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

後藤励

総合リハビリテーション（株式会社医学書院） 52 （ 1 ） 35 - 41 2024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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Transportation for Patients with Stroke in Need of Mechanical Thrombectomy: A Simulation-Based Study in Hyogo Prefecture, Japan

Yamasaki Bumpei, Goto Rei, Imamura Hirotoshi, Sakai Nobuyuki

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） 18 （ 12 ） 305 - 312 2024年

ISSN 18824072

Objective: This study aimed to simulate patient transportation to a mechanical thrombectomy (MT)-capable hospital within 60 minutes, taking into account patient volume (demand side of healthcare) and hospital capacity to accept patients (supply side of healthcare).Methods: Simulations were conducted in Hyogo Prefecture, Japan. The estimates of the annual number of patients with stroke eligible for MT in 2020 were based on the incidence of stroke by age group and the percentage of patients with stroke indicated for MT in existing publications. Patients were then randomly placed on a 1 km2 mesh map. The patients were randomly generated 100 times using R software (version 4.1.2; R Foundation for Statistical Computing, Vienna, Austria). Hospitals were selected based on 2 criteria: (1) actual provision patterns (39 hospitals) and (2) consolidated patterns (12 hospitals). Simulations were performed using ArcGIS Pro (version 10.8; Esri, Redlands, CA, USA) and Network Analyst extension (Esri) in 3 cases: (1) number of patients estimated from the population in 2020 transported to hospitals that provided MT, (2) number of patients estimated based on the 2020 population transported to selected hospitals in the case of consolidation, and (3) number of patients estimated based on 2040’s projected population and transportation to the selected hospitals.Results: In Case 1, the estimated annual number of patients undergoing MT in 2020 was 976. The average number of patients undergoing MT and transported was 961, indicating that 98% (961/976) of the total generated patients could be transported within 60 min. In Case 2, the average number of patients undergoing MT and transported was 940, indicating that 96.3% (940/976) of the total patients could be transported within 60 min. In Case 3, the average number of patients undergoing MT and transported was 1184, showing that 95.1% (1184/1244) of the total generated patients could be transported within 60 min. A few patients in rural areas and remote islands required longer transport times.Conclusion: The simulations showed that patient estimates from the incidence of cerebral infarction by age group and the percentage of patients with stroke indicated for MT were similar to the actual values. The simulation was closed to reality when both the supply and demand sides of healthcare were considered. Thus, this simulation study informs future healthcare policy by demonstrating the geographic distribution of human and capital resources and potential cost reduction through consolidation, taking into account demographic changes.

The estimation of healthcare cost of kidney transplantation in Japan using large-scale administrative databases

Hasegawa M., Kato H., Yoshioka T., Goto R.

Clinical and Experimental Nephrology 2024年

ISSN 13421751

Background: The financial burden of kidney replacement therapy (KRT) is considerable, and detailed information on KRT costs is essential for managing these huge healthcare costs. However, cost analyses for kidney transplantation (KTx) are limited in Japan. This study aimed to report the healthcare costs of KTx recipients in Japan based on large medical receipt data. Methods: This cost analysis of KTx recipients using the Japan Medical Data Center Claims Database between January 2005 and August 2020 identified living donor KTx (LDKT) and deceased donor KTx (DKT) recipients. The primary outcome was the total direct healthcare costs of KTx recipients. As an exploratory analysis, we examined the factors that contributed to the increase in the costs of LDKT. Results: In total, 84 LDKT and 17 DKT recipients were included in this study. The total healthcare costs for LDKT and DKT recipients during the first year after KTx were 6,639,982 and 6,840,450 JPY/year, respectively. However, after the second year post-KTx, total healthcare costs decreased to 1,735,931 and 1,348,642 JPY/year for LDKT and DKT recipients, respectively. During the first year, inpatient costs accounted for > 70% of the total healthcare costs, whereas pharmaceutical costs accounted for more than half after the second year post-KTx. The use of everolimus and male sex were associated with higher and lower total healthcare costs in the first and subsequent years after LDKT, respectively. Conclusion: Using large-scale administrative databases, this study revealed the total healthcare costs of KTx in Japan and provided valuable information for the health technology assessment of KTx.

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連載医療システムの質・効率・公正--医療経済学の新たな展開・Vol.18 保健医療の経済学と行動経済学

後藤励

医学のあゆみ（医歯薬出版） 287 （ 10 ） 789 - 794 2023年12月

ISSN 00392359

Healthcare costs for hospitalized COVID-19 patients in a Japanese university hospital: a cross-sectional study

Uno S., Goto R., Honda K., Tokuda M., Kamata H., Chubachi S., Yamamoto R., Sato Y., Homma K., Uchida S., Namkoong H., Uwamino Y., Sasaki J., Fukunaga K., Hasegawa N.

Cost Effectiveness and Resource Allocation （Cost Effectiveness and Resource Allocation） 21 （ 1 ） 2023年12月

Background: A health-economic evaluation related to COVID-19 is urgently needed to allocate healthcare resources efficiently; however, relevant medical cost data in Japan concerning COVID-19 are scarce. Methods: This cross-sectional study investigated the healthcare cost for hospitalized COVID-19 patients in 2021 at Keio University Hospital. We calculated the healthcare costs during hospitalization using hospital claims data and investigated the variables significantly related to the healthcare cost with multivariable analysis. Results: The median healthcare cost per patient for the analyzed 330 patients was Japanese yen (JPY) 1,304,431 (US dollars ~ 11,871) (interquartile range: JPY 968,349–1,954,093), and the median length of stay was 10 days. The median healthcare cost was JPY 798,810 for mild cases; JPY 1,113,680 for moderate I cases; JPY 1,643,909 for moderate II cases; and JPY 6,210,607 for severe cases. Healthcare costs increased by 4.0% for each additional day of hospitalization; 1.26 times for moderate I cases, 1.64 times for moderate II cases, and 1.84 times for severe cases compared to mild cases; and 2.05 times for cases involving ICU stay compared to those not staying in ICU. Conclusions: We clarified the healthcare cost for hospitalized COVID-19 patients by severity in a Japanese university hospital. These costs contribute as inputs for forthcoming health economic evaluations for strategies for preventing and treating COVID-19.

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Comprehensive analysis of long COVID in a Japanese nationwide prospective cohort study

Terai H., Ishii M., Takemura R., Namkoong H., Shimamoto K., Masaki K., Tanosaki T., Chubachi S., Matsuyama E., Hayashi R., Shimada T., Shigematsu L., Ito F., Kaji M., Takaoka H., Kurihara M., Nakagawara K., Tomiyasu S., Sasahara K., Saito A., Otake S., Azekawa S., Okada M., Fukushima T., Morita A., Tanaka H., Sunata K., Asaoka M., Nishie M., Shinozaki T., Ebisudani T., Akiyama Y., Mitsuishi A., Nakayama S., Ogawa T., Sakurai K., Irie M., Yagi K., Ohgino K., Miyata J., Kabata H., Ikemura S., Kamata H., Yasuda H., Kawada I., Kimura R., Kondo M., Iwasaki T., Ishida N., Hiruma G., Miyazaki N., 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., Haraguchi M., Kagyo J., Shiomi T., Lee H., Sugihara K., Omori N., Sayama K., Otsuka K., Miyao N., Odani T., Watase M., Mochimaru T., Satomi R., Oyamada Y., Masuzawa K., Asakura T., Nakayama S., Suzuki Y., Baba R., Okamori S., Arai D., Nakachi I., Kuwahara N., Fujiwara A., Oakada T., Ishiguro T., Isosno T., Makino Y., Mashimo S., Kaido T., Minematsu N., Ueda S., Minami K., Hagiwara R., Manabe T., Fukui T.

Respiratory Investigation （Respiratory Investigation） 61 （ 6 ） 802 - 814 2023年11月

ISSN 22125345

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly since 2019, and the number of reports regarding long COVID has increased. Although the distribution of long COVID depends on patient characteristics, epidemiological data on Japanese patients are limited. Hence, this study aimed to investigate the distribution of long COVID in Japanese patients. This study is the first nationwide Japanese prospective cohort study on long COVID. Methods: This multicenter, prospective cohort study enrolled hospitalized COVID-19 patients aged ≥18 years at 26 Japanese medical institutions. In total, 1200 patients were enrolled. Clinical information and patient-reported outcomes were collected from medical records, paper questionnaires, and smartphone applications. Results: We collected data from 1066 cases with both medical records and patient-reported outcomes. The proportion of patients with at least one symptom decreased chronologically from 93.9% (947/1009) during hospitalization to 46.3% (433/935), 40.5% (350/865), and 33.0% (239/724) at 3, 6, and 12 months, respectively. Patients with at least one long COVID symptom showed lower quality of life and scored higher on assessments for depression, anxiety, and fear of COVID-19. Female sex, middle age (41–64 years), oxygen requirement, and critical condition during hospitalization were risk factors for long COVID. Conclusions: This study elucidated the symptom distribution and risks of long COVID in the Japanese population. This study provides reference data for future studies of long COVID in Japan.

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Efficacy and safety of a telemedicine system in subjects with gestational diabetes mellitus (TELEGLAM): Study protocol for a randomized controlled trial

Aoyama K., Nakajima Y., Meguro S., Sato Y., Goto R., Hida M., Arimitsu T., Kasuga Y., Tanaka M., Itoh H.

Heliyon （Heliyon） 9 （ 11 ） 2023年11月

ISSN 24058440

Background: Strict glycemic control is important to prevent perinatal complications in patients with gestational diabetes mellitus (GDM). Patients often require insulin injection, and frequent hospital visits are necessary to adjust the dose of insulin, which is considered burdensome for pregnant patients. Telemedicine may reduce the burden of hospital visits, and previous studies have reported its safety in GDM patients. This study aimed to evaluate the efficacy of telemedicine in GDM patients, focusing on patient satisfaction and health economic indicators. Methods: This is a single-center, two-arm, randomized, open-label parallel-group study. Subjects will be selected from the patient population attending the Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Japan. Patients diagnosed with GDM by an oral glucose tolerance test (OGTT) by 29 weeks and 6 days of gestation who have undergone self-monitoring of blood glucose (SMBG) and insulin injection are eligible for inclusion. In the intervention group, telemedicine will be administered using the MeDaCa telemedicine system developed by the Medical Data Card, Inc., Tokyo, Japan. Subjects in the control group will be examined face-to-face every 2–3 weeks, as usual. We set health economic indicators and patient satisfaction as the primary endpoints, and will perform a cost-consequence analysis. Glycemic control indicators and perinatal outcomes will be evaluated as secondary endpoints. Conclusions: Eligible patients are currently being recruited. Recruitment will be completed when the expected number of patients are enrolled.

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Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan

Ando T., Ibuka Y., Goto R., Haruta J., Le D.D., Fujishima S.

Public Health （Public Health） 224 152 - 158 2023年11月

ISSN 00333506

Objective: We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic. Study design and methods: This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality. Results: The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5–8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4–11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality. Conclusion: Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

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Effect of aqueous olanexidine versus alcohol-based chlorhexidine for surgical skin antisepsis on incidence of surgical site infections in gastrointestinal surgery: multicentre randomised controlled clinical trial (OEDO trial) protocol

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

BMJ Open （BMJ Open） 13 （ 8 ） 2023年08月

Introduction Surgical site infections (SSIs) are among the most common nosocomial infections in surgery patients. Two types of preparations, povidone-iodine and chlorhexidine-alcohol, are commonly used in preoperative antiseptic procedures worldwide. However, there are inconsistencies among international guideline recommendations concerning skin antiseptics. This trial aimed to evaluate the superiority of olanexidine, which reduced SSI rates more than povidone-iodine in our previous randomised trial, over chlorhexidine-alcohol in clean-contaminated surgery. Methods and analysis This multicentre randomised controlled clinical trial will compare two antiseptics (1.5% olanexidine and 1.0% chlorhexidine-alcohol) to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. On providing consent, patients aged <18 years will be included. The primary outcome will be the postoperative 30-day overall SSI rate, while the secondary outcomes will be the postoperative 30-day superficial incisional SSI rate, deep incisional SSI rate, organ/space SSI rate, positive bacterial wound culture rate, cultured bacterial strains, rates of intervention-related toxicity and allergic events (eg, erythema, pruritus, dermatitis and other symptoms of allergy around the region disinfected by the antiseptic during surgery), rate of reoperations due to SSI, medical economic effect indicators (based on health insurance claims) and hospital duration. The Mantel-Haenszel method will be used to estimate the adjusted risk ratio and its 95% CI for the primary analysis, which will compare the treatment effects. Ethics and dissemination The protocol was approved by the Institutional Review Board of Keio University School of Medicine and subsequently by the board of each participating site. Participant recruitment began in January 2023. The final results will be published in medical journals after international peer review. Trial registration number UMIN000049712.

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【連載】行動変容をそっと促す　ナッジを使ったアプローチ(14) 「記録しないこと」には理由がある?

竹林正樹, 後藤励

コミュニティケア（株式会社日本看護協会出版会） 25 （ 9 ） 42 - 44 2023年07月

ISSN 27580008

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 ） 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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The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups

Kato H., Goto R., Tsuji T., Kondo K.

European Journal of Health Economics （European Journal of Health Economics） 23 （ 5 ） 847 - 861 2021年

ISSN 16187598

Despite rapidly rising health expenditure associated with population aging, empirical evidence on the effects of cost-sharing on older people is still limited. This study estimated the effects of cost-sharing on the utilization of healthcare and health among older people, the most intensive users of healthcare. We employed a regression discontinuity design by exploiting a drastic reduction in the coinsurance rate from 30 to 10% at age 70 in Japan. We used large administrative claims data as well as income information at the individual level provided by a municipality. Using the claims data with 1,420,252 person-month observations for health expenditure, we found that reduced cost-sharing modestly increased outpatient expenditure, with an implied price elasticity of – 0.07. When examining the effects of reduced cost-sharing by income, we found that the price elasticities for outpatient expenditure were almost zero, – 0.08, and – 0.11 for lower-, middle-, and higher-income individuals, respectively, suggesting that lower-income individuals do not have more elastic demand for outpatient care compared with other income groups. Using large-scale mail survey data with 3404 observations for self-reported health, we found that the cost-sharing reduction significantly improved self-reported health only among lower-income individuals, but drawing clear conclusions about health outcomes is difficult because of a lack of strong graphical evidence to support health improvement. Our results suggest that varying cost-sharing by income for older people (i.e., smaller cost-sharing for lower-income individuals and larger cost-sharing for higher-income individuals) may reduce health expenditure without compromising health.

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Risk preferences, rationality of choices, and willingness to pay for preventive medicine in patients with graves’ thyrotoxicosis

Emoto N., Okazaki-Hada M., Yamaguchi Y., Okajima F., Goto R., Sugihara H.

Patient Preference and Adherence （Patient Preference and Adherence） 15 1971 - 1979 2021年

Purpose: Patients with thyrotoxicosis show neuropsychological changes, and these may damage the quality of informed consent in clinical practice. Therefore, we examined patients’ real-life preferences to assess whether change in risk preferences was dependent on thyroid function state. Patients and Methods: The participants were 86 patients who were newly diagnosed with Graves’ thyrotoxicosis between 1 January and 31 December 2018 (group A), and an additional 33 euthyroid patients diagnosed before 2018 (group B). In a survey conducted via a questionnaire based on the concept of behavioral economics, we sought to determine risk preferences, rationality of choices, and other relevant factors. An identical second survey was completed 6–12 months later by 36 patients in group A after their thyroid functions had been normalized by treatment, and by 11 euthyroid patients in group B. We performed paired analysis of the first and second surveys in 32 patients of group A and single regression analysis of a total of 140 surveys obtained from 119 patients by combining the first and second surveys of groups A and B with serum level of FT3 as an independent variable. Results: The paired analysis indicated that there was no significant difference in any survey item. The single regression analysis revealed that willingness-to-pay (WTP) for preventive medicine and monthly average out-of-pocket (OOP) expenditure on medical care were both significantly positively associated with serum level of FT3. Patients in the hyperthyroid state tend to have high WTP for preventive medicine, which may be accelerated by the anchoring effect of OOP expenditure. Conclusion: Almost all risk preferences of patients with Graves’ disease are constant, rational, and reproducible in the hyperthyroid and euthyroid states. However, medical professionals should be aware that the willingness of patients with thyrotoxicosis to pay for medical costs may change after the normalization of thyroid function.

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Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A multi-centre prospective cohort study

Matsuoka Y., Goto R., Atsumi T., Morimura N., Nagao K., Tahara Y., Asai Y., Yokota H., Ariyoshi K., Yamamoto Y., Sakamoto T.

Resuscitation （Resuscitation） 157 32 - 38 2020年12月

ISSN 03009572

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is an evolving resuscitative method for refractory cardiopulmonary arrests. However, considering the substantial healthcare costs and resources involved, there is an urgent need for a full economic evaluation. We therefore assessed the cost-effectiveness of ECPR for refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). Methods: We developed a decision model to estimate lifetime costs and outcomes for out-of-hospital cardiac arrest patients with VF/pVT who received either ECPR or conventional cardiopulmonary resuscitation. Quality-adjusted life-years (QALY) was used as the main outcome measure. This model was a combination of a decision tree model for the acute phase based on a prospective observational study (SAVE-J study), together with a Markov model for long-term follow-up periods extrapolated from published data. To evaluate the robustness of this model, we conducted a comprehensive deterministic sensitivity analysis (DSA) and a probabilistic sensitivity analysis (PSA). Results: ECPR was cost-effective, with an incremental cost of ¥3,521,189 (Є30,227), an incremental effectiveness of 1.34 QALY, and an incremental cost-effectiveness ratio of ¥2,619,692 (Є22,489) per QALY gained. DSA revealed that the present model was most sensitive to probability of Cerebral Performance Category 1 after ECPR (¥2,153,977/QALY to ¥3,186,475/QALY), patient age (¥2,170,112/QALY to ¥3,334,252/QALY), and long-term medical cost for modified Rankin Scale 0 (¥2,280,352/QALY to ¥2,855,330/QALY). PSA indicated ECPR to be cost-effective and below the willingness-to-pay threshold of ¥5,000,000 with an 86.7 % possibility. Conclusions: ECPR was an economically acceptable resuscitative strategy, and the results of the present study were robust even when considering the uncertainty of all parameters.

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Socio-demographic determinants of motorcycle speeding in Maha Sarakham, Thailand

Hong V., Iwamoto S.K., Goto R., Young S., Chomduangthip S., Weeranakin N., Nishi A.

PLoS ONE （PLoS ONE） 15 （ 12 December ） 2020年12月

Thailand has the highest road traffic fatality rate in Southeast Asia, making road safety a critical public health concern. A 2015 World Health Organization (WHO) Report showed that speeding behavior was the most important determinant for road traffic crashes in Thailand. Here, we aimed to examine associations of socio-demographic factors (gender, age, socioeconomic status) with self-reported motorcycle speeding behavior. Additionally, we examined a potential role of time discounting and risk preference as mediators in the association of socio-demographic factors with speeding. We used data obtained from the Mahasarakham University Social Network Survey 2018 (MSUSSS) (N = 150). We ran linear network autocorrelation models (lnam) to account for the data's social network structure. We found that males are more likely than females to engage in speeding behavior (β = 0.140, p = 0.001) and to discount the future (β = 5.175, p = 0.017). However, further causal mediation analysis showed that time discounting does not mediate the gender-speeding association (p for mediation = 0.540). Although socioeconomic status (subjective social class) was not associated with speeding (β = 0.039, p = 0.177), age was marginally associated with speeding (β = 0.005, p = 0.093). Future studies may consider using a larger sample.

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Prevalence of problem gambling among Japanese adults

Mori T., Goto R.

International Gambling Studies （International Gambling Studies） 20 （ 2 ） 231 - 239 2020年05月

ISSN 14459795

The prevalence of problem gambling has garnered considerable interest in numerous developed countries. In Japan, problem gambling may be far more prevalent than in other developed countries; however, there is little empirical research confirming this. Therefore, we estimated the prevalence of problem gambling in Japan using a standardized screening tool: The South Oaks Gambling Screen Revised (SOGS-R) and investigated the association between problem gambling and demographics such as gender, age, marital status, income, and educational background. We believe this study is necessary because gambling is a growing social problem in Japan that could worsen with the expected introduction of casinos in Japan due to the legalization of casino gambling in December 2016. Therefore, we surveyed participants’ experience of casino games both on the internet and abroad. Cross-sectional data were collected via a web-based survey of 6576 Japanese adults 20 years old and older. We found that the prevalence rate of problem gambling in Japan was significantly high from an international perspective. Restricting casino accessibility for individuals with high-risk factors could be effective in reducing gambling problems.

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Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

Hori M., Tanahashi N., Akiyama S., Kiyabu G., Dorey J., Goto R.

Journal of Medical Economics （Journal of Medical Economics） 23 （ 3 ） 252 - 261 2020年03月

ISSN 13696998

Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer’s perspective. Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis. Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (€1,011.11) per patient (1 JPY = 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 (€24,446.42) per QALY. Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases. Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY.

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Current treatment patterns and medical costs for multiple myeloma in Japan: a cross-sectional analysis of a health insurance claims database

Uno S., Goto R., Suzuki K., Iwasaki K., Takeshima T., Ohtsu T.

Journal of Medical Economics （Journal of Medical Economics） 23 （ 2 ） 166 - 173 2020年02月

ISSN 13696998

Aims: Various drugs have recently been launched for the treatment of multiple myeloma (MM). This increase in the number of treatment options has potentially changed treatment patterns and medical costs for patients with MM. Japanese public health insurance claims were analyzed to examine the change in the treatment patterns of MM drugs and medical costs per patient. Materials and methods: A claims database provided by Medical Data Vision was used, which includes data from ∼20 million patients from >300 acute care hospitals across Japan. The type of MM drugs prescribed and medical costs for patients with MM between April 2008 and December 2016 were examined using monthly cross-sectional analyses. Patients with an International Classification of Diseases, 10th Revision (ICD-10) diagnosis code of C90.0 were classified as having MM. MM drugs were defined by generic names. Results: In total, 19,137 patients with MM (average age at first diagnosis: 69.6 years; percentage of women: 47.9%) were identified from the database. The percentage of patients prescribed each MM drug changed substantially as novel drugs were launched. Total medical costs increased until 2010, then stabilized. MM drug costs increased from approximately 2010, but costs for other care decreased, particularly for hospitalization (including surgery). Limitations: The database contained data from large, acute care hospitals, which may have caused bias in terms of patients’ clinical history and disease severity. Conclusions: Total medical costs for MM have remained stable since 2010. MM drug costs increased, but costs for other care decreased after the launch of lenalidomide in 2010 and other drugs in 2015 and later. More detailed research is required to confirm whether the launch of novel drugs caused the changes in medical costs.

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Irrational responses to risk preference questionnaires by patients with diabetes with or without retinopathy and comparison with those without diabetes

Emoto N., Soga A., Fukuda I., Tanimura-Inagaki K., Harada T., Koyano H.M., Goto R., Sugihara H.

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy （Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy） 13 4961 - 4971 2020年

Purpose: The risk preferences of patients with diabetes have profound effects on the progression of complications. The present study aimed to clarify whether the preferences of patients with diabetes and retinopathy are deliberately risk-seeking or irrational and whether this propensity is specific to those with retinopathy or is also found in patients without retinopathy compared with those without diabetes. Patients and Methods: A total of 394 patients with diabetes (264 without retinopathy and 130 with retinopathy) and 198 patients without diabetes agreed to participate in this survey. The questions were modified versions of those from the Japan Household Survey on Consumer Preferences and Satisfaction, which sought to determine the participants’ personal socioeconomic status and risk preferences. In the questionnaires, responses were analyzed by determining the participants’ willingness to pay for a lottery ticket and for an insurance policy. Irrational responses were defined as violations of two axioms of the Expected Utility Theory: completeness and transitivity. Results: The incidence of irrational responses increased with age and was associated with educational level. The incidence of irrational responses was significantly higher in patients with retinopathy than in those without retinopathy after adjusting for age and educational level. There was no significant difference in the incidence of irrational responses between patients with diabetes but without retinopathy and those without diabetes. Conclusion: The risk-seeking behavior of patients with diabetes and retinopathy was not deliberate but was irrational under uncertainty. Medical professionals should be aware of their patients’ propensity to make irrational decisions, which is an important risk factor for the progression of retinopathy in patients with diabetes regardless of age and educational level.

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Nudging patients with chronic kidney disease at screening to visit physicians: A protocol of a pragmatic randomized controlled trial

Fukuma S., Ikenoue T., Sasaki S., Saigusa Y., Misumi T., Saito Y., Yamada Y., Goto R., Taguri M.

Contemporary Clinical Trials Communications （Contemporary Clinical Trials Communications） 16 2019年12月

ISSN 24518654

Background/Aims: Strategies for an effective intervention after chronic kidney disease (CKD) screening have not been well examined. We describe the rationale and design of a protocol of a pragmatic randomized controlled trial (RCT) to test the effect of a behavioral intervention using the nudge approach in behavioral economics on CKD patients’ visiting behaviors to physicians and change in their kidney function after CKD screening. Methods: The RCT will include CKD patients (N = 4500) detected at screening (estimated glomerular filtration rate [eGFR] <60 mL/min/1.74 m2 or urine protein ≥1+), aged 40–63 years. The two intervention groups will receive a “usual letter” and “nudge-based letter,” while the control group will only receive a conventional follow-up. Our primary outcome is proportion of patients’ visiting physicians for 6 months after the intervention; the secondary outcome is change in the eGFR at 2 years after the intervention. Results: We developed an efficient intervention program after CKD screening and designed the pragmatic RCT to assess its effectiveness in the real world. Our trial is unique in that it investigates the effect of the nudge approach in behavioral economics. By the end of 2018, we have enrolled 1,692 participants, and randomized 677 participants into the usual letter group, 677 participants into the nudge-based letter group, and 338 participants into the control group. We have confirmed that health checkup data could identify a large number of eligible participants. Conclusion: The trial's results will contribute to filling in the gap between screening and subsequent medical interventions for preventing CKD progression.

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Willingness to pay for QALY: perspectives and contexts in Japan

Igarashi A., Goto R., Yoneyama-Hirozane M.

Journal of Medical Economics （Journal of Medical Economics） 22 （ 10 ） 1041 - 1046 2019年10月

ISSN 13696998

Objectives: Theoretically, willingness-to-pay (WTP) for quality-adjusted life years (QALY) can vary depending on social and personal preferences and on ex-ante and ex-post settings. However, empirical investigations into the theoretical differences are lacking. In Japan, setting the threshold has been controversial since a pilot project to implement health technology assessments (HTA) launched in 2016. The study aim is to estimate WTP values for one additional QALY from different perspectives, health statuses, and contexts to confirm the difficulty in setting a uniform price threshold using WTP. Methods: More than 1,000 respondents representing a cross-section of the Japanese population answered each of nine questionnaire decks in an online panel. WTP values were estimated on three different perspectives (personal, social, and socially inclusive) and on two contexts (ex-ante and ex-post). This study primarily used the non-parametric spike model based on double-bounded dichotomous choice (DBDC) settings to obtain the conditional WTP values. Results: WTP per QALY was higher in the severe health status than in the moderate health status from all perspectives. Respondents from the socially inclusive perspective estimated the highest WTP value for a new drug. Respondents were also asked about life-threatening diseases in ex-post and ex-ante. The WTP value in ex-ante was higher than in ex-post, and demographic factors affecting the WTP were different in both situations. The various WTP values were obtained from these surveys. Limitations: The analysis was based on data collected from an internet panel, which could be biased. There is also a risk that respondents answered the questionnaire differently if asked in everyday situations. Conclusion: Use of a uniform price threshold may not be appropriate in policy settings, because it may not reflect diverse preferences based on different situations, such as disease type and severity. Setting a price threshold as Japan institutes an HTA system requires further research.

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Impact of improved price transparency on patients' demand of healthcare services

Kobayashi D., Goto R., Tsugawa Y.

Social Science and Medicine （Social Science and Medicine） 235 2019年08月

ISSN 02779536

Evidence is limited and mixed as to how improved price transparency affects patients' demand for healthcare. Price transparency usually affects both the supply and the demand side of healthcare. However, in Japan—where healthcare providers cannot compete on prices—we can examine an independent impact of price transparency on patients' demand for healthcare. The aim of this study is to investigate the impact of improved price transparency on patients' demand for healthcare. We conducted an experiment by presenting patients with the “price list” of individual healthcare services. We provided the price list for a limited time and compared the healthcare spending and utilization of care between these patients who were provided the price list (patients who visited between the first and third week of January in 2016) versus those who were not (patients who visited during the same period in 2015 or 2017), adjusting for potential confounders. A total of 1053 patients were analyzed (27.5% were provided the price list). We found that improved price transparency was associated with a higher total cost per patient (adjusted difference, +16.1%; 95%CI, +0.6% to +34.0%; p = 0.04). We also found that improved price transparency was associated with higher costs related to laboratory tests and imaging studies, and a larger total number of items of blood tests and urine tests. By conducting an experiment in a real-world setting, we found that improved price transparency paradoxically increased the utilization of healthcare services in Japan. These findings suggest that when prices are relatively low, as is the case in Japan, reduced uncertainty about the prices of healthcare service may make patients comfortable requesting more healthcare services.

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From fragmentation toward integration: A preliminary study of a new long-term care policy in a fast-aging country

Chiu T.Y., Yu H.W., Goto R., Lai W.L., Li H.C., Tsai E.T., Chen Y.M.

BMC Geriatrics （BMC Geriatrics） 19 （ 1 ） 2019年06月

Background: Taiwan, one of the fastest-aging countries in the world, started implementing version 1.0 of its long-term care (LTC) plan in 2008. In 2017, LTC Plan 2.0 began a new era with its goal to integrate Taiwan's fragmented LTC service system. LTC Plan 2.0 also aims to establish an integrated community-based LTC system incorporating both health care and disability prevention. This three-tier model consists of the following: two LTC services with a day-care center as their base and case management (Tier A), a day-care center and a single LTC service (Tier B), and LTC stations that provide primary prevention services and respite services for frail community-dwelling older adults to prevent further disabilities (Tier C). A defined cluster of agencies in a local area works together as a Tier ABC team. LTC Plan 2.0 is a new policy for Taiwan, and hence it is important to understand the agencies' initial difficulties with implementation and identify future challenges to help further policy development. Methods: This preliminary study explored the challenges to implementing LTC 2.0 through in-depth interviews based on Evashwick's integration mechanisms with representatives from three service teams. We interviewed three chief executive officers and three case managers. Results: We found that the LTC Plan 2.0 mechanisms for service integration have been insufficiently implemented. Recommendations include (1) Build up the trust between agencies and government, avoid duplication of LTC services within Tier ABC team, and encourage agencies within a team to create a shared administrative system with the same mission and vision. (2) Clarify the roles and responsibilities of government care managers and agency case managers. (3) Provide an integrated information system and create an official platform for sharing client records across different agencies and caregivers. (4) Establish a tool and platform to track the budget and payment across different levels of service as soon as possible. Conclusion: There is an increased demand for LTC services in Taiwan because of its rapidly aging population. Our findings shed some light on the challenges to developing integrated LTC services and thus may help both policymakers and service providers find ways to overcome these challenges.

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Comparison of Equity Preferences for Life Expectancy Gains: A Discrete Choice Experiment among the Japanese and Korean General Public

Goto R., Mori T.

Value in Health Regional Issues （Value in Health Regional Issues） 18 8 - 13 2019年05月

ISSN 22121099

Background: Setting priorities for limited public resources has become a topic of heated discussion the world over. Assigning different weights for the health gains of different population groups allows for equity considerations in cost-effectiveness analysis. However, only a few empirical works have elicited the preferences of the general public. Objective: To compare the equity preferemce assigned by Japanese and Koreans. Methods: We conducted a Web-based survey in March 2013, including a discrete choice experiment, to elicit the equity preferences of the general public for the life expectancy gains of different population groups. We selected attributes and designed the experiment following Norman et al.'s study (Norman R, Hall J, Street D, Viney R. Efficiency and equity: a stated preference approach. Health Econ 2013;22:568–81). Accordingly, we analyzed preference for sex, smoking status, lifestyle, caring status, income, and age. Results: The Japanese assigned a higher preference for males (P < 0.001), nonsmokers (P < 0.001), those with lower income (P < 0.001), and carers (P < 0.001), and they assigned a lower preference for those with a life expectancy of 60 years (P = 0.002) and 75-year-olds (P < 0.001). Koreans have the same patterns of preference for lower income (P < 0.001), caring (P < 0.001), and smoking status (P = 0.026). However, they prefer both sexes (P = 0.331) and different age groups equally. In both countries, respondents tend to prefer groups with characteristics similar to their own. Conclusions: People from the two Asian developed countries, with universal health insurance, show different equity preferences. These may reflect the variations in cultural background and coverage of health care services.

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Estimating the Net Utility Gains Among Donors and Recipients of Adult Living Donor Kidney Transplant

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

Transplantation Proceedings （Transplantation Proceedings） 51 （ 3 ） 676 - 683 2019年04月

ISSN 00411345

Objectives: Living donor kidney transplant relieves the disease burden of patients with end-stage renal disease but may shorten donor life expectancy; however, their quality of life (QOL) is preserved. Nevertheless, the magnitude of the net gain of this procedure is unknown. We evaluated the QOL of both donors and recipients concurrently and calculated the net utility gain. Methods: We recruited 210 subjects who visited the kidney transplantation clinic of a university hospital. Subjects were asked to complete the 5-level EQ-5D-based questionnaire, and patient characteristics were extracted from their medical records. We performed multivariate tobit models analysis to evaluate the QOL change caused by transplant surgery and subsequently ran computational simulations to determine the net utility gains of donors and recipients. We also performed sensitivity analyses. Results: After excluding 16 answers with missing data, we analyzed 203 answers in total. After the transplant surgery, recipients gained 0.07 in utility value while donors lost 0.04. In the net utility analysis, we found that the quality-adjusted life years gained ranged from 7.2 to 7.8 in the most favorable case observed in the combination of middle-aged recipients and elderly donors. Assuming no utility discount, the most favorable combination was that with older donors and younger recipients. Conclusions: These findings indicated that the QOL improvement in recipients was larger than the loss among donors. When calculating the net utilities, a combination of middle-aged recipients and elderly donors yielded the largest net utility, but this was likely derived from assumption in the discount of QOL.

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The impact of anti-vascular endothelial growth factor agents on visual impairment/blindness prevention in patients with diabetic macular edema and on associated patient and caregiver burden in Japan

Kitano S., Sakamoto T., Goto R., Fukushima A., Vataire A.L., Hikichi Y.

Journal of Medical Economics （Journal of Medical Economics） 22 （ 3 ） 254 - 265 2019年03月

ISSN 13696998

Aims: To estimate the impact of anti-vascular endothelial growth factor (VEGF) agents on visual impairment and blindness avoided in patients with diabetic macular edema (DME) and on associated patient and caregiver productivity loss in Japan. Methods: This study compared the impact of current care (estimated at 53.8% utilization of anti-VEGF agents using current data) with that of hypothetical care (characterized by a higher utilization of anti-VEGF agents [80.0%], as estimated by an expert panel) of DME patients. A population-based Markov model (two-eye approach) simulated visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] letters) transitions over 5 years with DME treatments (intravitreal aflibercept, ranibizumab, and triamcinolone acetonide, and grid/focal laser) in patients with DME. Patient and caregiver productivity loss was determined using the human capital method. Results: In total, 570,000 DME patients were included in the model over 5 years. Increased utilization of anti-VEGF agents resulted in 6,659 fewer cases of severe visual impairment (SVI; 26–35 ETDRS letters) or blindness (0–25 ETDRS letters) compared with the current care approach (26,023 vs 32,682 cases; 20.38% reduction) over this period. Increased utilization of anti-VEGF agents also contributed to productivity loss savings of ¥12.58 billion (US $115.64 million) (i.e., 17.01%) at the end of year 5. The total overall saving over 5 years was ¥45.83 billion (US $421.27 million) (13.45%). Limitations: Few Japanese data were available, and assumptions were made for some inputs. Vision changes dependent on the function of both eyes were not studied. Only intravitreal (not sub-Tenon’s) injections of triamcinolone were considered in this model. Direct costs were not considered. Conclusions: Increased utilization of anti-VEGF agents can reduce SVI and legal blindness in patients with DME in Japan. This would also be associated with substantial savings in patient and caregiver productivity loss.

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The effect of model selection on cost-effectiveness research: A comparison of kidney function-based microsimulation and disease grade-based microsimulation in chronic kidney disease modeling

Hiragi S., Tamura H., Goto R., Kuroda T.

BMC Medical Informatics and Decision Making （BMC Medical Informatics and Decision Making） 18 （ 1 ） 2018年11月

Background: Cost effectiveness research is emerging in the chronic kidney disease (CKD) research field. Especially, an individual-level state transition model (microsimulation) is widely used for these researches. Some researchers set CKD grades as discrete health states, and the transition probabilities between these states were dependent on the CKD grades (disease grade-based microsimulation, MSM-dg), while others set estimated glomerular filtration rate value which determines the severity of CKD as a main variable describing patients' continuous status (kidney function-based microsimulation, MSM-kf). MSM-kf seems to reflect the real world more precisely but is more difficult to implement. We compared the calculation results of these two microsimulation models to evaluate the effect of model selection on CKD cost-effectiveness analysis. Methods: We implemented simplified MSM-dg and MSM-kf emulating natural course of CKD in general, and compared models using parameters derived from an IgA nephropathy cohort. After checking these models' overall behavior, life-years, utilities, and thresholds regarding intervention costs below which the intervention is thought as dominant (V0) or cost-effective (V1) were calculated. In addition, one-way and probabilistic sensitivity analyses were performed. Results: With base-case parameters, the calculated life-years was shorter in MSM-dg (73.89 vs. 75.80 years) while the thresholds were almost equal (86.87 vs. 90.43 (V0), 132.29 vs. 146.25 [V1 in 1000 USD]) compared to MSM-kf. Sensitivity analyses showed a tendency of the MSM-dg to show shorter results in life-years. V0 and V1 were distributed by approximately ±100,000 USD (V0) and ± 150,000 USD (V1) between models. Conclusions: Estimated cost-effectiveness thresholds by both models were not the same and its difference distributed too wide to be ignored. This result indicated that model selection in CKD cost-effectiveness research has large effect on their conclusions.

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Influence of Japan's 2004 postgraduate training on ophthalmologist location choice, supply and distribution

Sakai-Bizmark R., Goto R., Hiragi S., Tamura H.

BMC Medical Education （BMC Medical Education） 18 （ 1 ） 2018年03月

Background: Highly-competent patient care is paramount to medicine. Quality training and patient accessibility to physicians with a wide range of specializations is essential. Yet, poor quality of life for physicians cannot be ignored, being detrimental to patient care and leading to personnel leaving the medical profession. In 2004, the Japanese government reformed postgraduate training for medical graduates, adding a 2-year, hands-on rotation through different specialties before the specialization residency was begun. Residents could now choose practice location, but it sparked concerns that physician distribution disparities had been created. Japanese media reported that residents were choosing specialties deemed to offer a higher quality of life, like Ophthalmology or Dermatology, over underserved areas like Obstetrics or Cardiology. To explore the consequences of Japan's policy efforts, through the residency reform in 2004, to improve physician training, analyzing ophthalmologist supply and distribution in the context of providing the best possible patient care and access while maintaining physician quality of life. Methods: Using secondary data, we analyzed changes in ophthalmologist supply at the secondary tier of medical care (STM). We applied ordinary least-squares regression models to ophthalmologist density to reflect community factors such as residential quality and access to further professional development, to serve as predictors of ophthalmologist supply. Coefficient equality tests examined predictor differences before and after 2004. Similar analyses were conducted for all physicians excluding ophthalmologists (other physicians). Ophthalmologist coverage in top and bottom 10% of STMs revealed supply inequalities. Results: Change in ophthalmologist supply was inversely associated with baseline ophthalmologist density before (P <.01) and after (P =.01) 2004. Changes in other physician supply were not associated with baseline other physician density before 2004 (P = 0.5), but positively associated after 2004 (P <.01). Inequalities between top and bottom 10% of ophthalmologist supply in STMs were large, with best-served areas maintaining roughly five times greater coverage than least-served areas. However, inequalities gradually declined between 1998 and 2012. Conclusions: Ophthalmologist supply increased both before and after the 2004 reform, yet contrary to media reports, proceeded at a lesser rate than supply increases for other physicians. After 2004, geographical disparities decreased for ophthalmologists, while increasing for other physicians.

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Geographical accessibility to gambling venues and pathological gambling: an econometric analysis of pachinko parlours in Japan

Kato H., Goto R.

International Gambling Studies （International Gambling Studies） 18 （ 1 ） 111 - 123 2018年01月

ISSN 14459795

The relationship between geographical accessibility to gambling venues and the prevalence of pathological gambling is still unknown. This study aimed to reveal this relationship in Japan as well as its variation by subpopulation. A cross-sectional study was conducted, based on an original web-based survey to understand the level of pathological gambling depending on accessibility to pachinko parlours. Pathological gamblers were measured using the Japanese version of the South Oaks Gambling Screen. Accessibility to gambling venues was defined as the number of pachinko parlours within a 1.5 km radius from home. Moreover, the study adopted the instrumental variable approach to solve the potential endogeneity problem. The results showed that the accessibility was not significantly associated with pathological gambling in general, but that the effects of accessibility varied by subpopulation. Accessibility was significantly and positively correlated with pathological gambling for men and people in low-income areas, but this was not so for women and people in high-income areas. The study’s findings show the importance of the neighbourhood environment and could help in implementing more effective interventions for pathological gamblers.

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Examining the impact of smoking on work productivity and associated costs in Japan

後藤励

Journal of Medical Economics 2017年

共著, 査読有り

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Does lack of resources impair access to breast and cervical cancer screening in Japan?

後藤励

PLoS 2017年

共著, 査読有り

Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)

後藤励

Environmental Health and Preventive Medicine 22 （ 51 ） 2017年

共著, 査読有り

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Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health system

GOTO Rei,Shingo Fukuma, Shahira Ahmad, Inui S Thomas, Rifat Atun and Shunichi Fukuhara

Journal of Global Health 7 （ 1 ） 2017年

共著, 査読有り

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Potential capacity of endoscopic screening for gastric cancer in Japan

GOTO Rei, Chisato Hamashima

Cancer Science 108 （ 1 ） 101 - 107 2017年

共著, 査読有り

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へき地の勤務条件に対する大都市の内科系勤務医の選好

後藤励,　佐野洋史, 村上正泰, 柿原浩明

日本労働研究雑誌（ 680 ） 86 - 101 2017年

共著, 査読有り

医療における費用対効果とは？

後藤励

Cancer Board Square 3 （ 2 ） 50 - 55 2017年

A discrete choice experiment studying students' preferences for scholarships to private medical schools in Japan

後藤励

HUMAN RESOURCES IN HEALTH 14 （ 4 ） 2016年02月

研究論文（学術雑誌）, 査読有り, ISSN 1478-4491

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Cost-effectiveness analysis of smoking cessation interventions in Japan using a discrete event simulation

後藤励

Applied Health Economics and Health Policy 14 77 - 87 2016年

研究論文（学術雑誌）, 査読有り

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A socioeconomic and behavioral survey of patients with difficult-to-control type 2 diabetes reveals an association between diabetic retinopathy and educational attainment.

後藤励

Patient Preference and Adherence 10 2151 - 2162 2016年

共著, 査読有り

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生活習慣病・行動変容と医療経済

後藤励

治療 98 （ 4 ） 551 - 555 2016年

単著

患者満足度と従業員満足度の影響要因

新井康平福嶋誠宣前平秀志後藤励

久留米大学ビジネス研究 1 （ 1 ） 2016年

研究論文（大学，研究機関等紀要）, 単著

Study protocol of the TRICOLORE trial: a randomized phase III study of oxaliplatin-based chemotherapy versus combination chemotherapy with S-1, irinotecan, and bevacizumab as first-line therapy for metastatic colorectal cancer

後藤励

BMC CANCER 15 2015年09月

研究論文（学術雑誌）, 査読有り, ISSN 1471-2407

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The Clinical Effectiveness and Cost-Effectiveness of Screening for Age-Related Macular Degeneration in Japan: A Markov Modeling Study

後藤励

PLOS ONE 10 （ 7 ） 785 - 791 2015年07月

研究論文（学術雑誌）, 査読有り, ISSN 1932-6203

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Evaluating the effect of Japan's 2004 postgraduate training programme on the spatial distribution of physicians

後藤励

HUMAN RESOURCES FOR HEALTH 13 （ 5 ） 1018 - 1024 2015年01月

研究論文（学術雑誌）, 査読有り, ISSN 1478-4491

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外科領域におけるHealth Technology Assessment

後藤励錦織達人川上浩司肥田侯矢坂井義治

日本外科学会雑誌 116 （ 1 ） 64 - 69 2015年

共著

Behavioral economics survey of patients with type 1 and type 2 diabetes

後藤励

PATIENT PREFERENCE AND ADHERENCE 9 649 - 658 2015年

研究論文（学術雑誌）, 査読有り, ISSN 1177-889X

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Why screening rates vary between Korea and Japan - Differences between two national healthcare systems

後藤励

Asia Pacific Journal of Cancer Prevention 16 （ 2 ） 395 - 400 2015年

研究論文（学術雑誌）, 査読有り

Study protocol of the TRICOLORE trial: A randomized phase III study of oxaliplatin-based chemotherapy versus combination chemotherapy with S-1, irinotecan, and bevacizumab as first-line therapy for metastatic colorectal cancer.

後藤励

BMC Cancer 15 626 2015年

共著, 査読有り

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Cost-effectiveness analysis of screening for age-related macular degeneration in Japan: a Markov modeling study.

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PLoS 10 （ 7 ） 2015年

共著, 査読有り

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内視鏡胃がん検診プログラムへの参加要因

後藤励,新井康平　謝花典子　濱島ちさと

厚生の指標 62 （ 2 ） 1 - 6 2015年

共著, 査読有り

韓国のNational Cancer Screening Program －胃がん内視鏡検診の現状を中心に

後藤励

臨牀消化器内科 31 （ 2 ） 171 - 176 2015年

単著

FCTC 6条たばこ税増税の経済評価とたばこによる経済損失　―たばこ税の影響と，禁煙政策の医療経済評価にまつわる諸問題―

後藤励五十嵐　中福田　敬

保健医療科学 64 （ 5 ） 426 - 432 2015年

共著

医療に対する社会的価値判断～何を保険診療で支払っていくべきか？

後藤励

研究技術計画 30 （ 1 ） 55 - 67 2015年

単著

「成人を対象とした眼検診」研究班中間報告書

後藤励平塚　義宗小野　浩一中野　匡田村　寛川崎　良川島　素子山田　昌和

日本の眼科 86 （ 7 ） 984 - 1001 2015年

共著

行動経済学からみた予防医療　　特集：経済学からみたこれからの医療

後藤励

病院 74 （ 6 ） 30 - 34 2015年

単著

Web-based survey on smoking cessation behaviors of current and former smokers in Japan

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CURRENT MEDICAL RESEARCH AND OPINION 30 （ 10 ） 1911 - 1921 2014年10月

研究論文（学術雑誌）, 査読有り, ISSN 0300-7995

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Labor Resource Use for Endoscopic Gastric Cancer Screening in Japanese Primary Care Settings: A Work Sampling Study

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PLOS ONE 9 （ 2 ） 1169 - 1182 2014年02月

研究論文（学術雑誌）, 査読有り, ISSN 1932-6203

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高血圧の疾患関連医療費

後藤励

血圧 21 （ 3 ） 45 - 48 2014年

単著

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

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ASIAN PACIFIC JOURNAL OF CANCER PREVENTION 15 （ 6 ） 2607 - 2612 2014年

研究論文（学術雑誌）, 査読有り, ISSN 1513-7368

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A work sampling study to analyze resource use for endoscopic gastric cancer screening in Japanese primary care settings

後藤励

PLoS 9 （ 2 ） 2014年

共著, 査読有り

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The Impact of Japan's 2004 Postgraduate Training Program on Intra-prefectural Distribution of Pediatricians in Japan

後藤励

PLOS ONE 8 （ 10 ） 785 - 791 2013年10月

研究論文（学術雑誌）, 査読有り, ISSN 1932-6203

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ベースラインPSA値による検診間隔の個別設定は前立腺癌スクリーニングの効率を改善する～数理モデルを用いた社会経済学的考察～

後藤励小林恭，樋之津史郎, 小川修

泌尿器科紀要 59 （ 3 ） 159 - 166 2013年

共著, 査読有り

診療所における内視鏡胃がん検診数の決定要因

後藤励新井康平　謝花典子　濱島ちさと

病院管理 50 （ 3 ） 25 - 33 2013年

共著, 査読有り

ポリオワクチンの選好因子：コンジョイント分析を用いた解析

後藤励牟田広実　松山剛

外来小児科 16 （ 2 ） 160 - 169 2013年

共著, 査読有り

禁煙治療の費用と禁煙意思　～コンジョイント分析を用いた解析～

後藤励　牟田広実, 後藤励, 高橋裕子

禁煙科学 6 （ 6 ） 1 - 10 2012年

共著, 査読有り

Can economic-psychological parameters predict successful smoking cessation?

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JOURNAL OF SOCIO-ECONOMICS 40 285 - 295 2011年05月

研究論文（学術雑誌）, 査読有り, ISSN 1053-5357

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Changes in Smokers' Attitudes Toward Intended Cessation Attempts in Japan

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VALUE IN HEALTH 14 （ 5 ） 785 - 791 2011年01月

研究論文（学術雑誌）, 査読有り, ISSN 1098-3015

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高血圧治療行動に関する研究 ―良好な血圧管理へ向けた行動変容ステージごとの分析

後藤励荒川規矩男, 中山健夫, 宮崎貴久子, 當山まゆみ, 荒井優気, 日和田邦男, 荻原俊男, 島本和明, 上島弘嗣, 西村周三 (2011)

血圧 18 （ 4 ） 101 - 105 2011年

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日本の禁煙強化政策に対する喫煙者の反応.

後藤励　依田高典, 高橋裕子

厚生の指標 58 （ 5 ） 7 - 13 2011年

共著, 査読有り

日本の将来と製薬企業が果たす役割

後藤励柿原浩明

社会保険旬報 2010年

共著

SIMULTANEOUS MEASUREMENT OF TIME AND RISK PREFERENCES: STATED PREFERENCE DISCRETE CHOICE MODELING ANALYSIS DEPENDING ON SMOKING BEHAVIOR

後藤励

INTERNATIONAL ECONOMIC REVIEW 50 （ 4 ） 1169 - 1182 2009年11月

研究論文（学術雑誌）, 査読有り, ISSN 0020-6598

Interdependency among addictive behaviours and time/risk preferences: Discrete choice model analysis of smoking, drinking, and gambling

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JOURNAL OF ECONOMIC PSYCHOLOGY 30 （ 4 ） 608 - 621 2009年08月

研究論文（学術雑誌）, 査読有り, ISSN 0167-4870

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A cohort study to examine whether time and risk preference is related to smoking cessation success

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ADDICTION 104 （ 6 ） 1018 - 1024 2009年06月

研究論文（学術雑誌）, 査読有り, ISSN 0965-2140

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禁煙意思と時間・危険選好率

後藤励依田高典

京都大学経済論叢 182 （ 1 ） 56 - 70 2009年

研究論文（大学，研究機関等紀要）, 共著

クロスアディクションと時間/危険選好

依田高典後藤励

京都大学経済論叢 182 （ 1 ） 1 - 26 2009年

研究論文（大学，研究機関等紀要）, 共著

高齢患者の薬剤理解に影響する要因の分析

岸田研作後藤励谷垣靜子

岸田研作 182 （ 1 ） 43 - 55 2009年

研究論文（大学，研究機関等紀要）

行動経済学の現在

依田高典西村周三後藤励

「行動健康経済学」第一回　経済セミナー（ 636 ） 106 - 113 2008年

共著

たばこ増税が総税収に及ぼす影響の推計　～コンジョイント分析に基づく推計～

後藤励　五十嵐中, 池田俊也, 後藤励, 清原康介, 三浦秀史, 高橋裕子, 西村周三

禁煙科学 2 （ 3 ） 25 - 35 2008年

共著, 査読有り

時間選好、危険選好ならびに喫煙習慣.

後藤励　依田高典

応用経済学研究（ 1 ） 1 - 14 2008年

共著, 査読有り

243928

後藤励依田高典西村周三

「行動健康経済学」第十一回　経済セミナー（ 646 ） 90 - 95 2008年

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臨床の行動健康経済学

後藤励依田高典西村周三

「行動健康経済学」第十回　経済セミナー（ 645 ） 93 - 97 2008年

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行動健康経済学とニューロエコノミクス

後藤励依田高典西村周三

「行動健康経済学」第九回　経済セミナー（ 644 ） 82 - 88 2008年

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アディクションにおおけるアノマリーと衝動性の架け橋

後藤励依田高典西村周三

「行動健康経済学」第八回　経済セミナー（ 643 ） 84 - 91 2008年

共著

禁煙の成功と失敗の経済心理学

後藤励依田高典西村周三

「行動健康経済学」第七回　経済セミナー（ 642 ） 87 - 95 2008年

共著

クロスアディクションの経済心理学

後藤励依田高典西村周三

「行動健康経済学」第六回　経済セミナー（ 641 ） 79 - 84 2008年

共著

喫煙の経済心理学

後藤励依田高典西村周三

「行動健康経済学」第五回　経済セミナー（ 640 ） 78 - 84 2008年

共著

ニコチン依存と禁煙意思

後藤励依田高典西村周三

「行動健康経済学」第五回　経済セミナー（ 639 ） 90 - 97 2008年

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行動経済学から行動健康経済学へ

西村周三依田高典後藤励

「行動健康経済学」第三回　経済セミナー（ 638 ） 104 - 111 2008年

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嗜癖と依存症の経済学

後藤励依田高典西村周三

「行動健康経済学」第二回　経済セミナー（ 637 ） 106 - 113 2008年

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Discrete choice experiment of smoking cessation behaviour in Japan

後藤励

TOBACCO CONTROL 16 （ 5 ） 336 - 343 2007年10月

研究論文（学術雑誌）, 査読有り, ISSN 0964-4563

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Prostate cancer screening strategies with rescreening interval determined by individual baseline prostate-specific antigen values are cost-effective

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JOURNAL OF UROLOGY 177 （ 4 ） 66 - 66 2007年04月

研究論文（学術雑誌）, 査読有り, ISSN 0022-5347

医療経済学の視点から” 　医療経営と可視化⑥　

後藤励

病院管理フォーラム　病院 67 （ 2 ） 173 - 175 2007年

単著

Prostate cancer screening strategies with re-screening interval determined by individual baseline prostate-specific antigen values are cost-effective

後藤励

European Journal of Surgical Oncology 33 （ 6 ） 783 - 789 2007年

研究論文（学術雑誌）, 査読有り

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Impact of improvement in specificity of primary screening test on total cost of prostate cancer mass screening.

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International Journal of Urology, 14 （ 9 ） 805 - 810 2007年

共著, 査読有り

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運動習慣、節酒習慣、良い食事習慣のヘルス・ビリーフ・モデルによる分析

後藤励　岸田研作、柿原浩明、髙塚直能

医療と社会 17 （ 3 ） 329 - 338 2007年

共著, 査読有り

禁煙意思に関するコンジョイント分析.

後藤励　西村周三, 依田高典

厚生の指標 54 （ 10 ） 38 - 43 2007年

共著, 査読有り

Implications of using different factors in risk adjustment formula of health care funds allocation.

後藤励

甲南経済学論集 46 （ 3 ） 61 - 74 2006年

研究論文（大学，研究機関等紀要）, 共著

マルコフモデルを用いた前立腺がん検診の費用効果分析　－最適な検診の設計－

渡辺励　小林恭, 光森健二

医療経済研究 17 21 - 41 2005年

査読有り

がん検診の受診要因に関する分析

渡辺　励

医療と社会 13 （ 2 ） 113 - 132 2003年

単著, 査読有り

転移性前立腺癌に対するホルモン療法についての費用効用分析.

渡辺励、藤川慶太、粟倉康夫、岡部達士郎、西村周三

日本泌尿器科学会雑誌 94 （ 4 ） 503 - 512 2003年

共著, 査読有り

医師の薬剤処方に関する実証分析.

渡辺励,高塚直能, 西村周三

医療経済研究 13 45 - 70 2003年

共著, 査読有り

社会医療診療行為別調査を用いた外来肺炎・気管支炎患者における抗生物質選択に関する分析.

渡辺励,　大日康史

病院管理 39 （ 3 ） 175 - 187 2002年

共著, 査読有り

社会医療診療行為別調査を用いた人工呼吸器使用期間と医療費への影響に関する分析.

渡辺励、大日康史

日本公衆衛生雑誌 49 （ 4 ） 314 - 323 2002年

共著, 査読有り

Alternative splicing of the erythropoietin receptor gene correlates with erythroid differentiation in rat hematopoietic and leukemic cells

36. Masayuki Fujita, Rei Takahashi, Kazuhiro Kitada, Rei Watanabe, Sohei Kitazawa, Faramarz Ashoori, Ping Liang, Hideyuki Saya, Tadao Serikawa, Sakan Maeda

Cancer Letters 112 （ 1 ） 47 - 55 1997年

研究論文（学術雑誌）

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