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Background: Japan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region. Regional differences in prevalence might cause regional differences in physicians' experiences and the efficiency of care-resource use. This study investigated regional differences in the performance of bone marrow transplantation (BMT), outcome and care-resource use in patients with ATL in Japan.Methods: This was a cross-sectional study using a Japanese hospital administrative database in 2010, with a diagnostic-procedure combination/per diem payment system. We examined the association between BMT performance, resource use, outcomes and region.Results: We analysed data for 712 subjects of whom 60.5% were Kyushu/Okinawa residents. Significantly more patients with ATL underwent BMT in Kanto (p = 0.018) and Kansai (p < 0.001) regions compared with the Kyushu/Okinawa regions. The lengths of hospital stay were longer in Kanto (p = 0.002) and Kansai (p = 0.006) regions than in the Kyushu/Okinawa region. Total health-care costs were higher in Kanto (p = 0.001) and Kansai (p = 0.005) regions than the Kyushu/Okinawa region. The risks of in hospital mortality were not significantly different between regions.Conclusions: There were significant regional differences in BMT performance and resource use within Japan. ATL prevalence was not related to the performance of BMTs, resource use or outcomes. Factors related to regional socioeconomics might affect the performance of BMTs and care resource use within Japan. [ABSTRACT FROM AUTHOR]

Background: Cost sharing, including copayment and coinsurance, is often used to contain medical expenditure by decreasing unnecessary or excessive use of healthcare resources. Previous studies in Japan have reported the effects of a coinsurance rate reduction for healthcare from 30 to 10% on the demand for healthcare among 70-74-year-old individuals. However, the coinsurance rate for this age group has recently increased from 10 to 20%. This study aimed to estimate the economic impact of coinsurance rate revision on healthcare resource utilization., Methods: We collected claims data from beneficiaries of the municipality National Health Insurance and the Japanese Health Insurance Association in Fukuoka Prefecture. We categorized subjects born between March 2, 1944 and April 1, 1944 into the 20% coinsurance rate reduction group and those born between April 2, 1944 and May 1, 1944 into the 10% reduction group. An interrupted time-series analysis for multiple groups was employed to compare healthcare resource utilization trends before and after coinsurance rate reduction at 70 years., Results: The 10% coinsurance rate reduction led to a significant increase in healthcare expenditure for outpatient care. The 20% reduction group showed a significantly sharper increase in healthcare expenditure for outpatient care than the 10% reduction group. Similarly, the 10% coinsurance group significantly increased in the number of ambulatory visits. The 20% coinsurance rate reduction group had more frequent ambulatory care visits than the 10% reduction group., Conclusions: These results suggest that increasing the coinsurance rate among the elderly would reduce outpatient healthcare resource utilization; however, it would not necessarily reduce overall healthcare resource utilization.

Background: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease worldwide. Renin-angiotensin system (RAS) inhibitors are the first-line treatment for diabetic patients with hypertension. However, whether RAS inhibitors prevent the development of DKD remains controversial. We conducted a retrospective cohort study quantifying the preventive effect of antihypertensive treatment with RAS inhibitors on DKD, using data from specific health check-ups and health insurance claims., Methods: The study subjects were 418 patients with diabetes and hypertension, drawn from health insurance societies located in Fukuoka and Shizuoka prefectures in Japan. The subjects were divided into three groups, according to the type of antihypertensive treatment they received. They were then compared in terms of the development of DKD, using the diagnostic codes from ICD-10., Results: Thirty subjects (6.2%) developed DKD during the study period between April 2011 and September 2013. RAS inhibitor treated group showed a significantly lower risk of DKD [adjusted odds ratio (AOR) = 0.35; 95% confidential interval (CI): 0.16-0.76] compared with the no treatment group., Conclusion: We conclude that antihypertensive treatment with RAS inhibitors is potentially useful for preventing the development of DKD.