Koichi Kawabuchi

An analysis of the length of hospital stay for cataract patients in Japan using the discrete-type proportional hazard model

We analyze the length of hospital stays of patients hospitalized for cataract and related diseases (Diagnosis Related Groups (DRG) 2041) in Japan, utilizing the data pertaining to 3436 patients on whom one-eye lens operations are performed. We use the discrete-type proportional hazard model to analyze variables that may affect the length of stay. We find that estimates of the Child and Other Facility Dummies are negative and significant. These variables affect the leaving rate and the length of stay. The length of stay also changes at age 40. With regard to the types of affiliated operations and treatments, the estimates of dummy variables are negative and significant at the 1% level. We also find large differences in the length of stay among hospitals, despite eliminating the influence of both the characteristics of the patient and the types of affiliated operations and treatments. The longest average length of stay is over 3.5 times as long as the shortest average length of stay. Finally, we analyze the factors pertaining to hospitals that may affect the length of stay. The estimates of the Profit and Cold Region dummies are negative and significant; in other words, the leaving rate is reduced and the length of stay is increased if the hospital becomes more profitable and is located in the cold regions of Hokkaido and Tohoku.

Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood

Background: The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood. Methods: We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters. Results: The ICER for EQ-5D, HUI3 and SF-6D were

Evaluation of the DPC-based inclusive payment system in Japan for cataract operations by a new model

21 716/QALY,

Pharmacoeconomic analysis of consolidation therapy with pemetrexed after first-line chemotherapy for non-small cell lung cancer

11 773/QALY, and

Evaluation of the antiobesity effects of an amino acid mixture and conjugated linoleic acid on exercising healthy overweight humans: a randomized, double-blind, placebo-controlled trial.

20 150/QALY, respectively. One-way sensitivity analyses found that the results were sensitive to discount rate, the risk of hearing loss after proton therapy, and costs of proton irradiation. Cost-effectiveness acceptability curve analysis revealed a 99% probability of proton therapy being cost effective at a societal willingness-to-pay value. Conclusions: Proton beam therapy with cochlear dose reduction improves health outcomes at a cost that is within the acceptable cost-effectiveness range from the payers standpoint.

An analysis of hip fracture treatments in Japan by the discrete-type proportional hazard and ordered probit models

Since medical care expenses have been increasing rapidly with the ageing of the population, reducing the length of hospital stay (LOS) has become an important political issue in Japan. A new inclusive payment system based on the diagnosis procedure combination (DPC) was introduced in 82 special functioning hospitals in April 2003. Since April 2004, use of the DPC system has been gradually extended to general hospitals. As of July 2009, a total of 1,283 hospitals, about 14% of the 8,862 general hospitals in Japan, had joined the DPC system. These 1,283 hospitals have 434,231 beds, which is nearly half of the total beds (913,234 beds) of general hospitals in Japan. The DPC system is an original system developed in Japan. Inclusive payments based on the DPC system cover fees for the following categories only: basic hospital stays, medical checkups, image diagnosis, medication, injections, treatments under 1,000 points (10 yen per point has been paid to hospitals), and medicines used during rehabilitation treatments and related activities. Fees for all other categories, such as fees for operations, are paid on the basis of the conventional fee-for- service system. Unlike the diagnosis-related group/prospective payment system (DRG/PPS) used in the U.S. and other countries, the Japanese DPC system is a per diem prospective payment system. The per diem payment becomes less as the LOS becomes longer. Three periods, Period I, Period II, and Specific Hospitalization Period, are determined for each DPC code. For stays over the Specific Hospitalization Period, the per diem payment is determined through the conventional fee-for-service system. The introduction of the DPC system was one of the largest and most important revisions of the payment system since the Second World War. For the effective use of medical resources, improvement of the DPC system by thorough analyses of the system is absolutely necessary. In this paper, we first propose a new model that considers heterogeneity of variances. We then present our analysis of the LOS for cataract operations before and after the introduction of the DPC system using the proposed model. The number of cataract patients in Japan has been increasing rapidly with the ageing of the population. According to a survey conducted by the Ministry of Health, Labour and Welfare (2008), nearly 800,000 cataract operations are performed annually and nearly 2.5 billion yen are spent for cataract operations annually. We analyzed the influence of the DPC system and factors that might affect the LOS for cataract patients by examining data collected from 5 general hospitals before and after the introduction of the system. To eliminate the influences of types of operations and treatments, we used data strictly pertaining to the patients who underwent cataract operations and insertion of a prosthetic lens on one eye only. The number of patients was 2,533. The estimates of the Female, Age 50, Age 90, Not_Home dummies are significant and affect the LOS. We found large differences in the changes of average lengths of stay (ALOSs) among hospitals. In hospitals where the ALOSs were long, the ALOSs decreased significantly under the DPC system. On the other hand, in hospitals where the ALOSs were already short, the ALOSs did not decrease under the DPC system. The results of empirical study imply that the DPC system gave strong incentives to reduce the ALOSs for the former hospitals but it gave weak (or no) incentives for the latter hospitals, where the ALOSs were already short.

New Casemix Classification as an Alternative Method for Budget Allocation in Thai Oral Healthcare Service: A Pilot Study

Prolongation of progression-free survival and overall survival have been reported with consolidation therapy after first-line chemotherapy in non-small cell lung cancer, but only a few pharmacoeconomic analyses have been performed. We performed a pharmacoeconomic analysis to assess the cost-effectiveness of consolidation therapy with pemetrexed compared with non-consolidation therapy. We developed a Markov model to evaluate the incremental cost-effectiveness ratio (ICER) of consolidation therapy with pemetrexed compared with non-consolidation therapy based on previous reports. We analyzed all histology groups together, and individually analyzed non-squamous cell carcinoma, in which pemetrexed has been shown to be more effective, and squamous cell carcinoma, in which pemetrexed has been shown to be less effective. We conducted a Monte-Carlo simulation to assess the uncertainty for our analysis model and the willingness to pay using thresholds. The ICER for consolidation therapy with pemetrexed was about US

Inequality and Mother’s Age as Determinants of Breastfeeding Continuation in Bangladesh

109,024/life years gained (LYG) (JPY 12.5 million/LYG) and US

An analysis of the length of stay and effectiveness of treatment for hip fracture patients in Japan: Evaluation of the 2002 revision of the medical service fee schedule

203,022/quality-adjusted life years (QALY) (JPY 23.3 million/QALY) for all histology. For non-squamous cell carcinoma, respective values were US

Evaluation of the introduction of a diagnosis procedure combination system for patient outcome and hospitalisation charges for patients with hip fracture or lung cancer in Japan

80,563/LYG (JPY 9.3 million/LYG) and US