Co-insurance and health care utilization in Japanese patients with rheumatoid arthritis: a discontinuity regression approach

Abstract Background Co-insurance rates in Japan decrease when patients turn 70 years of age. We aim to compare changes in medical demand for Japanese patients with rheumatoid arthritis (RA) at age 70 prior to 2014, when there was a reduction in co-insurance rates from 30 to 10%, with changes in medical demand at age 70 after 2014 when co-insurance rates decreased from 30% to only 20%. Methods We used administrative data from large Japanese hospitals. We employed a discontinuity regression (RD) approach to control for unobserved endogeneity in the data. Results We identified a total of 7343 patients with RA, 4905 (67%) turned age 70 before April, and found that a 20% decrease in co-insurance was associated with increased utilization of more expensive biologic RA drugs, more outpatient visits and higher total medical costs. However, a 10% decrease in co-insurance for patients who turned 70 after 2014 did not significantly change demand for medical services. Conclusions For the younger cohort, we did not observe any changes in medical demand after a price decrease. We therefore conclude that the economic goal of cost sharing, namely a behavioural change towards lower health-care utilization, is not achieved in this particular cohort of chronic patients

Preference for shared decision-making in Japanese patients with rheumatoid arthritis

Purpose: The goal of this study was to examine preference for collaborative decision-making in Japanese patients with rheumatoid arthritis (RA). Patients and methods: A national online survey identified five hundred Japanese patients with RA who met study eligibility criteria. Subjects were queried regarding their preference for shared decision-making (SDM), using a questionnaire developed by Baars et al. to evaluate preference for SDM among Dutch patients. Participants in this study were asked to identify a number of clinical and socioeconomic characteristics, medical history, and treatment details. Multivariable regression analyses were applied to determine factors that were related to patient preference for SDM. Results: The study showed that 52% of patients surveyed considered shared medical decision-making “Very important” on a 4-item Likert scale. Females and patients with RA in Japan who are treated with biologic agents are more likely to have a preference for SDM. On the other hand, patients with a comorbidity of depression are less likely to prefer SDM. Conclusion: A majority of Japanese patients with RA prefer a collaborative role in medical decision-making. Treatment with biologic agents is associated with a higher likelihood of preference for SDM

The underrated prevalence of depression in Japanese patients with rheumatoid arthritis - evidence from a Nationwide survey in Japan

Abstract Background To determine the prevalence of depression among Japanese people with rheumatoid arthritis (RA) and explore the relationships between depression and an array of variables. Methods Nation-wide, cross-sectional online survey (n = 500) of people with RA including the Patient Health Questionnaire (PHQ-9) to measure the presence and severity of depressive symptoms were performed. Results While only 5% of the population studied had been officially diagnosed with depression, 35% had PHQ-9 scores indicating depression was present. People with RA are more likely to experience depression if they are younger, have greater functional impairment, or whose treatment regimen includes pain medications not biologic agents. Conclusions It is a potential risk of under-diagnosis and under-reporting of depression in Japanese people with RA. People with RA are more likely to experience depression if they are younger, have greater functional impairment, or whose treatment regimen includes pain medications without biologic drugs

Systematic review and network meta-analysis in health technology assessment

Conducting systematic review and meta-analysis (SR/MA) is a standard process for establishing evidences for health technology assessment. Quality assessment of studies included in SR/MA and SR/MA studies should be considered. This article provides recommendations on tools used for assessing the quality of studies included in each SR/MA and the quality of SR/MA. For assessing the quality of randomized controlled trial, we recommend a tool called "Risk of Bias", which focuses on random generation, allocation concealment, blinding and outcome reporting. For assessing the quality of observational study, the Newcastle Ottawa Scale (NOS) is recommended. The NOS consists of three different dimensionsselection, comparability, and outcomes or exposure. Another tool which is recommended is the Down and Black scale. It focuses on the quality of reporting, validity, bias and confounding, and power of study. For assessing the quality of SR/MA, we recommend to use a checklist developed by Klassen et al, covering well-defined question, inclusion criteria, comprehensiveness, quality of included studies, reproducibility, and external validity. This article also provides a fundamental of network metaanalysis that should be considered where no direct evidence exists or when there is a need to compare multiple interventions at the same time

A cost-effectiveness study of intravenous immunoglobulin in childhood idiopathic thrombocytopenia purpura patients with life-threatening bleeding

Background: Although the international guideline recommends intravenous immunoglobulin (IVIG) as the first-line treatment for childhood idiopathic thrombocytopenia purpura (ITP) with life-threatening bleeding, ITP patients may not be able to access IVIG because of the limitation in health benefit packages especially in developing countries. There remains an important policy question as to whether IVIG used as a first-line treatment is worth the money spent. Thus, the objective of this study was to perform a cost-effectiveness analysis of adding IVIG to the standard treatment of platelet transfusion and corticosteroids, for the treatment of childhood ITP with life-threatening bleeding in the context of Thailand. Methods: A cost-effectiveness analysis using a hybrid model consisting of a decision tree and Markov models was conducted with a societal perspective. The effectiveness and utility parameters were determined by systematic reviews, while costs and mortality parameters were determined using a retrospective electronic hospital database analysis. All costs were presented in 2012 US$. The discount rate of 3$3,172 per quality-adjusted life-year gained ($/QALY) for the addition of IVIG versus standard treatment alone. The probability of response to corticosteroids was the most influential parameter on ICER. According to the willingness-to-pay of Thailand, of approximately$3,861/QALY, the probability of IVIG being cost effective was 33 %. Conclusions: The addition of IVIG to standard treatment in the treatment of childhood ITP with life-threatening bleeding is possibly a cost-effective intervention in Thailand. However, our findings were highly sensitive. Policy makers may consider our findings as part of the information for their decision making

Treatment patterns and healthcare resource utilization in palmoplantar pustulosis patients in Japan: A claims database study.

BACKGROUND:Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory autoimmune condition, characterized by sterile pustules on the palms and soles. The treatment patterns of PPP and total health care resource utilization in Japan are not well described. Investigating these areas is needed to understand current PPP management in Japan. OBJECTIVE:To describe the characteristics, medication treatment and health care resource utilization patterns, and associated costs of PPP patients in Japan. METHODS:A retrospective analysis of insurance claims data was conducted using the Japan Medical Data Center database. Adult Patients with at least two claims with a PPP diagnosis from January 1, 2011 to March 30, 2017 and six months of follow-up after the first diagnosis were included. Patient characteristics described include age, gender, and comorbid conditions. Treatment patterns assessed include the types of treatment, sequence of treatment, and rates of discontinuation, switching, persistence and use of concomitant medications. RESULTS:A total of 5,162 adult patients met all inclusion criteria. Mean (SD) patient age was 49.7 (11.6) years and 43.2% were male. A total of 2441 patients (47.8%) received systemic non-biologic drugs during the entire follow up period, 2,366 (46.4%) were prescribed topical therapy, 273 (5.4%) were prescribed phototherapy, while 18 (0.4%) of patients with other autoimmune comorbidities were eligible for prescribed biologics. For treatment-naïve patients with mild PPP, topical therapy was most commonly (77.1%) prescribed, whereas in moderate to severe cases of PPP, systemic non-biologic drugs (65%) were most often used. The frequency of switching was similar (64.3% to 75.3%) across various therapies and treatment lines. CONCLUSION:This study describes the treatment patterns and health care resource utilization for Japanese PPP patients using a large claims database, and highlights an unmet need to derive better treatment strategies for PPP and address disease burden in Japan

Cultural beliefs, utility values, and health technology assessment

Abstract Background Health-care utilities differ considerably from country to country. Our objective was to examine the association of cultural values based on Hofstede’s cultural dimensions’ theory with utility values that were identified using the time trade off method. Methods We performed a literature search to determine preference-based value algorithms in the general population of a given country. We then fitted a second-order quadratic function to assess the utility function curve that links health status with health-care utilities. We ranked the countries according to the concavity and convexity properties of their utility functions and compared this ranking with that of the Hofstede index to check if there were any similarities. Results We identified 10 countries with an EQ-5D-5L-based value set and 7 countries with an EQ-5D-3L-based value set. Japan’s degree of concavity was highest, while Germany’s was lowest, based on the EQ-5D-3L and EQ-5D-5L value sets. Japan also ranked first in the Hofstede long-term orientation index, and rankings related to the degree of concavity, indicating a low time preference rate. Conclusions This is the first evaluation to identify and report an association between different cultural beliefs and utility values. These findings underline the necessity to take local values into consideration when designing health technology assessment systems

Quality of reporting of randomised controlled trials of herbal interventions in ASEAN plus six countries: a systematic review

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Additional file 1: of The underrated prevalence of depression in Japanese patients with rheumatoid arthritis - evidence from a Nationwide survey in Japan

Reviewer reports and AU response to reviewers. (DOCX 18 kb