Estimation of the value of convenience in taking influenza antivirals in Japanese adult patients between baloxavir marboxil and neuraminidase inhibitors using a conjoint analysis

Aims: Estimating the monetary value of the convenience of using influenza antivirals approved in Japan from a patient perspective using a conjoint analysis. Methods: An online survey (August 2020) was performed on individuals aged 20–64 years living in Japan who had taken oral or inhalant antivirals for influenza treatment in the 2018/19 or 2019/20 seasons. Efficacy and safety were assumed to be equivalent among the antivirals. The attributes for the conjoint analysis included route (oral or inhalant), duration, frequency of administration, and out-ofpocket expenses. A conditional logit model was applied as a baseline model. The monetary value of each attribute was calculated by comparing the same utility of the linearly interpolated level of the out-of-pocket attribute. Another survey to determine the experiences of the latest antiviral intake was also conducted on the same respondents. Results: Of the respondents, 1,550 were men and 1,587 were women. The monetary value for oral antivirals was estimated to be higher, saving JPY 741 (USD 7.06, as of August 2020), compared with inhalant. Regarding the length and frequency of administration, five days corresponds to an increase of JPY 2,072, compared with one day, and twice a day corresponds to a JPY 574 increase compared to once a day. Conclusions: The results suggest that – among the antivirals approved in Japan – the monetary value of the utility is the highest in the single dose oral antiviral, baloxavir marboxil (baloxavir). Although the drug cost was highest in baloxavir among the brand antivirals, the difference in the value of utility for influenza patient was estimated to be larger than the difference in the drug costs. Limitations: Although individuals with diverse attributes from all over the country were included in the survey, they are not necessarily a representative population of the Japanese society

Should the provision of home help services be contained?: Validation of the new preventive care policy in Japan

<p>Abstract</p> <p>Background</p> <p>To maintain the sustainability of public long-term care insurance (LTCI) in Japan, a preventive care policy was introduced in 2006 that seeks to promote active improvement in functional status of elderly people who need only light care. This policy promotes the use of day care services to facilitate functional improvement, and contains the use of home help services that provide instrumental activity of daily living (IADL) support. However, the validity of this approach remains to be demonstrated.</p> <p>Methods</p> <p>Subjects comprised 241 people aged 65 years and over who had recently been certified as being eligible for the lightest eligibility level and had began using either home help or day care services between April 2007 and October 2008 in a suburban city of Tokyo. A retrospective cohort study was conducted ending October 2009 to assess changes in the LTCI eligibility level of these subjects. Cox's proportional hazards model was used to calculate the relative risk of declining in function to eligibility Level 4 among users of the respective services.</p> <p>Results</p> <p>Multivariate analysis adjusted for factors related to service use demonstrated that the risk of decline in functional status was lower for users of home help services than for users of day care services (HR = 0.55, 95% CI: 0.31-0.98). The same result was obtained when stratified by whether the subject lived with family or not. Furthermore, those who used two or more hours of home help services did not show an increase in risk of decline when compared with those who used less than two hours.</p> <p>Conclusions</p> <p>No evidence was obtained to support the effectiveness of the policy of promoting day care services and containing home help services for those requiring light care.</p

Radiation Exposure from CT Examinations in Japan

<p>Abstract</p> <p>Background</p> <p>Computed tomography (CT) is the largest source of medical radiation exposure to the general population, and is considered a potential source of increased cancer risk. The aim of this study was to assess the current situation of CT use in Japan, and to investigate variations in radiation exposure in CT studies among institutions and scanners.</p> <p>Methods</p> <p>Data-sheets were sent to all 126 hospitals and randomly selected 14 (15%) of 94 clinics in Gunma prefecture which had CT scanner(s). Data for patients undergoing CT during a single month (June 2008) were obtained, along with CT scan protocols for each institution surveyed. Age and sex specific patterns of CT examination, the variation in radiation exposure from CT examinations, and factors which were responsible for the variation in radiation exposure were determined.</p> <p>Results</p> <p>An estimated 235.4 patients per 1,000 population undergo CT examinations each year, and 50% of the patients were scanned in two or more anatomical locations in one CT session. There was a large variation in effective dose among hospitals surveyed, particularly in lower abdominal CT (range, 2.6-19.0 mSv). CT examinations of the chest and upper abdomen contributed to approximately 73.2% of the collective dose from all CT examinations. It was estimated that in Japan, approximately 29.9 million patients undergo CT annually, and the estimated annual collective effective dose in Japan was 277.4 *10³Sv person. The annual effective dose per capita for Japan was estimated to be 2.20 mSv.</p> <p>Conclusions</p> <p>There was a very large variation in radiation exposure from CT among institutions surveyed. CT examinations of the chest and upper abdomen were the predominant contributors to the collective dose.</p

The current shortage and future surplus of doctors: a projection of the future growth of the Japanese medical workforce

<p>Abstract</p> <p>Background</p> <p>Starting in the late 1980s, the Japanese government decreased the number of students accepted into medical school each year in order to reduce healthcare spending. The result of this policy is a serious shortage of doctors in Japan today, which has become a social problem in recent years. In an attempt to solve this problem, the Japanese government decided in 2007 to increase the medical student quota from 7625 to 8848. Furthermore, the Democratic Party of Japan (DPJ), Japan's ruling party after the 2009 election, promised in their manifesto to increase the medical student quota to 1.5 times what it was in 2007, in order to raise the number of medical doctors to more than 3.0 per 1000 persons. It should be noted, however, that this rapid increase in the medical student quota may bring about a serious doctor surplus in the future, especially because the population of Japan is decreasing.</p> <p>The purpose of this research is to project the future growth of the Japanese medical doctor workforce from 2008 to 2050 and to forecast whether the proposed additional increase in the student quota will cause a doctor surplus.</p> <p>Methods</p> <p>Simulation modeling of the Japanese medical workforce.</p> <p>Results</p> <p>Even if the additional increase in the medical student quota promised by the DPJ fails, the number of practitioners is projected to increase from 286 699 (2.25 per 1000 persons) in 2008 to 365 533 (over the national numerical goal of 3.0 per 1000) in 2024. The number of practitioners per 1000 persons is projected to further increase to 3.10 in 2025, to 3.71 in 2035, and to 4.69 in 2050. If the additional increase in the medical student quota promised by the DPJ is realized, the total workforce is projected to rise to 392 331 (3.29 per 1000 persons) in 2025, 464 296 (4.20 per 1,000 persons) in 2035, and 545 230 (5.73 per 1000 persons) in 2050.</p> <p>Conclusions</p> <p>The plan to increase the medical student quota will bring about a serious doctor surplus in the long run.</p

Treatment-related damage in elderly-onset ANCA-associated vasculitis: safety outcome analysis of two nationwide prospective cohort studies

Background It is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV). Methods Elderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL  Results Of the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00–1.35) was a predictor for diabetes. Conclusion A reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients

The Impact of Multiple Roles on Psychological Distress among Japanese Workers

Abstract Background There has been considerable interest in Japanese society in the problem of work-related stress leading to depressive symptoms, and an increasing number of primary houseworkers maintain paid employment. The purpose of this study was to examine the differential impact of multiple roles associated with psychological distress among Japanese workers. Methods We studied 722 men and women aged 18-83 years in a cross-sectional study. The K10 questionnaire was used to examine psychological distress. Results The proportion of participants with psychological distress was higher in women (17.8%) compared with men (11.5%). Having three roles significantly decreased the risk of psychological distress [women: odds ratio (OR), 0.37-fold; men: OR, 0.41] compared with only one role. In working married women, there was significantly less psychological distress (OR, 0.27), and those with childrearing or caregiving responsibilities for elderly parents had significantly less psychological distress (OR, 0.38) than those with only an employment role. Similarly, working married men who had childrearing or caregiving responsibilities for elderly parents had significantly less psychological distress (OR, 0.41) than those who had only an employment role. Conclusion The present study demonstrated that participants who had only an employment role had an increased risk of psychological distress. The degree of psychological distress was not determined solely by the number of roles. It is important to have balance between work and family life to reduce role conflict and/or role submersion, which in turn may reduce the risk of psychological distress

Industrial associations as ideational platforms : why Japan resisted American-style shareholder capitalism

Significant wage and treatment differentials between regular workers in long-term employment and precarious non-regular workers have been a major political issue in Japan since the mid-1990s. I argue this phenomenon was caused by Japanese society’s resistance to American neoliberal hegemony. Why has Japan resisted it, and how has the resistance resulted in the rapid increase in the working poor? I contend anti-liberal, anti-free market norms of Japanese society centred on ‘systemic support’ have bolstered resistance to convergence in order to prevent capitalist dominance from severing long-term social ties, such as management-labour cooperation. My broadened definition of systemic support incorporates dominant elites’ support and protection of subordinates in exchange for their loyalty and obedience. This paper will explore reasons for the resistance to convergence by examining an ideational conflict within Japanese elites between the market liberalisation and anti-free market camps, particularly between two major industrial associations, Keidanren and Keizai Doyukai, which have played a key role as ‘ideational platforms’ for Japanese corporate society. Under the Hashimoto (1996-8) and Koizumi (2001-6) administrations, the market liberalisation camp gained influence, but since 2006, both the anti-free market camp and its subordinates (e.g. regular workers) have driven anti-neoliberal backlash