non-SHG group were −JPY687 376 to JPY85 197 (−US$6226 to US$772) and −0.009 to 0.350 QALYs, respectively. Each scenario analysis indicated that programmes for improving both blood pressure and blood glucose levels among other risk factors for metabolic syndrome are essential for improving cost-effectiveness. Conclusions This study suggests that even small effects of counselling and education on behavioural modification may lead to the prevention of acute life-threatening events and chronic diseases, in addition to the reduction of medication resulting from metabolic syndrome, which results in cost savings.

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ビジネスパーソンのための医療経済学

後藤励

医療経済研究（医療経済学会/医療経済研究機構） 35 （ 2 ） 63 - 64 2024年03月

ISSN 1340895X

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年03月

ISSN 22121099

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.

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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年02月

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.

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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年02月

ISSN 03682811

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 (https://jrct.niph.go.jp/latest-detail/jRCTs031230219).

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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年01月

ISSN 10584838

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.

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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

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総合リハビリテーション（株式会社医学書院） 52 （ 1 ） 35 - 41 2024年01月

ISSN 03869822

Willingness to pay for nationwide wastewater surveillance system for infectious diseases in Japan

Yoo B.K., Goto R., Kitajima M., Sasaki T., Himmler S.

Environmental Science: Water Research and Technology （Environmental Science: Water Research and Technology） 11 （ 1 ） 29 - 38 2024年

ISSN 20531400

COVID-19 motivated the US and the European Union to establish a regular pathogen surveillance system at wastewater treatment plants, but other countries, including Japan, have been reluctant to adopt such a system. To determine whether a continuous pathogen surveillance system at wastewater treatment plants is economically justifiable in Japan, we conducted a contingent valuation experiment to estimate a hypothetical willingness to pay (WTP) for such a surveillance system. To collect primary data, an online WTP experiment was administered to a nationally representative sample in Japan in spring 2023 (N = 2457). Results indicated that mean WTP was US $23.47 (Median $8.83) per household per year, and that around 97% of individuals had a non-zero WTP. The monetary valuation aggregated to the national level ($497 million based on the median value) exceeds the likely costs of maintaining the system in Japan ($33 million). Based on the population's valuation of the nationwide wastewater surveillance system, its establishment would be economically justifiable in Japan. Our results are expected to inform stakeholders in Japan, the US, the European Union, and other countries considering expanding or maintaining wastewater surveillance systems that are applicable for diverse infectious diseases including COVID-19. For a future epidemic with uncertain risks, the surveillance systems' economic efficiency (e.g., cost-effectiveness and return-on-investment) is difficult to assess. Eliciting taxpayers' WTP can be informative for that purpose.

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Relationship between hospital surgical volume and the perioperative esophagectomy costs for esophageal cancer: a nationwide administrative claims database study

Sakamoto T., Nishigori T., Goto R., Kawakami K., Nakayama T., Tsunoda S., Hisamori S., Hida K., Obama K.

Esophagus 22 （ 1 ） 27 - 36 2024年

ISSN 16129059

Background: Numerous studies have described positive relationships between hospital volume (HV) and clinical outcomes in highly complex procedures, including esophagectomies. Although the centralization of surgery has been considered a possible solution for improving clinical outcomes, the HV impact on perioperative healthcare costs is unknown. This study aimed to determine the relationship between HV and perioperative healthcare costs for patients undergoing esophagectomy for esophageal cancer. Methods: This retrospective, nationwide cohort study used Japanese Administrative Claims Database data. Data on esophagectomies performed nationwide in 2015 were extracted. The outcome measure was perioperative healthcare costs per person from the perspective of the insurer. The healthcare costs in outpatient or inpatient settings of any hospital and clinic where patients received treatment were summed up from the month the surgery was performed to 3 months after. Linear regression analyses were conducted to assess the risk-adjusted effects of the HV category (1–4/5–9/10–14/15–) on perioperative costs. Results: A total of 5232 patients underwent an esophagectomy at 584 hospitals. The overall perioperative cost was 20.834 billion Japanese yen (JPY). The median perioperative costs per person for each HV category (1–4/5–9/10–14/15–) were 3.728 (709 patients), 3.740 (658 patients), 3.760 (512 patients), and 3.760 (3253 patients) million JPY, respectively (P = 0.676). Multivariate analyses revealed that each HV category had no significant impact on perioperative costs. Conclusions: There were no significant differences in the perioperative costs between high- and low-volume centers. Esophageal cancer surgery centralization may be achievable without increasing healthcare costs.

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