Published papers

Objective: To identify which chronic conditions and patient characteristics contribute to increases in the number of regularly visited facilities (RVF), a measure of polydoctoring, among adults with multimorbidity in Japan. Design: Retrospective cohort study using individual fixed-effects Poisson regression models to estimate within-person associations between the onset of each chronic condition and changes in RVF. This approach controlled for all time-invariant personal characteristics. Effect modification by age, geographic region and baseline multimorbidity was also assessed. Setting: A nationwide health claims database covering multiple insurance systems in Japan, including municipal National Health Insurance, Employees’ Health Insurance and the Long-Life Medical Care System. Participants: 4 696 790 adults with two or more chronic conditions and two or more consecutive years of follow-up. Results: The onset of examined chronic conditions was associated with changes in RVF, with substantial variation in effect size across conditions. The strongest association was observed for malignancy (RR=1.102; 95% CI 1.101 to 1.103), followed by osteoporosis (RR=1.065; 95% CI 1.064 to 1.065), arthritis (RR=1.061; 95% CI 1.060 to 1.061), obesity (RR=1.049; 95% CI 1.044 to 1.055), stroke (RR=1.044; 95% CI 1.041 to 1.048) and cardiovascular disease (RR=1.043; 95% CI 1.042 to 1.044). Associations between disease onset and RVF were consistently attenuated among individuals aged ≥75 years and those with higher baseline multimorbidity while differences between urban and rural residents were minimal. Conclusion: Substantial heterogeneity was observed in the magnitude of RVF increases across chronic conditions, with particularly strong associations for malignancy, osteoporosis and arthritis. Attenuated effects among older adults and individuals with higher multimorbidity suggest that patient capacity and treatment burden may influence patterns of healthcare utilisation. These findings underscore condition-specific drivers of care fragmentation and may inform more tailored care-coordination strategies for people living with multimorbidity.

Background: Financial toxicity (FT) arises from the economic burden of cancer treatment and is associated with reduced quality of life and worse survival. However, its association with socioeconomic and financial factors among Japanese cancer patients has not been fully elucidated. Methods: Between October 2023 and May 2024, a cross-sectional study was conducted among adult cancer patients undergoing chemotherapy for at least two months at two cancer centers in Japan. Patients receiving public assistance or who had participated in clinical trials were excluded. FT was assessed using the Comprehensive Score for Financial Toxicity (COST). Lower COST scores indicate higher FT. Associations between COST score and clinical, demographic, socioeconomic, and financial factors were analyzed using univariable linear regression. Results: Of 258 patients invited, 245 responded, and 203 (78.7%) were analyzed. The median age was 62 years, and the most common primary tumor sites were head and neck (22.7%), colorectal (12.3%), and lung (11.3%). The median COST score was 22 (range: 2–41), with FT (COST <26) observed in 69.0% of patients. The use of coping strategies (β: −3.09; P = .03) and having debts or loans (β: −3.23; P = .04) were significantly associated with lower COST scores. Higher education (β: 3.61; P = .02), household annual income ≥14 million JPY (β: 8.44; P = .02), and savings of 10–12 million JPY (β: 9.99; P = .003) were associated with higher COST scores. Conclusion: In this study, 69.0% of Japanese cancer patients experienced FT. The identified socioeconomic and financial factors may help clinicians detect patients at risk of financial vulnerability.

Background: The number of adult spinal deformity (ASD) surgery has increased in recent years; however, it remains associated with significant hospitalization cost. The purpose of this study is to evaluate the total hospitalization cost associated with ASD surgery in Japan and to identify cost-related factors. Methods: This multicenter prospective observational study included patients aged 50–79 years who underwent corrective fusion of more than 5 vertebral segments between March 2021 and March 2024. Demographic, surgical, and radiographic data were collected. Total hospitalization cost, including surgical procedure, surgical supplies, implants, anesthesia, transfusion, rehabilitation, and bundled hospitalization cost were obtained from medical billing data. Univariate and multivariate analyses were performed to determine factors independently associated with total cost. Results: A total of 194 patients (25 males, 169 females; mean age 69.4 ± 6.7 years) were included. The average total hospitalization cost was $47,923.8 ± 8631.1, with implant cost accounting for the largest proportion. Multivariate linear regression analysis identified staged surgery as the most significant independent predictor of increased total cost, followed by the number of fused vertebrae, surgical time, and the use of lateral lumbar interbody fusion (LLIF). Staged surgery was associated with longer surgical time, more fused vertebrae, and more frequent use of LLIF, resulting in approximately 10,000 USD higher total cost than single surgery. Conclusions: This multicenter prospective study revealed that the total hospitalization cost for ASD surgery exceeded USD 47,000 per patient. Staged surgery was identified as the most significant independent factor associated with increased costs, primarily due to higher surgical procedure and implant-related cost.

Background: Care robots are expected to be useful in long-term care (LTC) settings to resolve several challenges associated with aging populations. However, their use is still limited and little is known about the factors associated with their adoption. This study aimed to identify the factors associated with the adoption of care robots, using a quantitative analysis of a large sample at the organizational level in Japan. Methods: We analyzed residential service providers using 3 years of pooled cross-sectional data from the Fact-Finding Survey on Long-term Care Work in Japan. In this survey, care robots were categorized as robots for “Transfer support,” “Mobility assistance,” “Toiletry support,” “Monitoring and Communication,” “Bathing support,” and “Support for LTC workers.” We defined “adoption of care robots” as LTC providers having adopted at least one of the care robots. To identify the characteristics of LTC providers associated with the adoption of care robots, we conducted a multivariable logistic regression comparing providers with and without care robots. Results: Of the 4,688 LTC providers, 1,250 (26.7%) adopted care robots. The characteristics of LTC providers that were found to be associated with the adoption of care robots were: information and communication technology (ICT) equipment adoption (adjusted odds ratio [aOR] 3.115, 95% confidence interval [CI] 2.453, 3.956), younger average age of care workers (aOR 0.958, 95% CI 0.945, 0.971), large number of employees (aOR 1.008, 95% CI 1.006, 1.010) and appointment of employment management supervisor (aOR 1.611, 95% CI 1.400, 1.853). The primary results were consistent across robot categories. Conclusions: Our findings suggest that care robot adoption is highly compatible with ICT equipment adoption, particularly among younger workers, and among large-scale providers and those with a high awareness of improving employment management indicated by the appointment of an employment management supervisor. To promote adoption, we suggest staff technology-literacy training (especially for senior employees), targeted financial incentives for small providers, and management-led integration of robots within employment-management improvements. This study identified the factors associated with the adoption of care robots at the organizational level and is expected to contribute to realizing the implementation of care robots.

Introduction High-income countries face the urgent task of reducing healthcare spending incurred by low-value care. However, evidence is limited as to whether high-cost or low-cost low-value care services contribute more to total unnecessary healthcare spending, especially outside the United States. Methods Using a claims database covering all age groups in Japan from April 2022 to March 2023 (approximately 2 million beneficiaries, or 2% of the total population), we examined 52 low-value care services using two versions of claims-based measures with different sensitivities and specificities (narrower and broader definitions). Results We identified 3.1 million (narrower) to 3.7 million (broader) episodes of low-value care services, accounting for 42.6-67.2 million USD, or 0.7%-1.0% of total healthcare spending. In the narrower definition, lower-cost services (<80 USD per service) contributed to virtually all episodes of low-value care and 67% of total unnecessary healthcare spending—far exceeding the 33% attributed to the higher-cost services (≥80 USD). Conclusion This finding suggests that compared with focusing solely on higher-cost low-value care services, targeting the reduction of frequently performed, lower-cost low-value care services may be a more effective and efficient strategy for reducing wasteful spending.

The innovation patterns and institutional environments of software as a medical device (SaMD) were empirically, comparatively, and institutionally analyzed as SaMD is attracting attention as innovative medical technology. Data were collected on SaMD products approved by the U.S. Food and Drug Administration (FDA) and medical providers (n=581 and 268, respectively). The relationships among SaMD use, the interaction of SaMD with existing medical devices, and company characteristics were structurally evaluated. The use of the current SaMDs as highly concentrated in the medical image processing field, with emerging information and communication technology companies producing many products. The relationship between SaMDs and hardware-type medical devices varied with their use purpose, based on which an innovation regime map for SaMDs was constructed. Next, the differences in reimbursement systems in Japan, the U.S., and Europe were comparatively analyzed, considering the policy implications for high-uncertainty technologies, such as SaMD and orphan drugs. We specifically focused on the cost-effectiveness-oriented reimbursement decision in Europe, the approval-for-reimbursement structure in Japan, and the range of individual decisions by payers in the United States. We summarized the actual state of price setting and payment models in each region (e.g., performance-based payments, price caps, and rebates). A framework for risk allocation between manufacturers and insurers is required when the value of medical technology is uncertain, suggesting a need for flexible and data-linked evaluations in future system designs.

Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers’ exposure to the ban across cohorts and in “treatment intensity,” calculated based on region-level child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced under-5 mortality, with an effect of 19.7 percent corresponding to a one standard deviation change in treatment intensity. Increases in age at first marriage and first birth, which may have led to improved health-related decisions around the time of birth, appear to be the main drivers of the mortality reductions documented.

Objective: Urinary sediment is examined in Ningen Dock. We sought to evaluate the costs and diagnostic value associated with abnormal urinary sediment findings, in addition to estimated glomerular filtration rate (eGFR), urinary protein, and occult blood measurement, in Ningen Dock after 4 years.Methods: In the patients who underwent Ningen Dock in 2015, urinalysis was performed using a fully-automated urinalysis system at the central laboratory of each hospital. Urine sediment was microscopically examined by laboratory technicians. Granular casts, epithelial casts, and tubular epithelium were defined as pathological findings. Seventy-six patients who showed these findings in 2015 and were re-examined in 2019. The eGFR, urinary protein, and occult blood were statistically analyzed.Results: Pathological urinary sediment findings detected in 2015 spontaneously disappeared after 4 years in 91% of the patients. No significant change was observed in eGFR, urinary protein or occult blood in the patients who continued to have pathological findings after 4 years. At least \157 was spent per sample in supplies and personnel.Conclusions: Almost the pathological urine sediment was disappeared after four years. The benefit of urine sediment examinations was small for the cost. The eGFR, urine protein and occult blood test are sufficient in the kidney function examinations in Ningen Dock.

Background: The financial burden of kidney replacement therapy (KRT) is considerable, and detailed information on KRT costs is essential for managing these huge healthcare costs. However, cost analyses for kidney transplantation (KTx) are limited in Japan. This study aimed to report the healthcare costs of KTx recipients in Japan based on large medical receipt data. Methods: This cost analysis of KTx recipients using the Japan Medical Data Center Claims Database between January 2005 and August 2020 identified living donor KTx (LDKT) and deceased donor KTx (DKT) recipients. The primary outcome was the total direct healthcare costs of KTx recipients. As an exploratory analysis, we examined the factors that contributed to the increase in the costs of LDKT. Results: In total, 84 LDKT and 17 DKT recipients were included in this study. The total healthcare costs for LDKT and DKT recipients during the first year after KTx were 6,639,982 and 6,840,450 JPY/year, respectively. However, after the second year post-KTx, total healthcare costs decreased to 1,735,931 and 1,348,642 JPY/year for LDKT and DKT recipients, respectively. During the first year, inpatient costs accounted for > 70% of the total healthcare costs, whereas pharmaceutical costs accounted for more than half after the second year post-KTx. The use of everolimus and male sex were associated with higher and lower total healthcare costs in the first and subsequent years after LDKT, respectively. Conclusion: Using large-scale administrative databases, this study revealed the total healthcare costs of KTx in Japan and provided valuable information for the health technology assessment of KTx.

Background: The alignment of preferences between physicians and patients can cause variations in treatment decision-making, thereby affecting health outcomes. However, research on the differences in preferences between physicians and the general population is scarce. This study examines the risk and time preferences of physicians compared with those of the general population, exploring the influence of gender concordance on health outcomes and decision-making in healthcare. Methods: We conducted an online field experiment in October and November 2022 in Japan and analyzed the responses of 469 individuals, including physicians and the general population. The survey was stratified by age and gender to align with the demographics of physicians nationally. Participants’ preferences were measured across the health and monetary domains by using a modified multiple price list test format. Results: The findings revealed that physicians tended to be more risk-averse than the general population in the health and monetary domains, although no statistically significant differences were observed. Physicians were found to be statistically significantly future-oriented, particularly regarding their significant health or monetary gains. Furthermore, while the female general population was more risk-averse in both domains, a gender difference in the physician group was observed only in the monetary domain. Conclusion: The results affirm that preference differences between physicians and the general population exist in Japan and clarify the unique preference traits of female physicians.

Importance: Evidence is limited regarding the physician characteristics associated with the provision of low-value services in primary care, especially outside of the US. Objective: To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan. Design, Setting, and Participants: This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Data analysis was performed from June 2024 to February 2025. Main Outcomes and Measures: Multivariable-adjusted composite rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics. Results: Among 2542630 patients (mean [SD] age, 51.6 [19.8] years; 58.2% female) treated by 1019 primary care physicians (mean [SD] age 56.4 [10.2] years; 90.4% male), 436317 low-value care services were identified (17.2 cases per 100 patients overall). Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients (95% CI, 1.0-3.3) more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients (95% CI, 0.2-1.5) more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients (95% CI, 1.5-3.2) more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients (95% CI, 0.5-1.5) more than those in Eastern Japan. Conclusions and Relevance: The findings of this cross-sectional analysis suggest that low-value care services were common and concentrated among a small number of primary care physicians in Japan, with older physicians and not board-certified physicians being more likely to provide low-value care. Policy interventions targeting at a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than those targeting all physicians uniformly.

COVID-19 motivated the US and the European Union to establish a regular pathogen surveillance system at wastewater treatment plants, but other countries, including Japan, have been reluctant to adopt such a system. To determine whether a continuous pathogen surveillance system at wastewater treatment plants is economically justifiable in Japan, we conducted a contingent valuation experiment to estimate a hypothetical willingness to pay (WTP) for such a surveillance system. To collect primary data, an online WTP experiment was administered to a nationally representative sample in Japan in spring 2023 (N = 2457). Results indicated that mean WTP was US $23.47 (Median $8.83) per household per year, and that around 97% of individuals had a non-zero WTP. The monetary valuation aggregated to the national level ($497 million based on the median value) exceeds the likely costs of maintaining the system in Japan ($33 million). Based on the population's valuation of the nationwide wastewater surveillance system, its establishment would be economically justifiable in Japan. Our results are expected to inform stakeholders in Japan, the US, the European Union, and other countries considering expanding or maintaining wastewater surveillance systems that are applicable for diverse infectious diseases including COVID-19. For a future epidemic with uncertain risks, the surveillance systems' economic efficiency (e.g., cost-effectiveness and return-on-investment) is difficult to assess. Eliciting taxpayers' WTP can be informative for that purpose.

Background: Menstrual symptoms have been identified as a substantial burden among women of reproductive age, affecting their health status and quality of life globally. A range of menstrual symptoms have been studied as they affect the health-related quality of life (HRQoL), showing variations across specific menstrual symptoms and study settings. A major concern is demonstrated due to menstrual symptoms in women’s professional and social life, and consequently societal and economic loss for women and the society at large. Yet evidence is scarce that estimates the index form HRQoL score related to menstrual symptoms that is needed for health economic evaluations. Methods: This study aims to investigate the association between menstrual symptoms and the HRQoL among working women in Japan in an index form, using a self-reporting questionnaire (n = 6048). The EQ-5D-3L (EuroQoL 5-dimension 3-level) is used that is a widely used tool to measure health outcomes for health economic evaluations globally. Multivariate regression analysis is conducted to assess the association between the HRQoL score and specific nineteen physical and mental conditions related to menstruation (e.g., pain, heavy bleeding, concentration, negative affect). Results: The index form HRQoL score for menstrual symptoms is estimated as 0.682 in the study population (where a score one suggests perfect health). The association of the HRQoL score varies substantially across the menstrual symptoms. Several of the physical conditions and disorders show a substantial negative association with the HRQoL score. Also, most of the mental and psychological issues are significantly and negatively related to the HRQoL score. Conclusions: This study suggests that HRQoL is substantially and negatively affected by menstruation among working women in Japan. Distinct variations of negative influences across menstrual symptoms underscore the multi-dimensional nature of menstruation and consequently the need of collective interventions to address these difficulties. The evidence of HRQoL continues to be an important area for future research on women’s health and health economic evaluations to inform effective and efficient resource allocations for relevant health policies and financing strategies.

Objectives: To determine the health utility values (HUVs) of overactive bladder (OAB), defined as urinary urgency, usually accompanied by urinary daytime or nocturnal frequency, with or without urinary incontinence, among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity. Methods: This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each sex and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≤5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol five-dimension five-level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB. We selected eight covariates (age, sex, body mass index, education, income, smoking, alcohol use, and comorbidities) as potential confounders based on previous studies. The sample size was determined based on previous studies without statistical power calculations. Results: Among the 998 participants (51.9% male; mean age, 73.2 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs] and p values) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066, p = 0.014) and −0.0591 (−0.0844 to −0.0339, p < 0.001), respectively. Conclusions: Consistent with previous HUV studies on OAB, our results demonstrated that the prevalence of OAB was associated with substantially lower HUV. The results demonstrate that increased OAB severity is associated with greater disutility.

Background and Objective: The introduction of immune checkpoint inhibitors (ICIs) in oncology presents a critical healthcare policy challenge for resource allocation due to their substantial financial burden. This study assessed the reporting quality of health economic evaluation (HEE) studies of ICIs. Methods: This study conducted a systematic literature search of four databases (PubMed, EMBASE, Cochrane CENTRAL, and the International HTA Database) for studies published between January 1, 2014 and December 31, 2022. All ICIs approved up to December 31, 2022, in the USA, EU, China, and Japan were included. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards published in 2013 (CHEERS 2013), which is the most widely recognised and implemented reporting guideline for HEE studies. Subgroup analyses were also performed based on the risk of sponsorship bias or citation of CHEERS 2013. Results: A total of 5368 records were identified, 252 of which were included after full-text review. The study design, setting, and ICIs most frequently observed were cost-effectiveness and cost-utility analyses (63.5%), the USA (46.0%), and pembrolizumab (38.1%), respectively. Of the 24 items of CHEERS 2013, fully reported items were limited, particularly in the Methods section. Setting and location were not reported in 94.4% of the records. Subgroup analyses also revealed insufficient reporting of items in the Methods section, particularly “Setting and location”. Conclusion: Health economic evaluation studies on ICIs between 2014 and 2022 had limited reporting across the 24 items of CHEERS 2013, regardless of sponsorship bias risk or citations. The items on setting and location in the Methods section were particularly underreported, emphasising the need for transparent reporting in HEE studies of ICIs.

Purpose: In this study, we aimed to evaluate the cost-effectiveness of S-1 and oxaliplatin (SOX) plus bevacizumab (Bmab group) compared with SOX plus cetuximab (Cmab group) as a first-line treatment for patients with Kirsten rat sarcoma virus (KRAS) wild-type metastatic colorectal cancer (mCRC) in Japan from the perspective of healthcare payers. Methods: A partitioned survival model was developed using data from the randomized phase II Osaka Multicenter Study Group on Colorectal Cancer-1107 study, which included overall survival, progression-free survival, and treatment regimens for the Bmab and Cmab groups. Treatment costs were estimated from the Japanese medical claims database and the National Health Insurance drug price list. The utilities were derived from the literature. Outcomes were reported as incremental cost, incremental quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) threshold was set at 7.5 million JPY per QALY. The time horizon of the model was set to 20 years. Sensitivity analyses were conducted to assess the uncertainty of the model for various parameters. Findings: Compared with the Cmab group, the Bmab group had an incremental cost of 911,373 JPY (6,528 USD), an incremental effectiveness of 0.79 QALY, and an ICER of 1146,745 JPY (8,215 USD) per QALY. One-way sensitivity analysis showed that the cost of progressive disease treatment in the Bmab group had the greatest impact on the ICER. According to the probabilistic sensitivity analysis, the Bmab group had a 94.9% probability of being cost-effective compared with the Cmab group. Implications: Considering a WTP threshold of 7.5 million JPY (approximately 53,700 USD) per QALY, Bmab might be a cost-effective treatment option for patients with KRAS wild-type mCRC in Japan. Further studies on economic evaluations based on personalized drugs and patient selection based on clinical and genetic information are warranted.

Background: Surgical-site antisepsis is used to prevent surgical-site infections (SSIs). Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine, povidone-iodine, and olanexidine, in reducing the SSI rate, an optimal recommendation is still not established. The aim of this study was to evaluate the efficacy of aqueous olanexidine compared with chlorhexidine-alcohol as the optimal antiseptic for preventing SSI in clean-contaminated surgery. Methods: This multicentre randomized trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary-pancreatic surgeries in five hospitals evaluated the efficacy of olanexidine and chlorhexidine-alcohol. The primary endpoint was 30-day SSI. Secondary outcomes included the occurrence of SSI types, intervention-related toxicity, and reoperation caused by SSI. Results: Overall, 700 patients from five institutions underwent randomization; 347 received olanexidine and 345 received chlorhexidine-alcohol in the full analysis set. The 30-day SSI rate was 12.4% (43 of 347) in the olanexidine group and 13.6% (47 of 345) in the chlorhexidine-alcohol group (adjusted risk ratio (aRR) 0.911 (95% c.i. 0.625 to 1.327); P = 0.626). No significant differences were observed between the groups regarding the secondary outcomes, including the occurrence of superficial incisional SSI, deep incisional SSI, organ/space SSI, and reoperation caused by SSI. Overall adverse effects were seen in two patients (0.58%) in the olanexidine group and in three patients (0.87%) in the chlorhexidine-alcohol group (aRR 0.663 (95% c.i. 0.111 to 3.951)). Conclusion: Olanexidine did not significantly reduce the occurrence of overall SSI compared with chlorhexidine-alcohol. Nevertheless, these findings provide valuable insights for developing novel surgical SSI management protocols. Registration number: UMIN 000049712 (University Hospital Medical Information Network Clinical Trials Registry).

Background: Numerous studies have described positive relationships between hospital volume (HV) and clinical outcomes in highly complex procedures, including esophagectomies. Although the centralization of surgery has been considered a possible solution for improving clinical outcomes, the HV impact on perioperative healthcare costs is unknown. This study aimed to determine the relationship between HV and perioperative healthcare costs for patients undergoing esophagectomy for esophageal cancer. Methods: This retrospective, nationwide cohort study used Japanese Administrative Claims Database data. Data on esophagectomies performed nationwide in 2015 were extracted. The outcome measure was perioperative healthcare costs per person from the perspective of the insurer. The healthcare costs in outpatient or inpatient settings of any hospital and clinic where patients received treatment were summed up from the month the surgery was performed to 3 months after. Linear regression analyses were conducted to assess the risk-adjusted effects of the HV category (1–4/5–9/10–14/15–) on perioperative costs. Results: A total of 5232 patients underwent an esophagectomy at 584 hospitals. The overall perioperative cost was 20.834 billion Japanese yen (JPY). The median perioperative costs per person for each HV category (1–4/5–9/10–14/15–) were 3.728 (709 patients), 3.740 (658 patients), 3.760 (512 patients), and 3.760 (3253 patients) million JPY, respectively (P = 0.676). Multivariate analyses revealed that each HV category had no significant impact on perioperative costs. Conclusions: There were no significant differences in the perioperative costs between high- and low-volume centers. Esophageal cancer surgery centralization may be achievable without increasing healthcare costs.