研究者詳細 - 後藤　励

論文 - 後藤　励

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Model-based estimation of the health care expenditure and out-of-pocket payment for assisted reproductive technology: A retrospective linkage study using the Japanese national ART registry

Jwa S.C., Goto R., Maeda E., Kajihara T., Ishihara O.

Journal of Obstetrics and Gynaecology Research （Journal of Obstetrics and Gynaecology Research） 49 （ 7 ） 1778 - 1786 2023年07月

ISSN 13418076

Aim: From April 2022, the Japanese government funding system for assisted reproductive technology (ART) has shifted from government subsidies to universal health insurance. To date, studies estimating the health care expenditure for ART are scarce. We estimated health care expenditures for ART cycles and compared the proportion of patients' out-of-pocket payment by ovarian stimulation protocols under the Japanese government subsidy system. Methods: We linked payment information for government subsidies in Saitama Prefecture during 2016 and 2017 with the Japanese ART registry. Health care expenditures for all treatment cycles in Japan during 2017 among women aged <43 years (n = 369 757) were estimated using a generalized linear model. Results: We linked 6269 subsidy applications to the Japanese ART registry. The average treatment fee for a fresh cycle was 376 434 JPY (standard deviation = 159 581). However, significant variation was observed across ovarian stimulation protocols. The estimated health care expenditure for ART during 2017 was 101 278 629 888 JPY (920 714 817 USD), leading to a 0.24% increase in the national health care expenditure for fiscal year 2017. Fresh cycles accounted for 70% of the expenditure. The proportion of the average patient out-of-pocket payment for one treatment cycle was smaller for natural (0%) and mild ovarian stimulation using clomiphene citrate (4.5%–20.7%) than those of conventional stimulation (30.3%–32.4%). Conclusions: Health insurance coverage for ART would increase national health care expenditure by 0.24%. Under the subsidy system, the proportion of the average patient out-of-pocket payment was smaller for natural and mild ovarian stimulation than conventional stimulations.

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医療費負担の公平性について

後藤励

連合総研レポートDIO （公益財団法人連合総合生活開発研究所） 36 （ 3 ） 11 2023年03月

ISSN 27586030

Cost-effectiveness Analysis of Monoclonal Antibodies in the First-line Treatment of RAS Wild-type Metastatic Colorectal Cancer: A Systematic Review

Morimoto T., Fujito K., Yamasaki B., Goto R.

Clinical Therapeutics （Clinical Therapeutics） 45 （ 1 ） 41 - 54 2023年01月

ISSN 01492918

Purpose: First-line treatment with monoclonal antibodies (bevacizumab, cetuximab, and panitumumab) for RAS wild-type metastatic colorectal cancer (mCRC) has advanced. The costs of drugs targeted to mCRC are high. This systematic review aimed to summarize the cost-effectiveness of monoclonal antibodies in the first-line treatment of RAS wild-type mCRC. Methods: We searched 5 databases to find original-research cost-effectiveness analyses of monoclonal antibodies used in the first-line treatment of patients with RAS wild-type mCRC. Three reviewers independently evaluated all of the records to be screened. Findings: A total of 15 articles, 12 cost-effectiveness analyses, and 3 cost-utility analyses were identified. The reporting of identified articles was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. They were assigned to 1 of 6 categories based on the combination of the intervention and control groups, the most common of which was cetuximab + chemotherapy versus bevacizumab + chemotherapy. The results of the cost-effectiveness analyses may have varied because of the differences in settings, such as country, study population, RAS mutation status, efficacy data, and model structure, in which each study was conducted. Implications: Although treatment with monoclonal antibodies has demonstrated efficacy in terms of life-years gained and progression-free survival, the most cost-effective treatment among monoclonal antibodies remains controversial; however, most of the studies that compared a monoclonal antibody + chemotherapy versus chemotherapy alone reported that chemotherapy alone was a cost-effective strategy. Future studies are needed to evaluate the cost-effectiveness of treating patients with mCRC using biomarker-driven precision medicine.

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コロナ対応とワクチン接種に対する医療者と経済学者の相違

後藤励, 大竹文雄, 井深陽子, 野口晴子, 仲田泰祐

現代経済学の潮流（一般社団法人日本経済学会） 2022 （ 0 ） 225 - 270 2023年

The Natural Course of Patients Four Years after Pathological Urinary Sediment Findings at Ningen Dock: The Cost and Benefit of Urine Sediment Examination

Wada Takashi, Goto Rei

Ningen Dock International （公益社団法人日本人間ドック学会） advpub （ 0 ） 9 - 13 2023年

ISSN 21878072

Objective: Urinary sediment is examined in Ningen Dock. We sought to evaluate the costs and diagnostic value associated with abnormal urinary sediment findings, in addition to estimated glomerular filtration rate (eGFR), urinary protein, and occult blood measurement, in Ningen Dock after 4 years.Methods: In the patients who underwent Ningen Dock in 2015, urinalysis was performed using a fully-automated urinalysis system at the central laboratory of each hospital. Urine sediment was microscopically examined by laboratory technicians. Granular casts, epithelial casts, and tubular epithelium were defined as pathological findings. Seventy-six patients who showed these findings in 2015 and were re-examined in 2019. The eGFR, urinary protein, and occult blood were statistically analyzed.Results: Pathological urinary sediment findings detected in 2015 spontaneously disappeared after 4 years in 91% of the patients. No significant change was observed in eGFR, urinary protein or occult blood in the patients who continued to have pathological findings after 4 years. At least \157 was spent per sample in supplies and personnel.Conclusions: Almost the pathological urine sediment was disappeared after four years. The benefit of urine sediment examinations was small for the cost. The eGFR, urine protein and occult blood test are sufficient in the kidney function examinations in Ningen Dock.

Medical care costs according to the stage and subtype of breast cancer in a municipal setting: a case study of Hachioji City, Japan

Nishikawa Y., Agatsuma N., Utsumi T., Funakoshi T., Mori Y., Nakamura Y., Hoshino N., Horimatsu T., Saito T., Kashihara S., Fukuyoshi J., Goto R., Toi M., Takahashi Y., Nakayama T.

Breast Cancer （Breast Cancer） 31 （ 1 ） 105 - 115 2023年

ISSN 13406868

Background: It is important to assess whether the early detection of breast cancer affects medical care costs. However, research remains scant on the actual medical care costs associated with breast cancer treatment in Japan. This study aimed to determine the medical care costs of breast cancer treatment based on its stage using national health insurance claims data. Methods: This was an observational study including patients with breast cancer who had undergone breast cancer treatment, as defined by the disease name and related treatment codes. Between August 2013 and June 2016, patients who underwent surgical treatment without axillary lymph node dissection and other radical treatment were classified as the curable group, while those who underwent palliative treatment were classified as the non-curable group. Patients were further stratified by subtype. The total and treatment-specific medical care costs for the five years were calculated using the national health insurance claims data of Hachioji City between August 2013 and May 2021. Results: The mean total medical care costs for the curable and non-curable groups for the 5 years were JPY 3958 thousand (standard deviation 2664) and JPY 8289 thousand (8482), respectively. The mean medical care costs for specific breast cancer treatment for the curable and non-curable groups were JPY 1142 (728) thousand and JPY 3651 thousand (5337), respectively. Further, human epidermal growth factor receptor 2 + , Hormone + patients had the highest mean cost over the 5 years. Conclusions: The results suggest that the early detection of breast cancer may reduce medical care costs at the patient level.

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糖尿病患者の非合理的選択と慢性合併症

江本直也, 後藤励

日本医科大学医学会雑誌（日本医科大学医学会） 18 （ 4 ） 379 - 388 2022年12月

ISSN 13498975

Diabetes mellitus is a chronic disease in which high blood glucose over long periods leads to diabetic complications including retinopathy, neuropathy, chronic kidney disease, and increased risk for cardiovascular events. Despite the availability of scientifically proven medical treatments, a significant number of patients with diabetes do not attain optimal glycemic control due to failure in self-management and nonadherence to medication. These behaviors appear irrational in terms of conventional economic theory. We applied the theory of behavioral economics, a new concept for clarifying irrational human behaviors, to investigating risk preferences in patients with diabetes. We found specific features in the responses of patients with diabetic complications. Many of these patients had low socioeconomic status, were reluctant to participate in the survey, and had difficulty in making decisions explicitly. Their choices under uncertainty often violated two axioms of the Expected Utility Theory (completeness and transitivity) and were therefore considered irrational, meaning that their choices were difficult to understand and differed from those that would be chosen by the majority of people. Health professionals should be aware of the propensity of such patients to make irrational decisions, which might be an important risk factor for the progression of diabetic complications.

Prevalence and changes of low-value care at acute care hospitals: a multicentre observational study in Japan

Miyawaki A., Ikesu R., Tokuda Y., Goto R., Kobayashi Y., Sano K., Tsugawa Y.

BMJ Open （BMJ Open） 12 （ 9 ） 2022年09月

Objectives We aimed to examine the use and factors associated with the provision of low-value care in Japan. Design A multicentre observational study. Setting Routinely collected claims data that include all inpatient and outpatient visits in 242 large acute care hospitals (accounting for approximately 11% of all acute hospitalisations in Japan). Participants 345 564 patients (median age (IQR): 62 (40-75) years; 182 938 (52.9%) women) seeking care at least once in the hospitals in the fiscal year 2019. Primary and secondary outcome measures We identified 33 low-value services, as defined by clinical evidence, and developed two versions of claims-based measures of low-value services with different sensitivity and specificity (broader and narrower definitions). We examined the number of low-value services, the proportion of patients receiving these services and the proportion of total healthcare spending incurred by these services in 2019. We also evaluated the 2015-2019 trends in the number of low-value services. Results Services identified by broader low-value care definition occurred in 7.5% of patients and accounted for 0.5% of overall annual healthcare spending. Services identified by narrower low-value care definition occurred in 4.9% of patients and constituted 0.2% of overall annual healthcare spending. Overall, there was no clear trend in the prevalence of low-value services between 2015 and 2019. When focusing on each of the 17 services accounting for more than 99% of all low-value services identified (narrower definition), 6 showed decreasing trends from 2015 to 2019, while 4 showed increasing trends. Hospital size and patients' age, sex and comorbidities were associated with the probability of receiving low-value service. Conclusions A substantial number of patients received low-value care in Japan. Several low-value services with high frequency, especially with increasing trends, require further investigation and policy interventions for better resource allocation.

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医療経済評価における小児のQOL値測定法とその課題

本多貴実子, 白岩健, 後藤励, 福田敬

保健医療科学（国立保健医療科学院） 71 （ 3 ） 264 - 275 2022年08月

ISSN 13476459

適正な医療資源の配分のためのエビデンスを提供することを目的として行われる医療経済評価では，異なった領域の介入の比較を容易にするため，アウトカム指標を質調整生存年（Quality-adjusted life year: QALY）とすることが原則とされている．QALYは生存期間にQOL（Quality of life）を 0 から 1 の値に換算したQOL値を重み付けして得られる．QALYにはその国の人々の選好による重みづけが反映されることが望ましいという観点から，QOL値は国内の調査結果を優先的に使用することが推奨されているが，以前から日本人のデータが乏しいことが指摘されていた．近年成人ではその蓄積が進みつつあるが，小児においてはその測定に多くの課題があり，日本ではほぼ行われていないのが現状である．医療経済評価でQOL値測定に用いられる尺度は選好に基づく尺度（Preference-based measure: PBM）である．PBMによってQOL値を得る過程は，評価したい健康状態の「測定」と「価値づけ」に分けられる．これを一度に行うものを直接法，別々に行うものを間接法と呼ぶ．直接法には評点尺度法，時間得失法，基準的賭け法があるが，小児では実施可能性，信頼性，妥当性はまだ十分に検討されていない．成人も含め一般的に現在主流となっている間接法では，multi attribute utility instruments （MAUIs）と呼ばれる尺度を用い，実際にその健康状態にある人（患者）に自らの健康について質問票に記入してもらった後，換算表を用いてQOL値を算出する．一般的に成人を対象に開発されたMAUIsは，小児で使用するにあたって質問の記述の仕方や内容が適していない，さらに換算表が成人の健康についての価値付けになっているなどの問題があり，小児には小児用のMAUIsの使用が望ましいとされる．近年小児用のMAUIsの開発が進んできたが，各国での翻訳や換算表の有無により，どの国でもこれらが使用できるわけではなく，3歳以下の年少児では使用できるものは現在ない．また，どの領域をどのように評価するべきか，誰が記入するべきかなどの「測定」に関する課題，換算表の作成にあたって誰の選好をどの視点を使用して明らかにし，反映するべきなのかという「価値付け」の課題があり，現在あるMAUIsが十分に小児の健康関連QOLをとらえられていない可能性もある．日本ではこれまで小児の使用を想定したMAUIsがなかったが，最近EuroQol 5-dimension Youth version (EQ-5D-Y)日本語版とその換算表が発表され，今後日本人小児のデータの蓄積が期待される．小児のQOL値の測定と解釈にあたっては，その課題や限界を十分に理解しておく必要がある．

Effect of Nudge-Based Intervention on Adherence to Physician Visit Recommendations and Early Health Outcomes among Individuals Identified with Chronic Kidney Disease in Screens

Fukuma S., Sasaki S., Taguri M., Goto R., Misumi T., Saigusa Y., Tsugawa Y.

Journal of the American Society of Nephrology : JASN （Journal of the American Society of Nephrology : JASN） 33 （ 1 ） 175 - 185 2022年01月

ISSN 10466673

BACKGROUND: Although CKD screening programs have been provided in many settings, little is known as to how we can effectively translate those screening programs into improved health. METHODS: We conducted a randomized clinical trial on national health screening for CKD in Japan between April 2018 and March 2019. A total of 4011 participants in CKD screening programs aged 40-63 years were randomly assigned to two interventions or the control, with a ratio of 2:2:1, respectively: (1) the nudge-based letter that contained a message on the basis of behavioral economics, (2) the clinical letter including general information about CKD risks, and (3) the control (informed only of the screening results). The main outcome was adherence to a recommended physician visit within 6 months of the intervention. The secondary outcomes were eGFR, proteinuria, and BP 1 year after the intervention. RESULTS: Compared with the control group, the probability of undergoing a recommended physician visit was higher among participants who received the nudge-based letter (19.7% for the intervention group versus 15.8% for the control; difference, +3.9 percentage points [pp]; 95% CI, +0.8 to +7.0; P=0.02) and the clinical letter (19.7% versus 15.8%; difference, +3.9 pp; 95% CI, +0.8 to +7.0; P=0.02). We found no evidence that interventions were associated with improved early health outcomes. CONCLUSIONS: The behavioral economics intervention tested in this large RCT had limited effect on changing behavior or improving health outcomes. Although the approach has promise, this study demonstrates the challenge of developing behavioral interventions that improve the effectiveness of CKD screening programs.Clinical Trial registry name and registration number: University Hospital Medical Information Network Clinical Trial Registry, UMIN000035230.

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Real-world effectiveness of screening programs for age-related macular degeneration: amended Japanese specific health checkups and augmented screening programs with OCT or AI

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

Japanese Journal of Ophthalmology （Japanese Journal of Ophthalmology） 66 （ 1 ） 19 - 32 2022年01月

ISSN 00215155

Purpose: To investigate the effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan. Study design: Best-case-scenario analysis using a Markov model. Methods: The clinical effectiveness and cost-effectiveness of screening for AMD were assessed by calculating the reduction proportion of blindness and the incremental cost-effectiveness ratio (ICER). The Markov model simulation began at screening at the age of 40 years and ended at screening at the age of 90 years. The first-eye and second-eye combined model assumed annual state-transition probabilities in the development and treatment of AMD. Data on prevalence, morbidity, transition probability, utility value, and treatment costs were obtained from previously published reports. Sensitivity analysis was performed to assess the influence of the parameters. Results: In the base-case analysis, screening for AMD every 5 years, beginning at age 40 years and ending at age 74 years (reflecting the screening ages of the current Japanese legal “Specific Health Checkups”) showed a decrease of 40.7% in the total number of blind patients. The screening program reduced the number of blind people more than did the additional AREDS/AREDS2 formula supplement intake. However, the ICER of screening versus no screening was ¥9,846,411/QALY, which was beyond what people were willing to pay (WTP) in Japan. Sensitivity analysis revealed that neither OCT nor AI improved the ICER, but the scenario in which the prevalence of smoking decreased by 30% improved the ICER (¥4,655,601/QALY) to the level under the WTP. Conclusions: Ophthalmologic screening for AMD is highly effective in reducing blindness but is not cost-effective, as demonstrated by a Markov model based on real-world evidence from Japan.

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Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan

Yoshimoto T., Yamagami H., Sakai N., Toyoda K., Hashimoto Y., Hirano T., Iwama T., Goto R., Kimura K., Kuroda S., Matsumaru Y., Miyamoto S., Ogasawara K., Okada Y., Shiokawa Y., Takagi Y., Tominaga T., Uno M., Yoshimura S., Ohara N., Imamura H., Sakai C.

Neurologia Medico-Chirurgica （Neurologia Medico-Chirurgica） 62 （ 8 ） 369 - 376 2022年

ISSN 04708105

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per mil-lion population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.

ヘルスケアの幅広い価値とその評価. 週刊社会保障

後藤励

週刊社会保障 76(3176) 46 - 51 2022年

CiNii Research

Examining the association between menstrual symptoms and health-related quality of life among working women in Japan using the EQ-5D

Shimamoto K., Hirano M., Wada-Hiraike O., Goto R., Osuga Y.

BMC Women's Health （BMC Women's Health） 21 （ 1 ） 2021年12月

Background: Menstrual symptoms have been identified as a substantial burden among women of reproductive age, affecting their health status and quality of life globally. A range of menstrual symptoms have been studied as they affect the health-related quality of life (HRQoL), showing variations across specific menstrual symptoms and study settings. A major concern is demonstrated due to menstrual symptoms in women’s professional and social life, and consequently societal and economic loss for women and the society at large. Yet evidence is scarce that estimates the index form HRQoL score related to menstrual symptoms that is needed for health economic evaluations. Methods: This study aims to investigate the association between menstrual symptoms and the HRQoL among working women in Japan in an index form, using a self-reporting questionnaire (n = 6048). The EQ-5D-3L (EuroQoL 5-dimension 3-level) is used that is a widely used tool to measure health outcomes for health economic evaluations globally. Multivariate regression analysis is conducted to assess the association between the HRQoL score and specific nineteen physical and mental conditions related to menstruation (e.g., pain, heavy bleeding, concentration, negative affect). Results: The index form HRQoL score for menstrual symptoms is estimated as 0.682 in the study population (where a score one suggests perfect health). The association of the HRQoL score varies substantially across the menstrual symptoms. Several of the physical conditions and disorders show a substantial negative association with the HRQoL score. Also, most of the mental and psychological issues are significantly and negatively related to the HRQoL score. Conclusions: This study suggests that HRQoL is substantially and negatively affected by menstruation among working women in Japan. Distinct variations of negative influences across menstrual symptoms underscore the multi-dimensional nature of menstruation and consequently the need of collective interventions to address these difficulties. The evidence of HRQoL continues to be an important area for future research on women’s health and health economic evaluations to inform effective and efficient resource allocations for relevant health policies and financing strategies.

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Comprehensive and long-term surveys of COVID-19 sequelae in Japan, an ambidirectional multicentre cohort study: Study protocol

Nakagawara K., Namkoong H., Terai H., Masaki K., Tanosaki T., Shimamoto K., Lee H., Tanaka H., Okamori S., Kabata H., Chubachi S., Ikemura S., Kamata H., Yasuda H., Kawada I., Ishii M., Ishibashi Y., Harada S., Fujita T., Ito D., Bun S., Tabuchi H., Kanzaki S., Shimizu E., Fukuda K., Yamagami J., Kobayashi K., Hirano T., Inoue T., Kagyo J., Shiomi T., Ohgino K., Sayama K., Otsuka K., Miyao N., Odani T., Oyamada Y., Masuzawa K., Nakayama S., Suzuki Y., Baba R., Nakachi I., Kuwahara N., Ishiguro T., Mashimo S., Minematsu N., Ueda S., Manabe T., Funatsu Y., Koh H., Yoshiyama T., Saito F., Ishioka K., Takahashi S., Nakamura M., Goto A., Harada N., Kusaka Y., Nakano Y., Nishio K., Tateno H., Edahiro R., Takeda Y., Kumanogoh A., Kodama N., Okamoto M., Umeda A., Hagimura K., Sato T., Miyazaki N., Takemura R., Sato Y., Takebayashi T., Nakahara J., Mimura M., Ogawa K., Shimmura S., Negishi K., Tsubota K., Amagai M., Goto R., Ibuka Y., Hasegawa N., Kitagawa Y., Kanai T., Fukunaga K.

BMJ Open Respiratory Research （BMJ Open Respiratory Research） 8 （ 1 ） 2021年11月

Introduction The rapid spread of COVID-19 posed a global burden. Substantial number of people died of the disease in the acute phase of infection. In addition, a significant proportion of patients have been reported to suffer from post-acute phase symptoms, sequelae of COVID-19, which may negatively influence the quality of daily living and/or socioeconomic circumstances of the patients. However, no previous study has comprehensively and objectively assessed the quality of life of patients by using existing international scales. Further, evidence of socioeconomic consequences among patients with COVID-19 is scarce. To address the multidimensional issues from sequelae of COVID-19, evidence from comprehensive surveys beyond clinical perspectives is critical that investigates health, and social determinants of disease progression as well as socioeconomic consequences at a large scale. Methods and analysis In this study, we plan to conduct a nationwide and comprehensive survey for the sequelae of COVID-19 in a total of 1000 patients diagnosed at 27 hospitals throughout Japan. This study will evaluate not only the health-related status of patients from clinical perspectives but also the Health-related Quality of Life (HRQoL) scores, socioeconomic status and consequences to discuss the sequelae of the disease and the related risk factors. The primary endpoint is the frequency of long-term complications of COVID-19 infection. The secondary endpoints are risk factors for progression to sequelae of COVID-19 infection. The study will provide robust and important evidence as a resource to tackle the issues from the sequelae of COVID-19 from the multi-dimensional perspectives. Ethics and dissemination This trial was approved by the Keio University School of Medicine Ethics Committee (20200243, UMIN000042299). The results of this study will be reported at a society meeting or published in a peer-reviewed journal.

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Medical costs according to the stages of colorectal cancer: an analysis of health insurance claims in Hachioji, Japan

Utsumi T., Horimatsu T., Nishikawa Y., Hoshino N., Takahashi Y., Goto R., Kashihara S., Fukuyoshi J., Nakayama T., Seno H.

Journal of Gastroenterology （Journal of Gastroenterology） 56 （ 10 ） 903 - 913 2021年10月

ISSN 09441174

Background: Although the effect of the early detection of colorectal cancer (CRC) on medical costs needs to be clarified, there are few reports on the actual medical costs of CRC patients in Japan. We aimed to identify medical costs according to CRC stage, using health insurance claims. Methods: This observational study included CRC patients who had received specific treatment for CRC, which was defined by the procedure code and the claim computer processing system code associated with the treatment of CRC. CRC patients who underwent endoscopic or radical surgical treatment were defined as the curable group and those with palliative treatment, including palliative chemotherapy, as the non-curable group. Total medical costs and medical costs of specific treatments for CRC for 3 years were measured using the claims held by Hachioji City from May 2014 to July 2019. Results: This study included 442 patients in the curable group, including 267 patients who underwent endoscopic treatment, and 175 patients who underwent radical surgical treatment, and 161 patients in the non-curable group. The mean (standard deviation) total medical costs in the curable and non-curable groups were 2,130 (2,494) and 8,279 (5,600) thousand Japanese Yen (JPY), respectively. The mean (standard deviation) medical costs for the specific treatment of CRC in the curable and non-curable groups were 408 (352) and 3,685 (3,479) thousand JPY, respectively. Conclusions: We clarified the actual medical costs of CRC in curable and non-curable groups. These results suggest the effect of early detection of CRC in reducing medical costs.

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First-year healthcare resource utilization costs of five major cancers in Japan

Watanabe T., Goto R., Yamamoto Y., Ichinose Y., Higashi T.

International Journal of Environmental Research and Public Health （International Journal of Environmental Research and Public Health） 18 （ 18 ） 2021年09月

ISSN 16617827

Reports on the expenditure of cancer treatments per patient using comprehensive data remain unavailable in Japan. This study aimed to use Japan’s cancer registry data and health service utilization data for evaluating the disease-specific, per-patient costs of five major cancers—stomach, lung, colorectal, liver, and breast cancers. We used a database linking the 2017 data from a hospital-based cancer registry and the health service utilization data from the Diagnosis Procedure Combination survey. All patients who started their first treatment course at each hospital were included. The costs were calculated using the total volume of the health services provided and the unit fee information included in the data. We analyzed 304,698 patients. Lung cancer had the highest healthcare cost per-patient for the first year of diagnosis and the longest median hospitalization duration. Conversely, breast cancer showed the lowest cost and the shortest median hospitalization duration. However, in the first month after diagnosis, colorectal cancer showed the highest cost. Subsequently, the gaps between the costs of the five common cancers drastically diminished. The cancer type having the longest hospitalization duration had the highest overall healthcare resource utilization costs. This information is essential for care planning and research studies.

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Evaluation of the Quality of Life and Health-Related Quality of Life of Patients With End-Stage Kidney Disease Resulting From Kidney Transplantation Using the Kidney Disease Quality of Life-Short Form and EuroQOL-5 Dimension-5 Level Questionnaires

Sawada A., Hiragi S., Tamura H., Goto R., Matsuyama Y., Sakai K., Miyata H., Yanagita M., Kuroda T., Ogawa O., Kobayashi T.

Transplantation Proceedings （Transplantation Proceedings） 53 （ 3 ） 881 - 884 2021年04月

ISSN 00411345

Background: Renal transplantation improves the quality of life (QOL) of end-stage renal disease (ESRD) patients with renal failure. However, it remains unclear which renal disease-specific QOL aspects determine general health-related QOL of ESRD patients. This study aimed to identify these QOL items by examining the QOL of ESRD patients using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), version 1.3, and EuroQoL-5 dimension-5 levels (EQ-5D-5L) questionnaires. Methods: We conducted QOL surveys with 67 renal transplant recipients at our hospital. EQ-5D-5L, which evaluates general health-related QOL, was the response variable, and KDQOL-SF, which includes the renal disease-specific instrument and general health-related QOL SF-36 instrument, was the explanatory variable. We analyzed the effects of each KDQOL-SF domain on EQ-5D-5L using Pearson correlation coefficient. Results: Regarding the general health-related QOL assessed by SF-36, physical health aspects, such as physical functioning (R = 0.749) and daily functioning physical (R = 0.603), showed a strong correlation with EQ-5D-5L, and the domains related to the psychological and social aspects of QOL showed a limited correlation. Regarding kidney disease-specific scales, symptoms/problems related to physical function showed a good correlation (R = 0.691) with EQ-5D-5L, whereas other scales, including burden of kidney disease (R = 0.168), quality of social interaction (R = 0.284), and those related to the mental and social aspects of QOL showed a low correlation with EQ-5D-5L. Conclusion: Among kidney transplant recipients, the physical health aspects of QOL, such as symptoms/problems, were the major factors influencing overall QOL as assessed by EQ-5D-5L.

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うつ病患者の活動記録を利用した社会医学研究者と医療経済学者の共同研究

熊谷成将, 田近亜蘭, 後藤励, 古川

医療経済研究（医療経済学会/医療経済研究機構） 32 （ 2 ） 78 - 89 2021年03月

ISSN 1340895X

The current paper introduced the two joint studies by the study group of social medicine and health economist. The study group collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device.
　 Before these joint studies, no prior studies have established a method that could identify the warning signs of its recurrence. In addition, to prevent relapse of patients with major depression, it is necessary to examine the predictors influencing false negatives and identify the early signs of recurrence.
　The first study by a panel vector autoregressive model indicated that long sleep time was an important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks. Recurrent depression was defined by the Kessler Psychological Distress Scale and the Patient Health Questionnaire-9 scores. In contrast, considering the small number of relapsed cases and the overdispersion generated by excess zero, the second study aimed to investigate “sitting idly” as a predictor influencing falsenegatives using a zero-inflated negative binomial model because false negatives which can lead to delays in diagnosis and treatment must be avoided. Estimates of the population-averaged parameters indicated that daily hours of sitting idly increased the chances of recurrent depression two or four weeks later. The change in exposure to daily UV light from non-exposure reduced recurrent depression.
　Before the commencement of the joint study, it is indispensable to explain the significance of the economic study clearly to medical researchers. In the academic society where both of medical researchers and economists belong to, it is important to arrange the opportunity to understand the difference in each idea.

Association between single limb standing test results and healthcare costs among community-dwelling older adults

Tominaga R., Yamazaki S., Fukuma S., Goto R., Sekiguchi M., Otani K., Iwabuchi M., Shirado O., Fukuhara S., Konno S.i.

Archives of Gerontology and Geriatrics （Archives of Gerontology and Geriatrics） 92 2021年01月

ISSN 01674943

Background and objective: Identifying risks for older adults who will require healthcare resources is critical for the government, healthcare providers, and consumers. The objective of this study was to examine the relationship between the results of the single limb standing (SLS) test and healthcare costs among community-dwelling older adults. Methods: We used data obtained from a population-based prospective cohort study of the residents of Tadami town in Fukushima Prefecture, Japan. The participants were above 60 years of age and had undergone annual health check-ups, and data on their healthcare costs over the two-year study period were available. A censored regression model adjusted for potential confounders was used to estimate the mean difference in total healthcare costs between participants who could remain standing on a single limb for at least 30 s and those who could not. Results: Healthcare costs of participants who passed the SLS test were significantly lower than those who did not. The mean difference between the two groups’ healthcare costs was 4064 USD (95 % confidence interval: 2661–5467 USD, p < 0.05). After adjusting for potential confounders, the mean difference between the two groups was smaller (1686 USD) but remained statistically significant (95 % confidence interval: 125–3246 USD, p < 0.05). Conclusions: Among community-dwelling older adults, limited static balance (SLS time <30 s) was found to be associated with high healthcare costs in the two years after the SLS test. The SLS test may help identify individuals at high risk of becoming frequent users of healthcare services in the future.

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