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Dr. Tomoyuki Takura
Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan

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0 Cancer Immunotherapy
0 Cardiac Rehabilitation
0 Healthcare Technology
0 Pain therapy
0 revascularization

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Total Hip Arthroplasty

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Journal article
Published: 29 May 2021 in International Journal of Environmental Research and Public Health
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This study proposes a method for calculating the appropriate medical treatment price level for foreign visitors (FVs) in Japan. Hospital management costs and foreign prices were analyzed from a market principles perspective to determine the medical treatment price. The study involved two stages: a preliminary survey and an extended survey, supplemented by an international survey. Relatively frequent diseases were selected, and the costs incurred by hospitals for the treatment of FVs were analyzed though data from three hospitals, covering 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists with pharyngitis were analyzed. This study shows that the appropriate medical treatment prices for FVs, considering profits, were 1.22–4.26 times higher compared with prices under Japan’s public health insurance plans. Furthermore, these prices were 1.31–4.26 times higher for outpatients with pharyngitis and external injury and 1.22–3.66 times higher for inpatients with appendicitis and femoral fractures. The price of pharyngitis treatment in 12 countries was USD 20.32–158.75 per patient for Japanese tourists, whereas FVs paid 60.24 dollars (1.13 times higher than Japan’s public healthcare price) in Japan. This study shows it was appropriate to set the ideal price level for FVs higher than that for Japanese patients.

ACS Style

Tomoyuki Takura; Study Group: Research on Appropriate Medical Treatment Prices for Foreigners Visiting Japan. Preliminary Examination of an Appropriate Price Calculation Method and Medical Treatment Costs for Foreign Visitors in Japan. International Journal of Environmental Research and Public Health 2021, 18, 5837 .

AMA Style

Tomoyuki Takura, Study Group: Research on Appropriate Medical Treatment Prices for Foreigners Visiting Japan. Preliminary Examination of an Appropriate Price Calculation Method and Medical Treatment Costs for Foreign Visitors in Japan. International Journal of Environmental Research and Public Health. 2021; 18 (11):5837.

Chicago/Turabian Style

Tomoyuki Takura; Study Group: Research on Appropriate Medical Treatment Prices for Foreigners Visiting Japan. 2021. "Preliminary Examination of an Appropriate Price Calculation Method and Medical Treatment Costs for Foreign Visitors in Japan." International Journal of Environmental Research and Public Health 18, no. 11: 5837.

Original article
Published: 18 January 2021 in Journal of Nuclear Cardiology
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Background The procedural numbers and medical costs of percutaneous coronary intervention (PCI), mainly elective PCI, have been increasing in Japan. Owing to increased interest in the appropriateness of coronary revascularization, we conducted this medical economics-based evaluation of testing and diagnosis of stable coronary artery disease (CAD). Methods and Results We reviewed patients’ medical insurance data to identify stable CAD patients who underwent coronary computed tomography angiography, cardiac single-photon emission computed tomography, coronary angiography, or fractional flow reserve. Subjects were divided into anatomical and functional evaluation groups according to the modality of testing, and background factors were matched by propensity score. The endpoints were major adverse cardiovascular events (MACE), life years (LYs), medical costs, and cost-effectiveness analysis (CEA). The observations were performed for 36 months. MACE, medical costs, and CEA of the functional group in the overall category were trending to be better than the anatomical group (MACE, P = .051; medical costs: 3,105 US$ vs 4,430 US$, P = .007; CEA: 2,431 US$/LY vs 2,902 US$/LY, P = .043). Conclusions The functional evaluation approach improved long-term clinical outcomes and reduced cumulative medical costs. As a result, the modality composition of functional myocardial ischemia evaluation was demonstrated to offer superior cost-effectiveness in stable CAD.

ACS Style

Tomoyuki Takura; J-CONCIOUS Investigators; Hiroyoshi Yokoi; Nobuhiro Tanaka; Naoya Matsumoto; Eri Yoshida; Tomoaki Nakata. Health economics-based verification of functional myocardial ischemia evaluation of stable coronary artery disease in Japan: A long-term longitudinal study using propensity score matching. Journal of Nuclear Cardiology 2021, 1 -14.

AMA Style

Tomoyuki Takura, J-CONCIOUS Investigators, Hiroyoshi Yokoi, Nobuhiro Tanaka, Naoya Matsumoto, Eri Yoshida, Tomoaki Nakata. Health economics-based verification of functional myocardial ischemia evaluation of stable coronary artery disease in Japan: A long-term longitudinal study using propensity score matching. Journal of Nuclear Cardiology. 2021; ():1-14.

Chicago/Turabian Style

Tomoyuki Takura; J-CONCIOUS Investigators; Hiroyoshi Yokoi; Nobuhiro Tanaka; Naoya Matsumoto; Eri Yoshida; Tomoaki Nakata. 2021. "Health economics-based verification of functional myocardial ischemia evaluation of stable coronary artery disease in Japan: A long-term longitudinal study using propensity score matching." Journal of Nuclear Cardiology , no. : 1-14.

Journal article
Published: 08 January 2021 in BMC Medicine
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Background Medical costs and the burden associated with cardiovascular disease are on the rise. Therefore, to improve the overall economy and quality assessment of the healthcare system, we developed a predictive model of integrated healthcare resource consumption (Adherence Score for Healthcare Resource Outcome, ASHRO) that incorporates patient health behaviours, and examined its association with clinical outcomes. Methods This study used information from a large-scale database on health insurance claims, long-term care insurance, and health check-ups. Participants comprised patients who received inpatient medical care for diseases of the circulatory system (ICD-10 codes I00-I99). The predictive model used broadly defined composite adherence as the explanatory variable and medical and long-term care costs as the objective variable. Predictive models used random forest learning (AI: artificial intelligence) to adjust for predictors, and multiple regression analysis to construct ASHRO scores. The ability of discrimination and calibration of the prediction model were evaluated using the area under the curve and the Hosmer-Lemeshow test. We compared the overall mortality of the two ASHRO 50% cut-off groups adjusted for clinical risk factors by propensity score matching over a 48-month follow-up period. Results Overall, 48,456 patients were discharged from the hospital with cardiovascular disease (mean age, 68.3 ± 9.9 years; male, 61.9%). The broad adherence score classification, adjusted as an index of the predictive model by machine learning, was an index of eight: secondary prevention, rehabilitation intensity, guidance, proportion of days covered, overlapping outpatient visits/clinical laboratory and physiological tests, medical attendance, and generic drug rate. Multiple regression analysis showed an overall coefficient of determination of 0.313 (p < 0.001). Logistic regression analysis with cut-off values of 50% and 25%/75% for medical and long-term care costs showed that the overall coefficient of determination was statistically significant (p < 0.001). The score of ASHRO was associated with the incidence of all deaths between the two 50% cut-off groups (2% vs. 7%; p < 0.001). Conclusions ASHRO accurately predicted future integrated healthcare resource consumption and was associated with clinical outcomes. It can be a valuable tool for evaluating the economic usefulness of individual adherence behaviours and optimising clinical outcomes.

ACS Style

Tomoyuki Takura; Keiko Hirano Goto; Asao Honda. Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases. BMC Medicine 2021, 19, 1 -16.

AMA Style

Tomoyuki Takura, Keiko Hirano Goto, Asao Honda. Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases. BMC Medicine. 2021; 19 (1):1-16.

Chicago/Turabian Style

Tomoyuki Takura; Keiko Hirano Goto; Asao Honda. 2021. "Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases." BMC Medicine 19, no. 1: 1-16.

Review
Published: 10 September 2019 in Circulation Reports
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Because electronic medical record systems may affect productivity of clinical practice, we examined the effects of different types of medical record systems on consultation time and total fee claims for outpatient consultation for cardiovascular cases. We investigated consultation time (i.e., the sum of practice time and work-up time) and total fee claims by 13 cardiovascular physicians for 862 outpatients. The means of consultation time and total fee claims were calculated for 3 types of medical records: electronic, paper-based, and hybrid. No difference in mean consultation time was seen between the electronic and paper-based medical record groups (paper based, 11.4±0.3 min/case; electronic, 12.7±0.8 min/case; hybrid, 13.5±0.5 min/case). In contrast, the electronic group had the highest mean practice time (10.9±0.6 min/case) and the lowest mean work-up time (1.7±0.4 min/case). There was no difference in total fee claims between the 3 medical record groups. The total fee claims per practice time was lower for the electronic group than the paper-based (67.5±52.8 vs. 108.8±108.1 points/min, P<0.001). The findings suggest that physicians using the electronic medical record system can be more directly involved with patients due to higher productivity, as reflected in the lower work-up time.

ACS Style

Tomoyuki Takura; Haruki Itoh. Health Economics ― Effect of Electronic Medical Record Systems on Cardiovascular Disease Outpatient Consultation Time ―. Circulation Reports 2019, 1, 355 -360.

AMA Style

Tomoyuki Takura, Haruki Itoh. Health Economics ― Effect of Electronic Medical Record Systems on Cardiovascular Disease Outpatient Consultation Time ―. Circulation Reports. 2019; 1 (9):355-360.

Chicago/Turabian Style

Tomoyuki Takura; Haruki Itoh. 2019. "Health Economics ― Effect of Electronic Medical Record Systems on Cardiovascular Disease Outpatient Consultation Time ―." Circulation Reports 1, no. 9: 355-360.

Original research
Published: 01 September 2019 in ClinicoEconomics and Outcomes Research
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Background: In Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the “PD first” concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated. Methods: This multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases. Results: The mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12–24 months (4,367 vs. 4,852; p<0.05). The CUA reported significantly better results in the glomerulonephritis group than in the other diseases, and the baseline CUA was significantly age sensitive. The utility score was higher in the APD group (mean age, 70.1±3.5 years) than in the CAPD group (mean age, 70.6±4.2 years; 0.987 vs. 0.860; p<0.05, 9 patients). Compared with CAPD, APD had an overall ICUR of USD 126,034/QALY. Conclusion: The cost-effectiveness of PD was potentially good in the elderly and in patients on dialysis for <24 months. Therefore, the prevalence of PD may influence the public health insurance system, particularly when applying the “PD first” concept.

ACS Style

Tomoyuki Takura; Makoto Hiramatsu; Hidetomo Nakamoto; Takahiro Kuragano; Jun Minakuchi; Hironori Ishida; Masaaki Nakayama; Susumu Takahashi; Hideki Kawanishi. Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study. ClinicoEconomics and Outcomes Research 2019, ume 11, 579 -590.

AMA Style

Tomoyuki Takura, Makoto Hiramatsu, Hidetomo Nakamoto, Takahiro Kuragano, Jun Minakuchi, Hironori Ishida, Masaaki Nakayama, Susumu Takahashi, Hideki Kawanishi. Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study. ClinicoEconomics and Outcomes Research. 2019; ume 11 ():579-590.

Chicago/Turabian Style

Tomoyuki Takura; Makoto Hiramatsu; Hidetomo Nakamoto; Takahiro Kuragano; Jun Minakuchi; Hironori Ishida; Masaaki Nakayama; Susumu Takahashi; Hideki Kawanishi. 2019. "Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study." ClinicoEconomics and Outcomes Research ume 11, no. : 579-590.

Journal article
Published: 09 August 2019 in Circulation Reports
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Background: Circulatory diseases now comprise a larger share of medical expenses, accounting for 19.7% (2016) of total national health expenditure. Medical economics is an area of study encompassing medical science and economics that deals with a wide variety of topics and issues related to the medical and health-care field.

ACS Style

Tomoyuki Takura. Current Trends in Medical Economics in the Circulatory Field ― Socioeconomics Background and Research Issue ―. Circulation Reports 2019, 1, 342 -346.

AMA Style

Tomoyuki Takura. Current Trends in Medical Economics in the Circulatory Field ― Socioeconomics Background and Research Issue ―. Circulation Reports. 2019; 1 (8):342-346.

Chicago/Turabian Style

Tomoyuki Takura. 2019. "Current Trends in Medical Economics in the Circulatory Field ― Socioeconomics Background and Research Issue ―." Circulation Reports 1, no. 8: 342-346.

Review
Published: 04 June 2019 in Cardiology Research and Practice
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Background. Medical costs associated with cardiovascular disease are increasing considerably worldwide; therefore, an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. There have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome.Methods. The target population in this meta-analysis included convalescent and comprehensive CR patients with coronary artery disease (CAD), the status most commonly observed postmyocardial infarction (MI). Here, we evaluated medical costs, quality-adjusted life year (QALY), cost-effectiveness, mortality, and life year (LY). Regarding cost-effectiveness analysis, we analyzed medical costs per QALY, medical costs per LY, and the incremental cost-utility ratio (ICUR). We then examined the differences in effects for the 2 treatment arms (CR vs. usual care (UC)) using the risk ratio (RR) and standardized mean difference (SMD).Results. We reviewed 59 studies and identified 5 studies that matched our selection criteria. In total, 122,485 patients were included in the analysis. Meta-analysis results revealed that the CR arm significantly improved QALY (SMD: −1.78; 95% confidence interval (CI): −2.69, −0.87) compared with UC. Although medical costs tended to be higher in the CR arm compared to the UC arm (SMD: 0.02; 95% CI: −0.08, 0.13), cost/QALY was significantly improved in the CR arm compared with the UC arm (SMD: −0.31; 95% CI: −0.53, −0.09). The ICURs for the studies (4 RCTs and 1 model analysis) were as follows: −48,327.6 USD/QALY; −5,193.8 USD/QALY (dominant, CR is cheaper and more effective than UC); and 4,048.0 USD/QALY, 17,209.4 USD/QALY, and 26,888.7 USD/QALY (Conclusions. While there are some limitations, primarily regarding data sources, our results suggest that CR is potentially cost-effective.

ACS Style

Tomoyuki Takura; Nozomi Ebata-Kogure; Yoichi Goto; Masahiro Kohzuki; Masatoshi Nagayama; Keiko Oikawa; Teruyuki Koyama; Haruki Itoh. Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis. Cardiology Research and Practice 2019, 2019, 1 -11.

AMA Style

Tomoyuki Takura, Nozomi Ebata-Kogure, Yoichi Goto, Masahiro Kohzuki, Masatoshi Nagayama, Keiko Oikawa, Teruyuki Koyama, Haruki Itoh. Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis. Cardiology Research and Practice. 2019; 2019 ():1-11.

Chicago/Turabian Style

Tomoyuki Takura; Nozomi Ebata-Kogure; Yoichi Goto; Masahiro Kohzuki; Masatoshi Nagayama; Keiko Oikawa; Teruyuki Koyama; Haruki Itoh. 2019. "Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis." Cardiology Research and Practice 2019, no. : 1-11.

Book chapter
Published: 07 May 2018 in Molecular Pathology and Genetics of Alport Syndrome
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Nephrotic syndrome is a type of intractable disease caused by a disorder in the kidneys, which produces swelling. Although some patients show rapid improvement and recover completely with conventional treatment, many others experience frequent recurrence (frequently relapsing nephrotic syndrome) while some remain dependent on the same high dose of steroids they were initially prescribed at the start of treatment (steroid-dependent nephrotic syndrome). In the latter cases, side effects of prolonged steroid use are a major issue. Some reports show that administering rituximab is effective in treating patients with steroid resistance. However, drugs like rituximab, directed at specific molecular targets, are generally expensive and therefore need to be evaluated from a health economics perspective before being approved for widespread use. The research team compared the number of relapses and total medical costs in the 24-month period before and the same period after patients took rituximab. We found that relapse decreased from a mean of 4.30 (±2.76) times to 0.27 (±0.52) times, and the total medical costs shrank from USD 2,923 to 1,280 per month (mainly the result of lower inpatient costs). The study also identified a correlation between lower urinary protein levels and a reduction in total medical costs. Rituximab, therefore, proved beneficial in both clinical and cost-effective terms. While rising healthcare costs are becoming a major social problem, we should expect that the development of new drugs with high cost performance will be encouraged from the vantage of socioeconomics.

ACS Style

Tomoyuki Takura; Takashi Takei; Kosaku Nitta. Socioeconomics of Administering Rituximab for Nephrotic Syndrome. Molecular Pathology and Genetics of Alport Syndrome 2018, 195, 110 -119.

AMA Style

Tomoyuki Takura, Takashi Takei, Kosaku Nitta. Socioeconomics of Administering Rituximab for Nephrotic Syndrome. Molecular Pathology and Genetics of Alport Syndrome. 2018; 195 ():110-119.

Chicago/Turabian Style

Tomoyuki Takura; Takashi Takei; Kosaku Nitta. 2018. "Socioeconomics of Administering Rituximab for Nephrotic Syndrome." Molecular Pathology and Genetics of Alport Syndrome 195, no. : 110-119.

Review
Published: 01 May 2018 in Internal Medicine
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In order to maintain and develop a universal health insurance system, it is crucial to utilize limited medical resources effectively. In this context, considerations are underway to introduce health technology assessments (HTAs), such as cost-effectiveness analyses (CEAs), into the medical treatment fee system. CEAs, which is the general term for these methods, are classified into four categories, such as cost-effectiveness analyses based on performance indicators, and in the comparison of health technologies, the incremental cost-effectiveness ratio (ICER) is also applied. When I comprehensively consider several Japanese studies based on these concepts, I find that, in the results of the analysis of the economic performance of healthcare systems, Japan shows the most promising trend in the world. In addition, there is research indicating the superior cost-effectiveness of Rituximab against refractory nephrotic syndrome, and it is expected that health economics will be actively applied to the valuation of technical innovations such as drug discovery.

ACS Style

Tomoyuki Takura. An Evaluation of Clinical Economics and Cases of Cost-effectiveness. Internal Medicine 2018, 57, 1191 -1200.

AMA Style

Tomoyuki Takura. An Evaluation of Clinical Economics and Cases of Cost-effectiveness. Internal Medicine. 2018; 57 (9):1191-1200.

Chicago/Turabian Style

Tomoyuki Takura. 2018. "An Evaluation of Clinical Economics and Cases of Cost-effectiveness." Internal Medicine 57, no. 9: 1191-1200.

Journal article
Published: 01 August 2017 in Health Policy
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Economic evaluation is used for decision-making processes in healthcare technologies in many developed countries. In Japan, no health economic data have been requested for drugs, medical devices, and interventions till date. However, economic evaluation is gradually gaining importance, and a trial implementation of the cost-effectiveness evaluation of drugs and medical devices has begun. Discussions on economic evaluation began in May 2012 within a newly established sub-committee of the Chuikyo, referred to as the "Special Committee on Cost Effectiveness." After four years of discussions, this committee determined that during the trial implementation, the results of the cost-effectiveness evaluation would be used for the re-pricing of drugs and medical devices at the end of fiscal year (FY) 2017. Chuikyo selected 13 products (7 drugs and 6 medical devices) as targets for this evaluation. These products will be evaluated until the end of FY 2017 based on the following process: manufacturers will submit the data of economic evaluation; the National Institute of Public Health will coordinate the review process; academic groups will perform the actual review of the submitted data, and the expert committee will appraise these data. This represents the first step to introducing cost-effectiveness analysis in the Japanese healthcare system. We believe that these efforts will contribute to the efficiency and sustainability of the Japanese healthcare system.

ACS Style

Takeru Shiroiwa; Takashi Fukuda; Shunya Ikeda; Tomoyuki Takura. New decision-making processes for the pricing of health technologies in Japan: The FY 2016/2017 pilot phase for the introduction of economic evaluations. Health Policy 2017, 121, 836 -841.

AMA Style

Takeru Shiroiwa, Takashi Fukuda, Shunya Ikeda, Tomoyuki Takura. New decision-making processes for the pricing of health technologies in Japan: The FY 2016/2017 pilot phase for the introduction of economic evaluations. Health Policy. 2017; 121 (8):836-841.

Chicago/Turabian Style

Takeru Shiroiwa; Takashi Fukuda; Shunya Ikeda; Tomoyuki Takura. 2017. "New decision-making processes for the pricing of health technologies in Japan: The FY 2016/2017 pilot phase for the introduction of economic evaluations." Health Policy 121, no. 8: 836-841.

Clinical study
Published: 07 April 2017 in Scientific Reports
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With regard to the use of rituximab for patients with steroid-dependent nephrotic syndrome and frequently relapsing nephrotic syndrome, not only has the regimen not been clinically verified but also there is a lack of health economics evidence. Therefore, we conducted a prospective clinical study on 30 patients before (with steroids and immunosuppressants) and after introducing rituximab therapy. Relapse rates and total invoiced medical expenses were selected as the primary endpoints for treatment effectiveness and treatment costs, respectively. As secondary endpoints, cost-effectiveness was compared before and after administering rituximab in relation to previous pharmacotherapy. The observation period was 24 months before and after the initiation of rituximab. We showed that there was a statistically significant improvement in the relapse rate from a mean of 4.30 events before administration to a mean of 0.27 events after administration and that there was a significantly better prognosis in the cumulative avoidance of relapse rate by Kaplan–Meier analysis (p < 0.01). Finally, the total medical costs decreased from 2,923 USD to 1,280 USD per month, and the pre–post cost-effectiveness was confirmed as dominant. We, therefore, conclude that treatment with rituximab was possibly superior to previous pharmacological treatments from a health economics perspective.

ACS Style

Tomoyuki Takura; Takashi Takei; Kosaku Nitta. Cost-Effectiveness of Administering Rituximab for Steroid-Dependent Nephrotic Syndrome and Frequently Relapsing Nephrotic Syndrome: A Preliminary Study in Japan. Scientific Reports 2017, 7, 46036 .

AMA Style

Tomoyuki Takura, Takashi Takei, Kosaku Nitta. Cost-Effectiveness of Administering Rituximab for Steroid-Dependent Nephrotic Syndrome and Frequently Relapsing Nephrotic Syndrome: A Preliminary Study in Japan. Scientific Reports. 2017; 7 (1):46036.

Chicago/Turabian Style

Tomoyuki Takura; Takashi Takei; Kosaku Nitta. 2017. "Cost-Effectiveness of Administering Rituximab for Steroid-Dependent Nephrotic Syndrome and Frequently Relapsing Nephrotic Syndrome: A Preliminary Study in Japan." Scientific Reports 7, no. 1: 46036.

Special section
Published: 01 April 2017 in Clinical Spine Surgery: A Spine Publication
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Study Design: Single-center, single-arm, prospective time-series study. Objective: To assess the cost-effectiveness and improvement in quality of life (QOL) of percutaneous vertebroplasty (PVP). Summary of Background Data: PVP is known to relieve back pain and increase QOL for osteoporotic compression fractures. However, the economic value of PVP has never been evaluated in Japan where universal health care system is adopted. Methods: We prospectively followed up 163 patients with acute vertebral osteoporotic compression fractures, 44 males aged 76.4±6.0 years and 119 females aged 76.8±7.1 years, who underwent PVP. To measure health-related QOL and pain during 52 weeks observation, we used the European Quality of Life–5 Dimensions (EQ-5D), the Rolland-Morris Disability Questionnaire (RMD), the 8-item Short-Form health survey (SF-8), and visual analogue scale (VAS). Quality-adjusted life years (QALY) were calculated using the change of health utility of EQ-5D. The direct medical cost was calculated by accounting system of the hospital and Japanese health insurance system. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER): Δ medical cost/Δ QALY. Results: After PVP, improvement in EQ-5D, RMD, SF-8, and VAS scores were observed. The gain of QALY until 52 weeks was 0.162. The estimated lifetime gain of QALY reached 1.421. The direct medical cost for PVP was ¥286,740 (about 3061 US dollars). Cost-effectiveness analysis using ICER showed that lifetime medical cost for a gain of 1 QALY was ¥201,748 (about 2154 US dollars). Correlations between changes in EQ-5D scores and other parameters such as RMD, SF-8, and VAS were observed during most of the study period, which might support the reliability and applicability to measure health utilities by EQ-5D for osteoporotic compression fractures in Japan as well. Conclusions: PVP may improve QOL and ameliorate pain for acute osteoporotic compression fractures and be cost-effective in Japan.

ACS Style

Tomoyuki Takura; Misako Yoshimatsu; Hiroki Sugimori; Kenji Takizawa; Yoshiyuki Furumatsu; Hirotaka Ikeda; Hiroshi Kato; Yukihisa Ogawa; Shingo Hamaguchi; Atsuko Fujikawa; Toshihiko Satoh; Yasuo Nakajima. Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures. Clinical Spine Surgery: A Spine Publication 2017, 30, E205 -E210.

AMA Style

Tomoyuki Takura, Misako Yoshimatsu, Hiroki Sugimori, Kenji Takizawa, Yoshiyuki Furumatsu, Hirotaka Ikeda, Hiroshi Kato, Yukihisa Ogawa, Shingo Hamaguchi, Atsuko Fujikawa, Toshihiko Satoh, Yasuo Nakajima. Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures. Clinical Spine Surgery: A Spine Publication. 2017; 30 (3):E205-E210.

Chicago/Turabian Style

Tomoyuki Takura; Misako Yoshimatsu; Hiroki Sugimori; Kenji Takizawa; Yoshiyuki Furumatsu; Hirotaka Ikeda; Hiroshi Kato; Yukihisa Ogawa; Shingo Hamaguchi; Atsuko Fujikawa; Toshihiko Satoh; Yasuo Nakajima. 2017. "Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures." Clinical Spine Surgery: A Spine Publication 30, no. 3: E205-E210.

Journal article
Published: 01 March 2017 in Value in Health
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ObjectivesIn Japan, cost-effectiveness evaluation was implemented on a trial basis from fiscal year 2016. The results will be applied to the future repricing of drugs and medical devices. On the basis of a request from the Central Social Insurance Medical Council (Chuikyo), our research team drafted the official methodological guideline for trial implementation. Here, we report the process of developing and the contents of the official guideline for cost-effectiveness evaluation.MethodsThe guideline reflects discussions at the Chuikyo subcommittee (e.g., the role of quality-adjusted life-year) and incorporates our academic perspective. Team members generated research questions for each section of the guideline and discussions on these questions were carried out. A draft guideline was prepared and submitted to the Ministry of Health, Labour and Welfare (MHLW), and then to the subcommittee. The draft guideline was revised on the basis of the discussions at the subcommitte, if appropriate.ResultsAlthough the “public health care payer’s perspective” is standard in this guideline, other perspectives can be applied as necessary depending on the objective of analysis. On the basis of the discussions at the subcommittee, quality-adjusted life-year will be used as the basic outcome. A discount rate of 2% per annum for costs and outcomes is recommended. The final guideline was officially approved by the Chuikyo general assembly in February 2016.ConclusionsThis is the first officially approved guideline for the economic evaluation of drugs and medical devices in Japan. The guideline is expected to improve the quality and comparability of submitted cost-effectiveness data for decision making

ACS Style

Takeru Shiroiwa; Takashi Fukuda; Shunya Ikeda; Tomoyuki Takura; Kensuke Moriwaki. Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan. Value in Health 2017, 20, 372 -378.

AMA Style

Takeru Shiroiwa, Takashi Fukuda, Shunya Ikeda, Tomoyuki Takura, Kensuke Moriwaki. Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan. Value in Health. 2017; 20 (3):372-378.

Chicago/Turabian Style

Takeru Shiroiwa; Takashi Fukuda; Shunya Ikeda; Tomoyuki Takura; Kensuke Moriwaki. 2017. "Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan." Value in Health 20, no. 3: 372-378.

Journal article
Published: 26 May 2016 in Cardiovascular Intervention and Therapeutics
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Few socioeconomic studies have so far reported on revascularization for stable ischemic heart disease in Japan. This study aimed to validate the sensitivity of the health-related quality of life (HRQOL) scale for determining the pathology and medical technology to be used and to validate the application of a cost-utility analysis model. We studied 32 patients who had undergone percutaneous coronary intervention (PCI) (mean age 67.9 ± 7.3 years). For HRQOL, utility and quality of life (QOL) were examined using the EuroQol 5 Dimension (EQ-5D) and EuroQol Visual Analogue Scale (EQ-VAS), respectively. The changes in the utility index before and after PCI were compared between the PCI and coronary angiography (CAG) groups to determine the sensitivity of the EQ-5D that was used to calculate quality-adjusted life years (QALY). Additionally, to estimate the cost-utility of PCI 120 months after the procedure, we analyzed our study results and the results of previous reports using the Markov chain model. The utility index was found to improve in the PCI group (0.08 ± 0.15), whereas it decreased in the CAG group (−0.02 ± 0.11) (p = 0.049). The estimated result of the cost-utility analysis as the increase in utility above baseline level was the expected value, that is, 70,000 US$/QALY. Our findings suggest that QALY may be valid as a utility index in the clinical and economic evaluation of PCI in Japan.

ACS Style

Tomoyuki Takura; Kouichi Tachibana; Takaaki Isshiki; Satoru Sumitsuji; Tadashi Kuroda; Isamu Mizote; Seiko Ide; Shinsuke Nanto. Preliminary report on a cost-utility analysis of revascularization by percutaneous coronary intervention for ischemic heart disease. Cardiovascular Intervention and Therapeutics 2016, 32, 127 -136.

AMA Style

Tomoyuki Takura, Kouichi Tachibana, Takaaki Isshiki, Satoru Sumitsuji, Tadashi Kuroda, Isamu Mizote, Seiko Ide, Shinsuke Nanto. Preliminary report on a cost-utility analysis of revascularization by percutaneous coronary intervention for ischemic heart disease. Cardiovascular Intervention and Therapeutics. 2016; 32 (2):127-136.

Chicago/Turabian Style

Tomoyuki Takura; Kouichi Tachibana; Takaaki Isshiki; Satoru Sumitsuji; Tadashi Kuroda; Isamu Mizote; Seiko Ide; Shinsuke Nanto. 2016. "Preliminary report on a cost-utility analysis of revascularization by percutaneous coronary intervention for ischemic heart disease." Cardiovascular Intervention and Therapeutics 32, no. 2: 127-136.

Review
Published: 01 May 2016 in Journal of Orthopaedic Science
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BackgroundThe financial burden of medical insurance on the government of Japan has recently become severe, which has led to the control of outpatient orthopedic reimbursements for common procedures. On the other hand, the overall disease burden for total hip or knee arthroplasty, decompression for cervical myelopathy or lumbar spinal canal stenosis, and new surgical technologies to treat other painful conditions and the post-surgical care related to these procedures has been reduced.MethodsMedical insurance systems in Japan are generally influenced by budget-balancing action. Consequently, the further development of interventional evaluation methods should be promoted. From the viewpoint of health economics, the value (meaning) of medical intervention can partly be explained by its cost-effectiveness. In order for appropriate medical reimbursement levels to be set for orthopedic surgery, the financial status of medical institutions needs to be concurrently reviewed. In particular, the relationship between the expense structure and medical reimbursement must be discussed to evaluate its role in community medicine system.ResultsOver the past 10 years, medical expenditures have increased by 9.6% in all fields, whereas the monthly medical reimbursements per patient have dropped by an average of 17.5%. Remarkably, surgery-related costs have increased by 36.5%, while other medical costs have decreased by 19.8%. There are a few reports of cost-utility analyses which investigate interventions such as total hip arthroplasty for hip osteoarthritis patients (US$ 4,600–70,500/QALY) and laminectomy for patients with spinal canal stenosis. Interventions may be an inevitable part of relative expense control under the current trend; however, there has been a slight increase in other parameters in response to changes in medical reimbursement evaluations - specifically, in the total income of medical institutions.ConclusionsIf medical professionals such as orthopedic surgeons contribute to the economic value of orthopedic surgery, it is crucial to clearly establish interventions among the different performances of medical reimbursement to motivate the increased allocation of management resources. To further develop this concept, discussions between stakeholders should involve the value of medicine based on cost and benefit.

ACS Style

Tomoyuki Takura; Kenji Miki. The future of medical reimbursement for orthopedic surgery in Japan from the viewpoint of the health economy. Journal of Orthopaedic Science 2016, 21, 273 -281.

AMA Style

Tomoyuki Takura, Kenji Miki. The future of medical reimbursement for orthopedic surgery in Japan from the viewpoint of the health economy. Journal of Orthopaedic Science. 2016; 21 (3):273-281.

Chicago/Turabian Style

Tomoyuki Takura; Kenji Miki. 2016. "The future of medical reimbursement for orthopedic surgery in Japan from the viewpoint of the health economy." Journal of Orthopaedic Science 21, no. 3: 273-281.

Multicenter study
Published: 22 March 2016 in Journal of Anesthesia
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The purpose of this study was to examine the cost-effectiveness of pain treatments in two pain centers in Japan.

ACS Style

Tomoyuki Takura; Masahiko Shibata; Shinsuke Inoue; Yoichi Matsuda; Hironobu Uematsu; Keiko Yamada; Takahiro Ushida. Socioeconomic value of intervention for chronic pain. Journal of Anesthesia 2016, 30, 553 -561.

AMA Style

Tomoyuki Takura, Masahiko Shibata, Shinsuke Inoue, Yoichi Matsuda, Hironobu Uematsu, Keiko Yamada, Takahiro Ushida. Socioeconomic value of intervention for chronic pain. Journal of Anesthesia. 2016; 30 (4):553-561.

Chicago/Turabian Style

Tomoyuki Takura; Masahiko Shibata; Shinsuke Inoue; Yoichi Matsuda; Hironobu Uematsu; Keiko Yamada; Takahiro Ushida. 2016. "Socioeconomic value of intervention for chronic pain." Journal of Anesthesia 30, no. 4: 553-561.

Multicenter study
Published: 10 March 2016 in Journal of Vascular and Interventional Radiology
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To assess cost-effectiveness of sclerotherapy for venous malformations (VMs) to improve patient quality of life (QOL). This prospective study enrolled 28 patients with symptomatic VMs who underwent sclerotherapy. EuroQol-5 Dimension (EQ-5D) and Short-Form 36 (SF-36) Health Survey were used to measure health-related QOL. Questionnaires were collected before and 1, 3, 6, and 12 months after sclerotherapy. Quality-adjusted life years (QALYs) were calculated using EQ-5D score as a measure of health utility. Medical costs obtained from the hospital accounting system and other costs of staff, drugs, materials, and angiographic equipment were calculated for each procedure. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER) as the medical cost/gain of QALYs. Median EQ-5D scores improved from 0.768 (range, 0.705-1) to 1 (range, 0.768-1) after 6 months (P = .023) and 1 (range, 0.768-1) after 12 months (P = .063). The gain of QALYs at 12 months was 0.043. The mean medical cost was ¥281,228 ($2,337). The pain group (baseline bodily pain scale of SF-36 score < 70) showed greater improvement in median EQ-5D score, from 0.705 (range, 0.661-0.768) to 0.768 (range, 0.705-1) after 6 months (P = .041) and 0.768 (range, 0.768-1) after 12 months (P = .049). ICER at 12 months was ¥6,600,483 ($54,840) in the overall group and decreased to ¥3,998,113 ($33,218) in the pain group, < ¥6,000,000 ($49,850), threshold for acceptance of a public health benefit in Japan, even accounting for 50% increase in costs. Sclerotherapy was cost-effective for improving QOL for symptomatic VMs, especially for patients with moderate to severe pain.

ACS Style

Yusuke Ono; Keigo Osuga; Tomoyuki Takura; Masahisa Nakamura; Kentaro Shibamoto; Akira Yamamoto; Hiroyasu Fujiwara; Hidefumi Mimura; Noriyuki Tomiyama. Cost-Effectiveness Analysis of Percutaneous Sclerotherapy for Venous Malformations. Journal of Vascular and Interventional Radiology 2016, 27, 831 -837.

AMA Style

Yusuke Ono, Keigo Osuga, Tomoyuki Takura, Masahisa Nakamura, Kentaro Shibamoto, Akira Yamamoto, Hiroyasu Fujiwara, Hidefumi Mimura, Noriyuki Tomiyama. Cost-Effectiveness Analysis of Percutaneous Sclerotherapy for Venous Malformations. Journal of Vascular and Interventional Radiology. 2016; 27 (6):831-837.

Chicago/Turabian Style

Yusuke Ono; Keigo Osuga; Tomoyuki Takura; Masahisa Nakamura; Kentaro Shibamoto; Akira Yamamoto; Hiroyasu Fujiwara; Hidefumi Mimura; Noriyuki Tomiyama. 2016. "Cost-Effectiveness Analysis of Percutaneous Sclerotherapy for Venous Malformations." Journal of Vascular and Interventional Radiology 27, no. 6: 831-837.

Journal article
Published: 01 January 2016 in Journal of Community Medicine & Health Education
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Background: We evaluated the production efficiency of physicians in outpatient consultation using Data Envelopment Analysis (DEA) to verify the applicability of this method in health care field. Methods: Clinical accomplishment by outpatient consultation (number of complex cases) and economic contribution to health service income (fee claims) were defined as the contributions of physicians in medical institutions. We investigated consultations and fee claims of 963 outpatients (all aged: 72.9 ± 11.8 years, males aged: 72.0 ± 11.7 years / females aged: 74.0 ± 12.0 years, hypertension: 17.5% / angina: 13.1%) consulted by 15 physicians in a week at a medical institution specialized in cardiovascular disease. The physician’s fee claim per practice time was used as an index in production efficiency of each cardiovascular case. We determined production efficiency of physicians using both of total fee claim and number of complex cases per consultation time using DEA. Results: There was no statistically significant difference between main disease of outpatients in consultation time (p=0.28). We showed a significant increment of physicians fee claim (point per min) according to the patient condition aggravated from mild to moderate cases in severity (71.4 ± 2.4: p=0.004). The production efficiency also significantly increased from the first consultation to follow-up (71.6 ± 2.4: p=0.048). There was a large variation among the 15 physicians in the consultations, and 4 physicians (26% of all subjects) formed a group with the most favorable production efficiency according to DEA. Conclusion: We demonstrated evaluation of production efficiency of physicians using clinical and economic accomplishments. The production efficiency is significantly influenced by disease severity and consultation step. Our finding suggests that DEA may be applicable for evaluation of health care services.

ACS Style

Tomoyuki Takura; Haruki Itoh. Production Efficiency of Physicians in Outpatient Consultation of Cardiovascular Cases. Journal of Community Medicine & Health Education 2016, 3, 1 .

AMA Style

Tomoyuki Takura, Haruki Itoh. Production Efficiency of Physicians in Outpatient Consultation of Cardiovascular Cases. Journal of Community Medicine & Health Education. 2016; 3 (4):1.

Chicago/Turabian Style

Tomoyuki Takura; Haruki Itoh. 2016. "Production Efficiency of Physicians in Outpatient Consultation of Cardiovascular Cases." Journal of Community Medicine & Health Education 3, no. 4: 1.

Journal article
Published: 14 December 2015 in International Journal of Clinical Oncology
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Few reports have thus far discussed the influence of economic factors on treatment decision-making by patients. The objective of the present study was to clarify the awareness among oncologists of health economics in cancer treatment. The present study was based on the questionnaire regarding health economics in cancer treatment carried out by the Japan Society of Clinical Oncology (JSCO) in July 2013. The subjects were trustees registered with JSCO. The survey investigated the influence of medical expenses on patient access to and selection of medical treatment in order to clarify the primary attributes of the respondents and their awareness of economics. The study also investigated the maximum allowable public medical expenses to prolong the life expectancy of a cancer patient by 1 year and the factors that can influence treatment selection. The 172 respondents had completed a mean of 30.3 ± 6.2 postgraduate years, and the mean number of patients they treated annually was 1323 ± 1963. The degree of treatment accessibility among patients was perceived positively by 112 (71.3 %) and negatively by 49 (28.7 %) of the respondents, irrespective of medical expenses. Of the 172 respondents, 66 (41.0 %) believed that the maximum allowable medical expenses for cancer treatment should be ≤4 million yen/LY, with 62 (39.8 %) reporting a value of 4.01–8 million yen/LY. The findings of this study suggest that a certain range of medical expenses has come to be regarded as the standard range of medical expenses for cancer treatment among oncologists, with answers based on the premise that patients should have access to effective medical treatment.

ACS Style

Tomoyuki Takura; Mikihiro Fujiya; Yasuhiro Shimada; Yutaka Kohgo. Perspectives of Japanese oncologists on the health economics of innovative cancer treatments. International Journal of Clinical Oncology 2015, 21, 633 -641.

AMA Style

Tomoyuki Takura, Mikihiro Fujiya, Yasuhiro Shimada, Yutaka Kohgo. Perspectives of Japanese oncologists on the health economics of innovative cancer treatments. International Journal of Clinical Oncology. 2015; 21 (4):633-641.

Chicago/Turabian Style

Tomoyuki Takura; Mikihiro Fujiya; Yasuhiro Shimada; Yutaka Kohgo. 2015. "Perspectives of Japanese oncologists on the health economics of innovative cancer treatments." International Journal of Clinical Oncology 21, no. 4: 633-641.

Comparative study
Published: 21 September 2015 in Therapeutic Apheresis and Dialysis
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The cost‐effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro‐QOL 5‐dimensions (EQ‐5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost‐effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ‐5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P < 0.05, <65; P < 0.01, 65≤; not significant). MHD is a treatment that could improve the socioeconomic state of elderly patients with end‐stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis.

ACS Style

Tomoyuki Takura; Takeshi Nakanishi; Hideki Kawanishi; Kosaku Nitta; Tadao Akizawa; Makoto Hiramatsu; Tadayuki Kawasaki; Kazutaka Kukita; Hidehisa Soejima; Hideki Hirakata; Toyohiko Yoshida; Takashi Miyamoto; Susumu Takahashi. Cost-Effectiveness of Maintenance Hemodialysis in Japan. Therapeutic Apheresis and Dialysis 2015, 19, 441 -449.

AMA Style

Tomoyuki Takura, Takeshi Nakanishi, Hideki Kawanishi, Kosaku Nitta, Tadao Akizawa, Makoto Hiramatsu, Tadayuki Kawasaki, Kazutaka Kukita, Hidehisa Soejima, Hideki Hirakata, Toyohiko Yoshida, Takashi Miyamoto, Susumu Takahashi. Cost-Effectiveness of Maintenance Hemodialysis in Japan. Therapeutic Apheresis and Dialysis. 2015; 19 (5):441-449.

Chicago/Turabian Style

Tomoyuki Takura; Takeshi Nakanishi; Hideki Kawanishi; Kosaku Nitta; Tadao Akizawa; Makoto Hiramatsu; Tadayuki Kawasaki; Kazutaka Kukita; Hidehisa Soejima; Hideki Hirakata; Toyohiko Yoshida; Takashi Miyamoto; Susumu Takahashi. 2015. "Cost-Effectiveness of Maintenance Hemodialysis in Japan." Therapeutic Apheresis and Dialysis 19, no. 5: 441-449.