[Health economics of transplantation system]

We arranged the main problem and the background factor of the transplantation from a viewpoint of health economics. As a result, we guessed that the people's recognition to public value of the transplantation system was low. And it was one of the fundamental factors to disturb the transplantation. In addition, we researched the explanation method and the case report about a health economics value of transplantation. According to the review, health economics value of transplantation should be accounted by cost-effectiveness (performance). Our country have to promote positively the transplantation, because the cost-effectiveness (USA$/QALY and USA$/DALY) of the transplantation is high.

Cost-Effectiveness Comparison of Carbon-Ion Radiation Therapy and Transarterial Chemoembolization for Hepatocellular Carcinoma

PURPOSE

Carbon-ion radiation therapy (CIRT) is a treatment option for patients with hepatocellular carcinoma (HCC) that results in better outcomes with fewer side effects despite its high cost. This study aimed to evaluate the cost-effectiveness of CIRT for HCC from medical and economic perspectives by comparing CIRT and transarterial chemoembolization (TACE) in patients with localized HCC who were ineligible for surgery or radiofrequency ablation.

METHODS AND MATERIALS

This study included 34 patients with HCC who underwent either CIRT or TACE at Gunma University between 2007 and 2016. Patient characteristics were employed to select each treatment group using the propensity score matching method. Life years were used as the outcome indicator. The CIRT technical fee was ¥3,140,000; however, a second CIRT treatment on the same organ within 2 years was performed for free.

RESULTS

Our study showed that CIRT was dominant over TACE, as the CIRT group had a higher life year (point estimate, 2.75 vs 2.41) and lower total cost (mean, ¥4,974,278 vs ¥5,284,524). We conducted a sensitivity analysis to validate the results because of the higher variance in medical costs in the TACE group, which demonstrated that CIRT maintained its cost effectiveness with a high acceptability rate.

CONCLUSIONS

CIRT is a cost-effective treatment option for localized HCC cases unsuitable for surgical resection.

Effect of cardiac rehabilitation on progression to long-term care: A clinical and economic longitudinal study in Japan

BACKGROUND

The social burden of nursing care is increasing with age, particularly for patients with heart failure who often require intensive care. This study aimed to clarify the relationship between nursing care needs and the clinical status of patients with a history of cardiovascular disease, focusing on the benefits of cardiac rehabilitation (CR) in reducing these needs.

METHODS

This single-gate, multicenter, retrospective observational study included patients of all ages with a history of hospitalization for cardiovascular diseases using government-administered insurance claims and health examination data. Data spanning a four-year period (April 2014 to March 2018) were analyzed, and the effects of CR on nursing care needs and associated factors were examined. Multivariate analysis and propensity score matching were used to adjust for confounding factors, ensuring a robust comparison between CR and non-CR groups.

RESULTS

A total of 48,456 patients were enrolled, with an average follow-up of 36.1 months. After propensity score matching, patients who participated in CR demonstrated significantly lower mortality rates and reduced nursing care needs compared to those who did not (0.02 ± 0.13 vs. 0.04 ± 0.20, p < 0.01, 0.94 ± 0.27 vs. base: 1, p = 0.05). CR was associated with improved adherence to medications and increased generic drug prescriptions, contributing to better long-term health outcomes. The adjusted odds ratio for CR in reducing nursing care needs was 0.574 (95 % CI, 0.347-0.948, p < 0.05).

CONCLUSIONS

This study confirms the potential critical role of CR in reducing mortality and nursing care needs in patients with cardiovascular disease. Although CR did not directly reduce nursing care costs, it contributed to improved health outcomes and reduced dependency on long-term care services. These findings highlight the benefits of CR as a preventive intervention, especially in aging populations. Further research is needed regarding its long-term economic benefits.

Factors Influencing Drug Prescribing for Patients With Hospitalization History in Circulatory Disease-Patient Severity, Composite Adherence, and Physician-Patient Relationship: Retrospective Cohort Study

BACKGROUND

With countries promoting generic drug prescribing, their growth may plateau, warranting further investigation into the factors influencing this trend, including physician and patient perspectives. Additional strategies may be needed to maximize the switch to generic drugs while ensuring health care system sustainability, focusing on factors beyond mere low cost. Emphasizing affordability and clarifying other prescription considerations are essential.

OBJECTIVE

This study aimed to provide initial insights into how patient severity, composite adherence, and physician-patient relationships impact generic switching.

METHODS

This study used a long-term retrospective cohort design by analyzing data from a national health care database. The population included patients of all ages, primarily older adults, who required primary-to-tertiary preventive actions with a history of hospitalization for cardiovascular diseases (ICD-10 [International Statistical Classification of Diseases, Tenth Revision]) from April 2014 to March 2018 (4 years). We focused on switching to generic drugs, with temporal variations in clinical parameters as independent variables. Lifestyle factors (smoking and drinking) were also considered. Adherence was measured as a composite score comprising 11 elements. The physician-patient relationship was established based on the interval between physician change and prescription. Logistic regression analysis and propensity score matching were used, along with complementary analysis of physician-patient relationships, proportion of days covered, and adherence for a subset of the population.

RESULTS

The study included 48,456 patients with an average follow-up of 36.1 (SD 8.8) months. The mean age was 68.3 (SD 9.9) years; BMI, 23.4 (SD 3.4) kg/m2; systolic blood pressure, 131.2 (SD 15) mm Hg; low-density lipoprotein cholesterol level, 116.6 (SD 29.3) mg/dL; hemoglobin A1c (HbA1c), 5.9% (SD 0.8%); and serum creatinine level, 0.9 (SD 0.8) mg/dL. Logistic regression analysis revealed significant associations between generic switching and systolic blood pressure (odds ratio [OR] 0.996, 95% CI 0.993-0.999), serum creatinine levels (OR 0.837, 95% CI 0.729-0.962), glutamic oxaloacetic transaminase levels (OR 0.994, 95% CI 0.990-0.997), proportion of days covered score (OR 0.959, 95% CI 0.948-0.97), and adherence score (OR 0.910, 95% CI 0.875-0.947). In addition, generic drug rates increased with improvements in the HbA1c level band and smoking level (P<.01 and P<.001). The group with a superior physician-patient relationship after propensity score matching had a significantly higher rate of generic drug prescribing (51.6%, SD 15.2%) than the inferior relationship group (47.7%, SD17.7%; P<.001).

CONCLUSIONS

Although physicians' understanding influences the choice of generic drugs, patient condition (severity) and adherence also impact this decision. For example, improved creatinine levels are associated with generic drug choice, while stronger physician-patient relationships correlate with higher rates of generic drug use. These findings may contribute to the appropriate prescription of pharmaceuticals if the policy diffusion of generic drugs begins to slow down. Thus, preventing serious illness while building trust may result in clinical benefits and positive socioeconomic outcomes.