Prescription of anti-influenza drugs in Japan, 2014-2020: A retrospective study using open data from the national claims database.

BACKGROUND: Both physicians and patients are proactive towards managing seasonal influenza in Japan and six drugs are approved. Although many countries have national influenza surveillance systems, data on nationwide prescription practices of anti-influenza drugs are lacking. Therefore, we aimed to clarify the status of anti-influenza drug use in Japan by analyzing real-world data. METHODS: This retrospective study analyzed open data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers most claims data from national health insurance. We estimated the annual number of patients prescribed anti-influenza drugs, which drugs they were prescribed, the patients' age and sex distribution, drug costs, and regional disparities for the period 2014-2020. RESULTS: For 2014-2019, an estimated 6.7-13.4 million patients per year were prescribed anti-influenza drugs, with an annual cost of 22.3-48.0 billion JPY (Japanese Yen). In addition, 21.1-32.0 million rapid antigen tests were performed at a cost of 30.1-47.1 billion JPY. In 2017, laninamivir was the most frequently prescribed anti-influenza drug (48%), followed by oseltamivir (36%), while in 2018, the newly introduced baloxavir accounted for 40.8% of prescriptions. After the emergence of COVID-19, the estimated number of patients prescribed anti-influenza drugs in 2020 dropped to just 14,000. In 2018, 37.6% of prescriptions were for patients aged < 20 years compared with 12.2% for those aged ≥ 65 years. Prescriptions for inpatients accounted for 1.1%, and the proportion of prescriptions for inpatients increased with age, with men were more likely than women to be prescribed anti-influenza drugs while hospitalized. CONCLUSIONS: Based on our clarification of how influenza is clinically managed in Japan, future work should evaluate the clinical and economic aspects of proactively prescribing anti-influenza drugs.

Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial.

BACKGROUND: Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. OBJECTIVE: This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. METHODS: This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. RESULTS: In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (-1.43, 95% CI -2.49 to -0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (-9.42, 95% CI -14.47 to -4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (-1.95, 95% CI -3.33 to -0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. CONCLUSIONS: The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. TRIAL REGISTRATION: University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb.

Clinical and cost-effectiveness of nurse-led cognitive behavioral group therapy for recovery of self-esteem among individuals with mental disorders: A single-group pre-post study.

AIM: To investigate whether the addition of a nurse-led cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) program to usual care for individuals with mental disorders can improve clinical outcomes and reduce direct medical costs. METHODS: This study employed single-group pre-post design, and recruited 51 community-dwelling individuals with mental disorders. Participants received 12 weekly CBGTRS sessions by a nurse in addition to usual care. The primary outcome measure was the level of self-esteem, with other clinical outcomes and direct medical costs. The clinical outcomes were measured at pre-intervention (T0), intervention midpoint (T1), immediate post-intervention (T2), and 3 months post-intervention (T3). Direct medical costs were calculated for 3 months pre-intervention (A0), 3 months post-intervention (A1), between 4-6 months post-intervention (A2), and between 7-9 months post-intervention (A3). RESULTS: Self-esteem scores were significantly improved from T0 to T2 and T3 (p = .009 and .006, respectively); within-group effect sizes were .49 (small) for T0-T2, and .51 (medium) for T0-T3. Other secondary clinical outcomes for mood, cognitive bias, global functioning, and quality of life were also improved by T3 (all p < .05). The mean total direct medical costs were significantly reduced from A0 (49,569.51 JPY) to A2 and A3 (21,845.76 JPY and 25,981.69 JPY, respectively) (p = .003 and .017, respectively). CONCLUSIONS: The results suggest that nurse-led CBGTRS for mental disorders is a potentially effective approach in improving self-esteem and other clinical outcomes, and in reducing direct medical costs. Further controlled studies that address the limitations of this study are required.

[Medical expenses for diabetes care in Japan: Analysis of inter-prefecture differences].

Objectives　Medical expenses for diabetes differ between Japan's 47 prefectures. The medical care expenditure regulation plan aims to reduce regional differences in outpatient medical costs through prevention of severe diabetes, promotion of specific health checkups and specific health guidance, promotion of generic drugs, and proper use of medicines. To achieve this goal, we need to conduct an in-depth analysis of inter-prefecture differences in diabetes care expenses. This study analyzed regional differences in prescription fees for dipeptidyl peptidase-4 (DPP-4) inhibitors and the use of generic sulfonylureas (SUs), glinides, biguanides, α-glucosidase inhibitors (α-GIs), and thiazoline derivatives, using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Furthermore, we analyzed regional differences in consultancy fees for dialysis prevention.Methods　We analyzed the 2nd NDB Open Data Japan website of the Ministry of Health, Labor, and Welfare. Pearson's correlation coefficient (r) was used to evaluate the relationship between the medical costs of diabetes and each factor. The correlation coefficient was analyzed with Student's t-test, and a P-value<0.05 was considered statistically significant.Results　Regarding oral hypoglycemic drugs, prefectures with a large number of DPP-4 inhibitors tended to have higher medical costs of diabetes (r=0.40, P=0.0048). Furthermore, such expenses tended to be low in prefectures where the use of generic SU drugs was high (r=-0.43, P=0.0023).Conclusions　In conclusion, the results revealed regional differences in the use of DPP-4 inhibitors and generic SU drugs, which may contribute to the regional differences in medical expenses for diabetes. This study suggests that NDB open data are useful for policy making to reduce regional differences in outpatient medical costs of diabetes.

A feasibility study of the clinical effectiveness and cost-effectiveness of individual cognitive behavioral therapy for panic disorder in a Japanese clinical setting: an uncontrolled pilot study.

BACKGROUND: In Japan, cognitive behavioral therapy (CBT) for panic disorder (PD) is not well established. Therefore, a feasibility study of the clinical effectiveness and cost-effectiveness of CBT for PD in a Japanese clinical setting is urgently required. This was a pilot uncontrolled trial and the intervention consisted of a 16-week CBT program. The primary outcome was Panic Disorder Severity Scale (PDSS) scores. Quality of life was assessed using the EuroQol's EQ-5D questionnaire. Assessments were conducted at baseline, 8 weeks, and at the end of the study. Fifteen subjects completed outcome measures at all assessment points. RESULTS: At post-CBT, the mean reduction in PDSS scores from baseline was -6.6 (95 % CI 3.80 to -9.40, p < 0.001) with a Cohen's d = 1.77 (95 % CI 0.88-2.55). Ten (66.7 %) participants achieved a 40 % or greater reduction in PDSS. By calculating areas under the curve for EQ-5D index changes, we estimated that patients gained a minimum of 0.102 QALYs per 1 year due to the CBT. CONCLUSIONS: This study demonstrated that individual CBT for PD may be useful in Japanese clinical settings but further randomized control trials are needed. TRIAL REGISTRATION: UMIN-CTR UMIN000022693 (retrospectively registered).

[Cost-benefit analysis of primary prevention programs for mental health at the workplace in Japan].

OBJECTIVES: To determine the cost-benefits of primary prevention programs for mental health at the workplace, we conducted a meta-analysis of published studies in Japan. METHODS: We searched the literature, published as of 16 November 2011, using the Pubmed database and relevant key words. The inclusion criteria were: conducted in the workplace in Japan; primary prevention focus; quasi-experimental studies or controlled trials; and outcomes including absenteeism or presenteeism. Four studies were identified: one participatory work environment improvement, one individual-oriented stress management, and two supervisor education programs. Costs and benefits in yen were estimated for each program, based on the description of the programs in the literature, and additional information from the authors. The benefits were estimated based on each program's effect on work performance (measured using the WHO Health and Work Performance Questionnaire in all studies), as well as sick leave days, if available. The estimated relative increase in work performance (%) in the intervention group compared to the control group was converted into labor cost using the average bonus (18% of the total annual salary) awarded to employees in Japan as a base. Sensitive analyses were conducted using different models of time-trend of intervention effects and 95% confidence limits of the relative increase in work performance. RESULTS: For the participatory work environment improvement program, the cost was estimated as 7,660 yen per employee, and the benefit was 15,200-22,800 yen per employee. For the individual-oriented stress management program, the cost was 9,708 yen per employee, and the benefit was 15,200-22,920 yen per employee. For supervisor education programs, the costs and benefits were respectively 5,209 and 4,400-6,600 yen per employee, in one study, 2,949 and zero yen per employee in the other study. The 95% confidence intervals were wide for all these studies. CONCLUSIONS: For the point estimates based on these cases, the participatory work environment improvement program and the individual-oriented stress management program showed better cost-benefits. For the supervisor education programs, the costs were almost equal to or greater than the benefits. The results of the present study suggest these primary prevention programs for mental health at the workplace are economically advantageous to employers. Because the 95% confidence intervals were wide, further research is needed to clarify if these interventions yield statistically significant cost-benefits.