Published papers

Since 2011, the Ministry of Health, Labour and Welfare (MHLW) has made the data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) available for research purposes. Recent trends in treatments and prognosis for intrahepatic cholangiocarcinoma (ICC) were analyzed using data from this comprehensive database. This repeated cross-sectional study employed NDB open data to determine the number of patients with ICC and those treated for ICC from fiscal years (FY) 2016 to 2020. The International Classification of Diseases version 10 (ICD-10) code of C22.1 (ICC) was used to define ICC patients. The number of patients diagnosed with ICC and treated in Japan did not change during the study period (FY2016: 1,119; FY2017: 1,136; FY2018: 1,213; FY2019: 1,185; FY2020: 1,194). The number of patients who underwent open liver resection (OLR) did not change either (FY2016: 748; FY2017: 771; FY2018: 807; FY2019: 760; FY2020: 753). On the other hand, patients who underwent laparoscopic liver resection (LLR) increased during the study period (FY2016: 84; FY2017: 118; FY2018: 143; FY2019: 171; FY2020: 195). This was primarily due to the increase in the number of patients who received laparoscopic liver resection larger than subsegmentectomy (FY2016, 57; FY2017, 81; FY2018, 98; FY2019, 101; FY2020, 133). The median postoperative survival was 5.25 years in the OLR group and was not reached in the LLR group. The national database analysis revealed that while the number of patients diagnosed with and treated for ICC has remained stable, the adoption of minimally invasive surgery has increased, possibly because of advancements in treatment techniques, resulting in good survival outcomes.

The academic technology assessment group (ATAG) reviewed a report on nirmatrelvir/ritonavir’s additional benefits and cost-effectiveness in patients with COVID-19 (Pfizer Japan Inc.). This report summarizes the results of the review and the re-analysis by the ATAG. The target population was adult COVID-19 patients with risk factors toward severe COVID-19. The situation in Japan was considered in the analysis scope since the emergence of the Omicron variant, as well as vaccination coverage.In evaluating the additional benefits of nirmatrelvir/ritonavir, the manufacturer noted that no randomized controlled trials (RCT) that directly compared nirmatrelvir/ritonavir and molnupiravir were identified. Given this, the manufacturer identified the EPIC-HR trial, a clinical trial evaluating nirmatrelvir/ritonavir, following a systematic review. The manufacturer conducted a matching-adjusted indirect comparison with the MOVe-OUT trial, a clinical trial evaluating molnupiravir (the comparator drug). The manufacturer found the effectiveness of nirmatrelvir/ritonavir in preventing severe disease (hospitalization or death due to COVID-19) and concluded that nirmatrelvir/ritonavir offers added benefit over molnupiravir.The ATAG pointed out that both the EPIC-HR and MOVe-OUT trials did not match the analysis scope, where the Omicron variant was prevalent and COVID-19 vaccination had become widespread. Furthermore, the EPIC-SR trial, published after the manufacturer’s analysis, failed to demonstrate efficacy in shortening the duration of symptoms compared with placebo, while nirmatrelvir/ritonavir had fewer hospitalizations or deaths in 28 days although the result was not statistically significant. Although the result indicates potential benefit, EPIC-SR was conducted when Delta variant was prevalent and its sample size was not sufficient to assess the efficacy in preventing severe disease. Therefore, the ATAG concluded that it was difficult to provide a definitive assessment of the additional benefits based on the available evidence as of May 2024 and recommended that the assessment be based on PANORAMIC trial. The trial is a platform-adaptive RCT involving three groups—nirmatrelvir/ritonavir, molnupiravir and placebo—, and was conducted in the United Kingdom amidst the ongoing vaccination program and the Omicron variant spread； it was therefore considered appropriate to assess the additional benefit of nirmatrelvir/ritonavir based on the results of this trial. The patient enrolment had already been completed by May 2024.The Central Social Insurance Medical Council determined to suspend the evaluation for one year in September 2024 and restart it in November 2025, with the 3-month additional analysis period. However, no additional literature supporting additional benefit was identified, including the available evidence from PANORAMIC trial. The ATAG therefore concluded that nirmatrelvir/ritonavir did not demonstrate additional benefit compared with the comparator technology.The manufacturer conducted a cost-effectiveness analysis using a decision tree model for the acute period from the onset of COVID-19 to the end of acute treatment, and a Markov model for the subsequent lifetime analysis period. Parameters from an indirect comparison of the EPIC-HR and MOVe-OUT trials were used for the model’s effectiveness in preventing severe disease. The ATAG evaluated that nirmatrelvir/ritonavir did not offer additional benefit compared to molnupiravir, and then the ATAG conducted a cost-minimization analysis. As a result, the cost of the nirmatrelvir/ritonavir group was 12,432 yen higher than that of the molnupiravir.Based on the result of the analysis, the ATAG suggest that nirmatrelvir/ritonavir is likely to fall into the category of “equivalent (or inferior) effectiveness and increased costs” when compared with molnupiravir.

The academic technology assessment group (ATAG) reviewed a report on ritlecitinib’s additional benefits and cost-effectiveness in adults and adolescents (12 years or older) with alopecia areata and 50% or greater scalp hair loss submitted by the manufacturer of ritlecitinib (Pfizer). This report summarizes the results of the review and re-analysis by the ATAG.When evaluating the additional benefits of ritlecitinib, the manufacturer noted that no randomized controlled trials (RCTs) directly comparing ritlecitinib with baricitinib were identified. Similarly, these RCTs were not identified in ATAG’s systematic review. The ATAG also identified the ALLEGRO-2b/3 study and the BRAVE-AA1/AA2 studies, which were consistent with the manufacturer’s review. For the adult population, the manufacturer insisted that additional benefits could not be adequately evaluated through a naive comparison of the treatment effects from the ALLEGRO-2b/3 and BRAVE-AA1/AA2 studies due to high uncertainty. The ATAG performed a network meta-analysis using these studies. However, the ATAG considered that the estimated treatment effects had high uncertainty given the wide 95% confidence intervals. The ATAG concluded that ritlecitinib had no additional benefits compared with baricitinib in the adult population. Thus, the ATAG examined the manufacturer’s cost-minimization analysis, as this analysis was appropriate. For the adolescent population, the manufacturer stated that ritlecitinib would show efficacy similar to the statistically significant results observed in the overall population of the ALLEGRO-2b/3 study. Therefore, the manufacturer insisted that ritlecitinib demonstrated additional benefits over best supportive care (BSC). While the estimated treatment effects could show uncertainty due to limited number of samples in the trial, the ATAG considered that the manufacturer’s evaluation was reasonable. The ATAG concluded that ritlecitinib had additional benefits compared with BSC in adolescents. Thus, the ATAG examined the manufacturer’s cost-effectiveness analysis, as this analysis was appropriate. The manufacturer’s analysis was conducted using a Markov model of nine health states stratified by the presence or absence of active treatments (ritlecitinib and baricitinib) and severity of alopecia tool score, and death. The ATAG conducted a re-analysis in several points, such as stage age, efficacy parameter, and subsequent treatment for the adolescent population. In particular, in the manufacturer’s analysis, patients were assumed to continue BSC throughout lifetime despite baricitinib is available in clinical practice for patients aged 15 years or olde. The ATAG’s re-analysis applied baricitinib after patients aged 15 years and older in the adolescent population.As a result, ATAG’s base-case analysis showed that ritlecitinib led to a cost increase of JPY 1,710,932 compared to baricitinib in the adult population. For the adolescent population, ATAG’s base-case analysis showed that ritlecitinib incurred the additional cost of JPY 1,210,540 and conferred the additional 0.06 quality-adjusted life years (QALYs) compared to the comparator, resulting in the incremental cost-effectiveness ratio (ICER) of JPY 19,436,419 per QALY. In conclusion, for patients with alopecia areata and 50% or greater scalp hair loss, the results of the ATAG’s analysis suggested that the ICERs for ritlecitinib compared to comparators are likely to be “cost increase” in the adult population and “more than JPY 15 million per QALY” in the adolescent population from the perspective of public healthcare payers in Japan.

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), provided by the Ministry of Health, Labour and Welfare (MHLW), is an exhaustive repository that can be used to understand the nationwide epidemiology of hepatocellular carcinoma (HCC) in Japan. This study was conducted to clarify the geographic distribution of patients with HCC and treatments performed in each region of Japan using data from the NDB. A retrospective analysis was performed to determine the number of patients diagnosed, with HCC (International Classification of Diseases, 10th edition, code C22.0), who received treatment between 2016 and 2020. Number of incidences of HCC per 100,000 individuals in each Japanese region are 76 (Hokkaido), 63 (Tohoku), 55 (Kanto), 58 (Tokai), 74 (Hokuriku), 77 (Kinki), 93 (Chugoku), 101 (Shikoku), 93 (Kyushu), and 37 (Okinawa). Transarterial embolization/transarterial chemoembolization and curative treatments, including laparoscopic liver resection (LLR), open liver resection, and radiofrequency ablation, were the most frequently performed treatments in all regions, followed by systemic therapy. The proportion of patients receiving LLR was lowest in the Shikoku region (6.7%), which also had the lowest frequency of institutions certified by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) relative to the number of patients with HCC. Although the incidence of HCC varies across regions in Japan, the most frequently performed treatments remain consistent nationwide. This suggests that HCC treatment practices are largely standardized, regardless of geographic location. Certification by the JSHBPS appears to play a role in patient access to LLR.

Chronic kidney disease (CKD) is a major public health problem. Most international guidelines recommend targeted testing of individuals at high risk rather than population-wide screening. In Japan, urinalysis is embedded in health examination systems across the life course. However, the existence of repeated urinalysis opportunities has not necessarily meant that these programs functioned as a coherent CKD screening pathway. Repeated urinalyses were introduced under different legal mandates and for different public health purposes, with substantial variation in target conditions, test components, and follow-up arrangements. In this context, the 2025 policy decision to add serum creatinine to workplace-based health examinations, following sustained advocacy by the Japanese Society of Nephrology and growing recognition of non-proteinuric CKD, marks an important policy turning point. This review provides an overview of Japan’s current health examination systems from the perspective of CKD screening throughout the life course. Specifically, this review describes the 3-year-old health examination, school urinary screening, workplace-based health examinations, the Specific Health Checkup, and late-stage elderly medical examinations by focusing on their institutional basis, structure, follow-up pathways, and current limitations. Taken together, Japan’s health examination systems provide repeated urinalyses; however, these opportunities do not automatically amount to a coherent CKD screening strategy. This overview highlights the need to clarify target conditions, downstream interventions, outcome measures, and continuity across programs.

Background: The optimal screening interval for fecal immunochemical testing (FIT) in Japan remains uncertain. Objective: This study aimed to evaluate the cost-effectiveness of biennial FIT screening compared with annual FIT screening to inform future national guidelines. Methods: We developed a microsimulation model of a cohort of 100 000 average-risk Japanese individuals aged 40 years and older followed over a 60-year horizon from a healthcare payer perspective. Two screening methods were compared: the current annual FIT and biennial FIT. Effectiveness was measured in quality-adjusted life-years (QALYs), and costs were measured in 2024 Japanese yen. Results: Annual FIT screening was dominant, resulting in lower total costs (¥408 058 vs. ¥451 407) and higher QALYs (26.483 vs 26.440) compared with biennial screening. Probabilistic sensitivity analysis indicated that annual screening was cost-effective in 92.7% of iterations at a WTP threshold of ¥5 million per QALY. Conclusions: The analysis indicated that annual FIT screening was dominant over biennial screening, because of its lower costs and higher QALY yield. These findings were supported by probabilistic sensitivity analysis. Although annual FIT screening is generally superior to biennial screening in Japan and provides greater health benefits at lower costs, future policies should aim to address endoscopic capacity constraints to ensure program sustainability.

Background: Women’s participation in the workforce not only promotes equal opportunity but also contributes to strengthening the social and economic development by addressing declining labour force participation rates linked to population ageing. Women have unique sexual and reproductive health needs, which can hinder their workplace participation and advancement. Therefore, understanding those needs is vital to make a work environment gender-responsive and equitable to ensure that all women can fully engage in social and economic activities. This study aims to provide evidence on the financial burden of productivity loss related to menstruation and menopause. Methods: To assess the financial impact of productivity loss due to menstruation- and menopause-related symptoms, we conducted an internet-based, cross-sectional survey in Japan in September 2022. The survey included 10,000 individuals with 4,950 women aged 25–59, of which we analysed 3,046 responses from those in paid work and with necessary information. Using the validated work productivity and activity impairment questionnaire, we assessed the financial burden of productivity loss, focusing on absenteeism and presenteeism, and estimated the national-level cost among working women aged 25 to 59. Results: Results show that approximately 7.0-8.8% of working women experienced absenteeism or reduced working hours because of the symptoms. Specifically, menstruation- and menopause-related absenteeism accounted for 2–3 days off and a reduction of 2–5 working hours in the preceding three months. Additionally, 79.7% of women reported that menstrual or menopausal symptoms impacted their work productivity. Our estimate suggests that the annual financial burden of productivity loss arising from the symptoms at the national level is approximately JPY 2,296.30 billion (USD 14.65 billion), comprising JPY 323.95 billion (USD 2.07 billion) from absenteeism and JPY 1,972.35 billion (USD 12.59 billion) from presenteeism. Discussion: This study highlights the potential of addressing menstruation- and menopause-related symptoms among working-age women in generating positive economic impacts. These findings underscore the need for workplaces to implement gender-responsive strategies that meet the sexual and reproductive health needs of women in order to ensure gender equality and women’s empowerment at workplace.

The Academic Technology Assessment Group (ATAG) reviewed a report by the manufacturer (UCB Japan Co. Ltd.) on the additional benefits and cost-effectiveness of brivaracetam in patients with uncontrolled focal-onset seizures. This report summarizes the ATAG review and reanalysis. The target population was divided into two groups: (a) patients receiving monotherapy, (b) patients receiving combination therapy. The comparator technology was levetiracetam for population (a) and levetiracetam + drug therapy for population (b). The technology under evaluation was brivaracetam for population (a) and brivaracetam + drug therapy for population (b).For evaluating additional effectiveness, the systematic review (SR) conducted by the manufacturer for population (a) identified no randomized controlled trials (RCTs) directly comparing brivaracetam and levetiracetam. No SR was conducted for non-RCTs. As a result, for population (a), it was determined that no trials of sufficient quality existed for evaluation, and thus no additional benefit could be drawn. For population (b), seven studies were identified to examine the additional benefit of combination therapy with brivaracetam, although no RCTs directly comparing brivaracetam + drug therapy and levetiracetam + drug therapy were identified. Furthermore, the manufacturer conducted a frequentist network meta-analysis (NMA) after performing literature selection and outcome extraction based on prior studies and applying continuity correction to data with zero events. The manufacturer concluded that additional benefit was demonstrated based on the point estimates for the complete seizure freedom rate and treatment discontinuation rate due to adverse events. ATAG conducted an independent SR and determined that there were no RCTs or appropriate non-RCTs for evaluating additional effectiveness for population (a). ATAG determined that for population (b), additional benefit was demonstrated for “treatment discontinuation due to adverse events”, while clear evidence demonstrating additional benefit for “seizure suppression” was lacking. Thus, ATAG considered it appropriate to conduct a cost-effectiveness analysis for population (b) and examined the analysis provided by the manufacturer.The manufacturer conducted a cost-effectiveness analysis for population (b) by constructing a Markov model to evaluate the cost-effectiveness of brivaracetam + drug therapy. ATAG identified several methodological issues with the analysis performed by the manufacturer and conducted a reanalysis. First, ATAG conducted a reanalysis assuming that treatment effects on seizure suppression were null (OR=1.000). Second, the manufacturer estimated a higher treatment continuation rate for brivaracetam + drug therapy by directly comparing data obtained from RCTs and observational studies. In the ATAG assessment, the treatment continuation rate for brivaracetam + drug therapy was estimated by multiplying the treatment discontinuation rate of levetiracetam + drug therapy by the treatment effect on “treatment discontinuation due to adverse events”. Third, while the manufacturer modeled the “post-treatment” state as equivalent to ‘death’, ATAG judged this approach to be inappropriate and applied the costs and QOL values for “non-responders”. Fourth, ATAG conducted a reanalysis using QOL values obtained directly from patients in the clinical trials (N01252, N01253, and N01254 trials).The reanalysis showed that, compared to levetiracetam + drug therapy, brivaracetam + drug therapy had an incremental cost of JPY 1,099,134 and 0.023 QALYs gained in population (b), with an incremental cost-effectiveness ratio (ICER) of JPY 48,163,534/QALY. In conclusion, these results suggest that the ICER for brivaracetam compared to the comparator is likely to belong to the “more than JPY 10 million/QALY” interval for population (b), from the perspective of public healthcare payers in Japan.

Diabetes mellitus is a chronic disease in which high blood glucose over long periods leads to diabetic complications including retinopathy, neuropathy, chronic kidney disease, and increased risk for cardiovascular events. Despite the availability of scientifically proven medical treatments, a significant number of patients with diabetes do not attain optimal glycemic control due to failure in self-management and nonadherence to medication. These behaviors appear irrational in terms of conventional economic theory. We applied the theory of behavioral economics, a new concept for clarifying irrational human behaviors, to investigating risk preferences in patients with diabetes. We found specific features in the responses of patients with diabetic complications. Many of these patients had low socioeconomic status, were reluctant to participate in the survey, and had difficulty in making decisions explicitly. Their choices under uncertainty often violated two axioms of the Expected Utility Theory (completeness and transitivity) and were therefore considered irrational, meaning that their choices were difficult to understand and differed from those that would be chosen by the majority of people. Health professionals should be aware of the propensity of such patients to make irrational decisions, which might be an important risk factor for the progression of diabetic complications.

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.

In 2011, the Ministry of Health, Labour and Welfare started providing data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) for research purposes. The NDB is an exhaustive and valuable database for health policymaking and research. It provides an accurate and most recent visualization of the burden of hepatocellular carcinoma (HCC) in Japan. In this study, we analyzed the trend in HCC treatments using data from the NDB. The NDB data were retrospectively analyzed to calculate the number of patients who were diagnosed with HCC (International Classification of Diseases, version 10 code of C22.0) and underwent treatment from fiscal year (FY) 2016 to 2020. We observed the following trends in HCC treatments during the past 5 years: a slight increase in the number of liver resection (LR) cases (+5.4%), a decrease in the number of radiofrequency ablation cases (−15.2%), and a considerable decrease in the number of transarterial chemoembolization/transarterial embolization cases (−38.2%). However, the number of patients who received systemic therapy dramatically increased from 471 in FY 2016 to 1,584 in FY 2020 (+236%). Among LR cases, there was a remarkable increase in the number of laparoscopic procedures from 1,227 in FY 2016 to 2,057 in FY 2020 (+67.6%). This analysis of a national highly comprehensive database revealed a very recent visualization of HCC management in Japan, wherein the impact of recent advances in systemic therapy and minimally invasive surgery was prominent.

Objective: Mechanical thrombectomy (MT) is an important procedure in the treatment of acute cerebral infarction, and its effectiveness depends largely on timely intervention after the onset. In the United States, a tiered accreditation system of stoke centers has been established to provide MT efficiently. In Japan, however, despite the large number of medical institutions performing MT, the establishment of a tiered accreditation system has yet to be seen. The low number of cases treated per institution raises concerns about the economic sustainability of MT in Japan because significant capital and human resource investment are required. This study aims to investigate the cost structure of MT procedure and the break-even point in 2 different hospital settings in Japan.Methods: We conducted a detailed cost analysis of MT at 2 distinct hospitals: Hospital A, a large public hospital in a government-designated city, and Hospital B, a private non-profit hospital in the Tokyo metropolitan area. Data collection involved face-to-face interviews with department heads and a structured survey based on the Japanese Hospital Accounting Standards, focusing on material, labor, and facility-related costs. Break-even points were calculated considering both fixed and variable costs, with adjustments made for the shared use of facilities in Hospital B.Results: The total cost per case was 349256 yen in Hospital A and 245150 yen in Hospital B, respectively. The total cost per case was elevated to 559866 yen assuming only MT was performed at Hospital B. This figure was significantly higher than the reimbursement price of MT (331500 yen). The number of procedures needed to exceed the break-even point for MT was approximately 290 cases per year in Hospital A and 125 cases per year in Hospital B, respectively.Conclusion: We conducted a break-even analysis of MT based on an interview survey. The number of cases required to cross the break-even point for MT alone was much higher than the actual number of MT procedures being performed in the 2 hospitals.

Objective: This study aimed to simulate patient transportation to a mechanical thrombectomy (MT)-capable hospital within 60 minutes, taking into account patient volume (demand side of healthcare) and hospital capacity to accept patients (supply side of healthcare).Methods: Simulations were conducted in Hyogo Prefecture, Japan. The estimates of the annual number of patients with stroke eligible for MT in 2020 were based on the incidence of stroke by age group and the percentage of patients with stroke indicated for MT in existing publications. Patients were then randomly placed on a 1 km2 mesh map. The patients were randomly generated 100 times using R software (version 4.1.2; R Foundation for Statistical Computing, Vienna, Austria). Hospitals were selected based on 2 criteria: (1) actual provision patterns (39 hospitals) and (2) consolidated patterns (12 hospitals). Simulations were performed using ArcGIS Pro (version 10.8; Esri, Redlands, CA, USA) and Network Analyst extension (Esri) in 3 cases: (1) number of patients estimated from the population in 2020 transported to hospitals that provided MT, (2) number of patients estimated based on the 2020 population transported to selected hospitals in the case of consolidation, and (3) number of patients estimated based on 2040’s projected population and transportation to the selected hospitals.Results: In Case 1, the estimated annual number of patients undergoing MT in 2020 was 976. The average number of patients undergoing MT and transported was 961, indicating that 98% (961/976) of the total generated patients could be transported within 60 min. In Case 2, the average number of patients undergoing MT and transported was 940, indicating that 96.3% (940/976) of the total patients could be transported within 60 min. In Case 3, the average number of patients undergoing MT and transported was 1184, showing that 95.1% (1184/1244) of the total generated patients could be transported within 60 min. A few patients in rural areas and remote islands required longer transport times.Conclusion: The simulations showed that patient estimates from the incidence of cerebral infarction by age group and the percentage of patients with stroke indicated for MT were similar to the actual values. The simulation was closed to reality when both the supply and demand sides of healthcare were considered. Thus, this simulation study informs future healthcare policy by demonstrating the geographic distribution of human and capital resources and potential cost reduction through consolidation, taking into account demographic changes.

The current paper introduced the two joint studies by the study group of social medicine and health economist. The study group collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device. 　 Before these joint studies, no prior studies have established a method that could identify the warning signs of its recurrence. In addition, to prevent relapse of patients with major depression, it is necessary to examine the predictors influencing false negatives and identify the early signs of recurrence. 　The first study by a panel vector autoregressive model indicated that long sleep time was an important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks. Recurrent depression was defined by the Kessler Psychological Distress Scale and the Patient Health Questionnaire-9 scores. In contrast, considering the small number of relapsed cases and the overdispersion generated by excess zero, the second study aimed to investigate “sitting idly” as a predictor influencing falsenegatives using a zero-inflated negative binomial model because false negatives which can lead to delays in diagnosis and treatment must be avoided. Estimates of the population-averaged parameters indicated that daily hours of sitting idly increased the chances of recurrent depression two or four weeks later. The change in exposure to daily UV light from non-exposure reduced recurrent depression. 　Before the commencement of the joint study, it is indispensable to explain the significance of the economic study clearly to medical researchers. In the academic society where both of medical researchers and economists belong to, it is important to arrange the opportunity to understand the difference in each idea.

BackgroundMedical corporations (Iryohoujin) are central to Japan’s healthcare delivery, yet their financial conditions have not been comprehensively assessed nationwide. This study aimed to describe financial trends and structural characteristics of hospital-operating corporations from fiscal year (FY) 2016 to FY2022 and examine fluctuations, including during the FY2020–FY2021 COVID-19 pandemic.MethodsA longitudinal analysis was conducted using financial data covering 95% of all hospital-operating medical corporations. Financial indicators, including total assets, medical revenue, and profit margin, were tracked from FY2016 to FY2022. Subgroup analyses were based on organizational size and integration. A linear mixed-effects model examined factors associated with profitability.ResultsThe number of hospital-operating medical corporations declined from 4,631 in FY2016 to 4,469 in FY2022. By FY2022, total assets and medical revenue reached 15.9 trillion JPY and 12.5 trillion JPY. Median medical profit margin declined from 1.8% (interquartile range [IQR], –1.2% to 5.3%) in FY2016 to 0.6% (IQR, –3.4% to 4.3%) in FY2021, then recovered to 1.6% (IQR, –2.5% to 5.5%) in FY2022. Smaller corporations, with fewer hospitals and beds, were more financially unstable, especially during the COVID-19 pandemic. A linear mixed-effects model showed that medical profit margin was negatively associated with hospital number and positively associated with long-term care and psychiatric beds.ConclusionsThis study highlights the structural scale and financial dynamics of Japanese medical corporations, revealing a large but unevenly resilient sector in which not only hospital size but also bed composition significantly influences profitability. These findings may inform policy discussions on healthcare system sustainability and financial support.

Background: In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited. Objective: This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy. Methods: This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes. Results: In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412-50,013 vs 59,202, 95% CI 42,603-75,800 Japanese yen; $284, 95% CI 134-435 vs $515, 95% CI 370-659, purchasing power parity [PPP]-adjusted; P=.01), direct non-health care costs (922, 95% CI -240 to 2084 vs 2561, 95% CI 1447-3676 yen; $8, 95% CI -2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; P=.02), and indirect costs (8981, 95% CI -7119 to 25,082 vs 32,832, 95% CI 17,384-48,279 yen; $78, 95% CI -62 to 218 vs $285, 95% CI 151-420 PPP-adjusted; P=.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (-7.6, 95% CI -13.7 to -1.4; P=.02) and Diabetes Therapy-Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; P=.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians. Conclusions: In this randomized trial, mobile health-enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significantly reduced psychological and economic burdens without compromising glycemic or perinatal outcomes, demonstrating its value as a patient-centered and cost-efficient model of care. These findings support the broader implementation of mobile-based telemedicine approaches in GDM management.