研究者詳細 - 後藤　励

論文 - 後藤　励

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Organization-level factors associated with the adoption of care robots in long-term care providers: insights from a 3-year pooled cross-sectional study in Japan

Tosaka Y., Funada S., Goto R.

BMC Health Services Research 26 （ 1 ） 2026年12月

Background: Care robots are expected to be useful in long-term care (LTC) settings to resolve several challenges associated with aging populations. However, their use is still limited and little is known about the factors associated with their adoption. This study aimed to identify the factors associated with the adoption of care robots, using a quantitative analysis of a large sample at the organizational level in Japan. Methods: We analyzed residential service providers using 3 years of pooled cross-sectional data from the Fact-Finding Survey on Long-term Care Work in Japan. In this survey, care robots were categorized as robots for “Transfer support,” “Mobility assistance,” “Toiletry support,” “Monitoring and Communication,” “Bathing support,” and “Support for LTC workers.” We defined “adoption of care robots” as LTC providers having adopted at least one of the care robots. To identify the characteristics of LTC providers associated with the adoption of care robots, we conducted a multivariable logistic regression comparing providers with and without care robots. Results: Of the 4,688 LTC providers, 1,250 (26.7%) adopted care robots. The characteristics of LTC providers that were found to be associated with the adoption of care robots were: information and communication technology (ICT) equipment adoption (adjusted odds ratio [aOR] 3.115, 95% confidence interval [CI] 2.453, 3.956), younger average age of care workers (aOR 0.958, 95% CI 0.945, 0.971), large number of employees (aOR 1.008, 95% CI 1.006, 1.010) and appointment of employment management supervisor (aOR 1.611, 95% CI 1.400, 1.853). The primary results were consistent across robot categories. Conclusions: Our findings suggest that care robot adoption is highly compatible with ICT equipment adoption, particularly among younger workers, and among large-scale providers and those with a high awareness of improving employment management indicated by the appointment of an employment management supervisor. To promote adoption, we suggest staff technology-literacy training (especially for senior employees), targeted financial incentives for small providers, and management-led integration of robots within employment-management improvements. This study identified the factors associated with the adoption of care robots at the organizational level and is expected to contribute to realizing the implementation of care robots.

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連載医療にいかす行動経済学・Vol.3 行動経済学とヘルスケア

後藤励

医学のあゆみ（医歯薬出版） 296 （ 4 ） 319 - 324 2026年01月

ISSN 00392359

Programmed Medical Device (SaMD) and Orphan Drug Innovation Processes and Industrial Systems

Goto R., Sengoku S., Kodama K.

Yakugaku Zasshi （公益社団法人日本薬学会） 146 （ 1 ） 35 - 46 2026年01月

ISSN 00316903

The innovation patterns and institutional environments of software as a medical device (SaMD) were empirically, comparatively, and institutionally analyzed as SaMD is attracting attention as innovative medical technology. Data were collected on SaMD products approved by the U.S. Food and Drug Administration (FDA) and medical providers (n=581 and 268, respectively). The relationships among SaMD use, the interaction of SaMD with existing medical devices, and company characteristics were structurally evaluated. The use of the current SaMDs as highly concentrated in the medical image processing field, with emerging information and communication technology companies producing many products. The relationship between SaMDs and hardware-type medical devices varied with their use purpose, based on which an innovation regime map for SaMDs was constructed. Next, the differences in reimbursement systems in Japan, the U.S., and Europe were comparatively analyzed, considering the policy implications for high-uncertainty technologies, such as SaMD and orphan drugs. We specifically focused on the cost-effectiveness-oriented reimbursement decision in Europe, the approval-for-reimbursement structure in Japan, and the range of individual decisions by payers in the United States. We summarized the actual state of price setting and payment models in each region (e.g., performance-based payments, price caps, and rebates). A framework for risk allocation between manufacturers and insurers is required when the value of medical technology is uncertain, suggesting a need for flexible and data-linked evaluations in future system designs.

Low-cost, high-volume healthcare services contribute the most to low-value care spending in Japan

Miyawaki A., Mafi J.N., Fukui T., Kimura Y., Kobayashi D., Odawara S., Abe K., Goto R., Tsugawa Y.

Health Affairs Scholar 3 （ 12 ） 2025年12月

Introduction High-income countries face the urgent task of reducing healthcare spending incurred by low-value care. However, evidence is limited as to whether high-cost or low-cost low-value care services contribute more to total unnecessary healthcare spending, especially outside the United States. Methods Using a claims database covering all age groups in Japan from April 2022 to March 2023 (approximately 2 million beneficiaries, or 2% of the total population), we examined 52 low-value care services using two versions of claims-based measures with different sensitivities and specificities (narrower and broader definitions). Results We identified 3.1 million (narrower) to 3.7 million (broader) episodes of low-value care services, accounting for 42.6-67.2 million USD, or 0.7%-1.0% of total healthcare spending. In the narrower definition, lower-cost services (<80 USD per service) contributed to virtually all episodes of low-value care and 67% of total unnecessary healthcare spending—far exceeding the 33% attributed to the higher-cost services (≥80 USD). Conclusion This finding suggests that compared with focusing solely on higher-cost low-value care services, targeting the reduction of frequently performed, lower-cost low-value care services may be a more effective and efficient strategy for reducing wasteful spending.

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Difference in time and risk preferences: physicians and general population across genders

Kasahara S., Kato H., Goto R.

Health Economics Review 15 （ 1 ） 2025年12月

Background: The alignment of preferences between physicians and patients can cause variations in treatment decision-making, thereby affecting health outcomes. However, research on the differences in preferences between physicians and the general population is scarce. This study examines the risk and time preferences of physicians compared with those of the general population, exploring the influence of gender concordance on health outcomes and decision-making in healthcare. Methods: We conducted an online field experiment in October and November 2022 in Japan and analyzed the responses of 469 individuals, including physicians and the general population. The survey was stratified by age and gender to align with the demographics of physicians nationally. Participants’ preferences were measured across the health and monetary domains by using a modified multiple price list test format. Results: The findings revealed that physicians tended to be more risk-averse than the general population in the health and monetary domains, although no statistically significant differences were observed. Physicians were found to be statistically significantly future-oriented, particularly regarding their significant health or monetary gains. Furthermore, while the female general population was more risk-averse in both domains, a gender difference in the physician group was observed only in the monetary domain. Conclusion: The results affirm that preference differences between physicians and the general population exist in Japan and clarify the unique preference traits of female physicians.

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The intergenerational health effects of child marriage bans

Le D.D., Molina T., Ibuka Y., Goto R.

Journal of Health Economics 104 2025年12月

ISSN 01676296

Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers’ exposure to the ban across cohorts and in “treatment intensity,” calculated based on region-level child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced under-5 mortality, with an effect of 19.7 percent corresponding to a one standard deviation change in treatment intensity. Increases in age at first marriage and first birth, which may have led to improved health-related decisions around the time of birth, appear to be the main drivers of the mortality reductions documented.

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Primary Care Physician Characteristics and Low-Value Care Provision in Japan

Miyawaki A., Mafi J.N., Abe K., Klomhaus A., Goto R., Kitajima K., Sato D., Tsugawa Y.

JAMA Health Forum 6 （ 6 ） 2025年06月

Importance: Evidence is limited regarding the physician characteristics associated with the provision of low-value services in primary care, especially outside of the US. Objective: To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan. Design, Setting, and Participants: This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Data analysis was performed from June 2024 to February 2025. Main Outcomes and Measures: Multivariable-adjusted composite rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics. Results: Among 2542630 patients (mean [SD] age, 51.6 [19.8] years; 58.2% female) treated by 1019 primary care physicians (mean [SD] age 56.4 [10.2] years; 90.4% male), 436317 low-value care services were identified (17.2 cases per 100 patients overall). Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients (95% CI, 1.0-3.3) more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients (95% CI, 0.2-1.5) more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients (95% CI, 1.5-3.2) more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients (95% CI, 0.5-1.5) more than those in Eastern Japan. Conclusions and Relevance: The findings of this cross-sectional analysis suggest that low-value care services were common and concentrated among a small number of primary care physicians in Japan, with older physicians and not board-certified physicians being more likely to provide low-value care. Policy interventions targeting at a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than those targeting all physicians uniformly.

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序文

鈴木亘, 後藤励

医療と社会（公益財団法人医療科学研究所） 35 （ 1 ） 5 - 10 2025年04月

ISSN 09169202

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 45 （ 5 ） 223 - 234 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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Evaluation of the geographic distribution of patients with hepatocellular carcinoma and treatments in Japan using data from the Japanese national database

Kokudo T., Yamada Y., Sugiyama T., Mihara Y., Nakamura M., Nagashima K., 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） advpub （ 0 ） 370 - 375 2025年

ISSN 24349186

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), provided by the Ministry of Health, Labour and Welfare (MHLW), is an exhaustive repository that can be used to understand the nationwide epidemiology of hepatocellular carcinoma (HCC) in Japan. This study was conducted to clarify the geographic distribution of patients with HCC and treatments performed in each region of Japan using data from the NDB. A retrospective analysis was performed to determine the number of patients diagnosed, with HCC (International Classification of Diseases, 10th edition, code C22.0), who received treatment between 2016 and 2020. Number of incidences of HCC per 100,000 individuals in each Japanese region are 76 (Hokkaido), 63 (Tohoku), 55 (Kanto), 58 (Tokai), 74 (Hokuriku), 77 (Kinki), 93 (Chugoku), 101 (Shikoku), 93 (Kyushu), and 37 (Okinawa). Transarterial embolization/transarterial chemoembolization and curative treatments, including laparoscopic liver resection (LLR), open liver resection, and radiofrequency ablation, were the most frequently performed treatments in all regions, followed by systemic therapy. The proportion of patients receiving LLR was lowest in the Shikoku region (6.7%), which also had the lowest frequency of institutions certified by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) relative to the number of patients with HCC. Although the incidence of HCC varies across regions in Japan, the most frequently performed treatments remain consistent nationwide. This suggests that HCC treatment practices are largely standardized, regardless of geographic location. Certification by the JSHBPS appears to play a role in patient access to LLR.

Investigation of hospitalization costs for spinal corrective surgery in adult spinal deformity: A multicenter prospective study in Japan

Murakami Y., Yamato Y., Watanabe K., Nakai K., Nagata K., Miyazaki M., Goto R., Matsukura Y., Hasegawa K., Takami M., Hirai T., Ohashi M., Watanabe K., Takahashi S., Ohnishi T., Imagama S., Inoue G., Miyakoshi N., Kobayashi T., Mori K., Tomita H., Fujimori T., Yamada H., Hashizume H., Kaito T., Yoshii T.

Journal of Orthopaedic Science 2025年

ISSN 09492658

Background: The number of adult spinal deformity (ASD) surgery has increased in recent years; however, it remains associated with significant hospitalization cost. The purpose of this study is to evaluate the total hospitalization cost associated with ASD surgery in Japan and to identify cost-related factors. Methods: This multicenter prospective observational study included patients aged 50–79 years who underwent corrective fusion of more than 5 vertebral segments between March 2021 and March 2024. Demographic, surgical, and radiographic data were collected. Total hospitalization cost, including surgical procedure, surgical supplies, implants, anesthesia, transfusion, rehabilitation, and bundled hospitalization cost were obtained from medical billing data. Univariate and multivariate analyses were performed to determine factors independently associated with total cost. Results: A total of 194 patients (25 males, 169 females; mean age 69.4 ± 6.7 years) were included. The average total hospitalization cost was $47,923.8 ± 8631.1, with implant cost accounting for the largest proportion. Multivariate linear regression analysis identified staged surgery as the most significant independent predictor of increased total cost, followed by the number of fused vertebrae, surgical time, and the use of lateral lumbar interbody fusion (LLIF). Staged surgery was associated with longer surgical time, more fused vertebrae, and more frequent use of LLIF, resulting in approximately 10,000 USD higher total cost than single surgery. Conclusions: This multicenter prospective study revealed that the total hospitalization cost for ASD surgery exceeded USD 47,000 per patient. Staged surgery was identified as the most significant independent factor associated with increased costs, primarily due to higher surgical procedure and implant-related cost.

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Financial Performance of Medical Corporations in Japan from 2016 to 2022: A Nationwide Longitudinal Analysis

Funada Satoshi, Hiragi Shusuke, Ashizawa Michiko, Goto Rei

Ｊｏｕｒｎａｌ　ｏｆ　Ｅｐｉｄｅｍｉｏｌｏｇｙ（日本疫学会） advpub （ 0 ） 2025年

ISSN 09175040

BackgroundMedical corporations (Iryohoujin) are central to Japan’s healthcare delivery, yet their financial conditions have not been comprehensively assessed nationwide. This study aimed to describe financial trends and structural characteristics of hospital-operating corporations from fiscal year (FY) 2016 to FY2022 and examine fluctuations, including during the FY2020–FY2021 COVID-19 pandemic.MethodsA longitudinal analysis was conducted using financial data covering 95% of all hospital-operating medical corporations. Financial indicators, including total assets, medical revenue, and profit margin, were tracked from FY2016 to FY2022. Subgroup analyses were based on organizational size and integration. A linear mixed-effects model examined factors associated with profitability.ResultsThe number of hospital-operating medical corporations declined from 4,631 in FY2016 to 4,469 in FY2022. By FY2022, total assets and medical revenue reached 15.9 trillion JPY and 12.5 trillion JPY. Median medical profit margin declined from 1.8% (interquartile range [IQR], –1.2% to 5.3%) in FY2016 to 0.6% (IQR, –3.4% to 4.3%) in FY2021, then recovered to 1.6% (IQR, –2.5% to 5.5%) in FY2022. Smaller corporations, with fewer hospitals and beds, were more financially unstable, especially during the COVID-19 pandemic. A linear mixed-effects model showed that medical profit margin was negatively associated with hospital number and positively associated with long-term care and psychiatric beds.ConclusionsThis study highlights the structural scale and financial dynamics of Japanese medical corporations, revealing a large but unevenly resilient sector in which not only hospital size but also bed composition significantly influences profitability. These findings may inform policy discussions on healthcare system sustainability and financial support.

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.

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