論文

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.

公的分析は、製造販売業者（ファイザー株式会社）より提出された、ニルマトレルビル/リトナビルのSARS-CoV-2による感染症（COVID-19）に対する追加的有用性及び経済評価に関する報告について、レビューを行った。本報告書ではその結果と、公的分析が実施した再分析の内容を要約した。分析対象集団は、重症化リスク因子を有するCOVID-19患者（小児を除く）とした。分析枠組みでは、本邦でのオミクロン株流行以降の状況や、ワクチン接種状況を考慮することとされた。追加的有用性の評価に際して、製造販売業者はシステマティックレビューの結果、ニルマトレルビル/リトナビルを評価した臨床試験であるEPIC-HR試験を同定した。比較対照技術であるモルヌピラビルを評価したMOVe-OUT試験との間接比較（MAIC）を実施し、ニルマトレルビル/リトナビルでより高い重症化（COVID-19による入院もしくは死亡）の予防効果が認められた。そこで、製造販売業者はニルマトレルビル/リトナビルがモルヌピラビルに対して追加的有用性を有すると判断した。しかし公的分析は、EPIC-HRおよびMOVe-OUT試験はいずれも、分析枠組みで定められた、オミクロン株流行/ワクチン接種下である本邦の実態と状況が異なると考えた。さらに、公的分析期間中に出版されたEPIC-SR試験では、ニルマトレルビル/リトナビルはプラセボに対して主要評価項目であるCOVID-19の有症状期間の短縮効果は認められず、副次評価項目である28日目までのCOVID-19関連入院又は全死亡割合はニルマトレルビル/リトナビルで低い傾向があった。この結果よりニルマトレルビル/リトナビルの重症化予防効果が示唆はされるものの、EPIC-SR試験がデルタ株流行下で行われたこと等を考慮して、公的分析はその時点のエビデンスで追加的有用性について、一定の評価の方向性を出すことは困難であると評価し、オミクロン株流行/ワクチン接種下でニルマトレルビル/リトナビルの有効性を評価したPANORAMIC試験に基づいて評価を行うことを推奨した。上記に基づいて、2024年9月11日に中央社会保険医療協議会総会にて1年間の分析中断が承認され、その後、2025年11月14日に分析期間を3か月として分析再開が承認された。現時点で利用可能な範囲のPANORAMIC試験の結果を含めて、ニルマトレルビル/リトナビルの追加的有用性を支持する文献は出版されていなかったため、公的分析はオミクロン株流行/ワクチン接種下でのニルマトレルビル/リトナビルのモルヌピラビルに対する追加的有用性は示されていないと判断した。経済評価については、製造販売業者はCOVID-19の発症から急性期治療終了までの分析期間は決定樹モデル、その後の分析期間（生涯）はマルコフモデルを用いた費用効果分析を実施した。モデルの有効性パラメータ（重症化予防効果）には、EPIC-HR試験とMOVe-OUT試験の間接比較のデータが用いられていた。公的分析では、ニルマトレルビル/リトナビルは比較対照技術に対して、追加的有用性を有すると判断できないと評価したことから、治療効果に群間差を設定せず、治療費用を比較する費用最小化分析を実施した。その結果、ニルマトレルビル/リトナビルは比較対照技術に対して12,432円の費用増加であった。以上より、公的分析の結果は、本邦における公的医療の立場において、モルヌピラビルに対してニルマトレルビル/リトナビルは「効果が同等 ( あるいは劣り )、かつ費用が増加」の区間に所属する可能性が高いことを示唆した。

公的分析は、リトレシチニブの製造販売業者（ファイザー株式会社）より提出された、頭部全体の概ね50％以上に脱毛が認められる成人及び小児（12歳以上）の円形脱毛症患者におけるリトレシチニブの追加的有用性及び経済評価に関する報告についてレビューを行った。本報告書では、その結果と公的分析が実施した再分析の内容を要約している。追加的有用性の評価に際して、製造販売業者は、リトレシチニブとバリシチニブを直接比較したランダム化比較試験（RCT）は同定されなかったことを報告した。公的分析は、独自に実施したシステマティックレビューの結果、リトレシチニブとバリシチニブを直接比較したRCTに関する文献が同定されないことを確認した。また、製造販売業者の評価と同様に、ALLEGRO-2b/3試験及びBRAVE-AA1/AA2試験に関する文献を同定した。成人集団において製造販売業者は、ALLEGRO-2b/3試験及びBRAVE-AA1/AA2試験における治療効果の単純な比較では、リトレシチニブのバリシチニブに対する優劣を判断することが困難であると判断した。公的分析は、リトレシチニブのバリシチニブに対する追加的有用性を評価するためネットワークメタアナリシスを実施したが、点推定値の95％信頼区間が広く、推定値には大きな不確実性が伴うと判断した。以上から、公的分析は製造販売業者の主張を受け入れ、成人集団において、リトレシチニブのバリシチニブに対する追加的有用性は示されていないと判断した。したがって、費用最小化分析を実施することが妥当であり、公的分析は製造販売業者から提出された費用最小化分析の内容について精査した。小児集団において製造販売業者は、ALLEGRO-2b/3試験の全体集団において認められたリトレシチニブの有効性が、小児集団においても同様に期待できると評価した。そのため、製造販売業者は、リトレシチニブがBest supportive care（BSC）に対する追加的有用性を有すると判断した。公的分析は、症例数が限られることなどから同集団のリトレシチニブの治療効果の推定には不確実性を伴う可能性を認めたものの、全体集団と同様の傾向が認められると判断した。以上から、公的分析は小児集団において、リトレシチニブのBSCに対する追加的有用性が示されていると判断した。したがって、費用効果分析を実施することが妥当であり、公的分析は製造販売業者から提出された費用効果分析の内容について精査した。製造販売業者の分析は、積極治療（リトレシチニブ、バリシチニブ）の有無とSeverity of alopecia toolスコアで層別化した健康状態及び死亡を含む9つの健康状態から構成されるマルコフモデルを用いて実施された。公的分析は、製造販売業者が実施した分析には、開始年齢、有効性のパラメータ設定、後治療の設定などのいくつかの課題が認められたため、再分析を実施した。特に、臨床診療においてバリシチニブは15歳以降の患者に対して使用可能であるものの、製造販売業者の分析では生涯にわたってBSCを適用し続けていたことが課題であると考えた。公的分析の再分析では、比較対照技術群において15歳以降はバリシチニブによる治療を受ける設定を適用した。その結果、成人集団における基本分析では、バリシチニブと比較してリトレシチニブは1,710,932円の増分費用が生じた。また、小児集団における基本分析では、BSCと比較してリトレシチニブは1,210,540円の増分費用と0.06質調整生存年（QALYs）の増分効果が生じ、増分費用効果比（ICER）は、19,436,419円/QALYであった。以上より、公的分析の結果は本邦における公的医療の立場において、比較対照技術に対するリトレシチニブのICERは、成人集団では「効果が同等（あるいは劣り）、かつ費用が増加」の区画に所属し、小児集団では「1,500万円/QALY以上」の区画に所属する可能性が高いことを示唆した。

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.

公的分析は、ブリーバラセタムの製造販売業者(ユーシービージャパン株式会社)より提出された、てんかん患者の部分発作(二次性全般化発作を含む)に対するブリーバラセタムの追加的有用性、および経済評価報告をレビューした。本報告書では、その結果と、公的分析による再分析を要約している。分析対象集団(a)は単剤療法による治療を受ける患者、分析対象集団(b)は併用療法による治療を受ける患者である。比較対照技術はそれぞれ、分析対象集団(a)ではレベチラセタム、分析対象集団(b)ではレベチラセタム＋薬物療法であり、評価対象技術は分析対象集団(a)ではブリーバラセタム、分析対象集団(b)ではブリーバラセタム+薬物療法であった。追加的有用性の評価に際して、製造販売業者が実施した、分析対象集団(a)を対象にしたシステマティックレビュー(SR)において、ブリーバラセタムとレベチラセタムを直接比較したRCTは特定されなかった。非RCTを対象としたSRは実施されなかった。この結果、評価に足る臨床試験が存在せず、追加的有用性の判断ができないとした。分析対象集団(b)を対象にしたSRにおいて、ブリーバラセタム＋薬物療法とレベチラセタム＋薬物療法を直接比較したRCTは特定されなかったが、ブリーバラセタムによる併用療法の追加的有用性を検討するための文献として7件特定された。製造販売業者は先行研究に基づき文献選択とアウトカム抽出を行い、イベント数0のデータに連続性補正を施した上で、頻度論的ネットワークメタ解析(NMA)を実施した。この結果、完全発作消失率と有害事象による治療中断率の点推定値に基づき、追加的有用性が示されていると結論付けた。公的分析におけるSRにおいても、集団(a)については追加的有用性評価に利用可能なデータは特定されなかった。分析対象集団(b)については、「発作抑制」に関しては追加的有用性が示されていないと判断したものの、「有害事象による治療中断」については追加的有用性が示されていると判断した。このため、公的分析は分析対象集団(b)については費用効果分析を実施することが妥当であると判断し、製造販売業者から提出された分析内容を精査した。製造販売業者は、分析対象集団(b)について、ブリーバラセタム+薬物療法の費用対効果を評価するため、マルコフモデルを構築し、費用効果分析を実施した。これに対して公的分析は、製造販売業者が実施した分析に、①発作抑制の有効性、②維持治療の継続率、③後治療の設定、④quality of life (QOL)値において課題が認められたため、再分析を実施した。①では「発作抑制」に関しては追加的有用性が示されていないと判断したために、発作抑制に関する治療効果(OR)はすべて1.0であると仮定して再分析を実施した。②では、製造販売業者はRCTおよび観察研究から得られたデータを単純に比較することによりブリーバラセタムの高い治療継続率を推計していたが、公的分析では、レベチラセタムの維持治療中断率に「有害事象による治療中断」のOR=0.678を乗じることで、ブリーバラセタムの治療継続率を推計した。③では「後治療」における費用(医療費)とQOL値は”0”であると仮定した製造販売業者の設定は妥当でないことから、「非レスポンダー」の費用及びQOL値を「後治療」に適用して再分析を行った。④では製造販売業者はQOL値のデータソースとして、韓国の一般人を対象としたビニエット法に基づくQOL値データを用いたが、公的分析では、ブリーバラセタムの臨床試験において、患者本人に対する調査で得られたQOL値を用いて再分析を行った。公的分析による再分析の結果、分析対象集団(b)において、ブリーバラセタム＋薬物療法はレベチラセタム＋薬物療法と比較して0.023QALYsの増分効果と1,099,134円の増分費用が生じ、増分費用効果比(ICER)は48,163,534円/QALYであった。以上より、本邦における公的医療の立場において、レベチラセタム＋薬物療法に対するブリーバラセタム＋薬物療法のICERは、「1,000万円/QALY以上」の区間に所属する可能性が高いことが示唆された。

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 mil-lion 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.

Background: Medical 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 coronavirus disease 2019 (COVID-19) pandemic. Methods: A 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. Results: The 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 Japanese yen (JPY) and 12.5 trillion JPY, respectively. 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. Conclusion: This 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.