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Abstract Background Vaccination programs often organize subsidies and public relations in order to obtain high uptake rates and coverage. However, effects of subsidies and public relations have not been studied well in the literature. In this study, the demand function of pneumococcal vaccination among the elderly in Japan is estimated, incorporating effects of public relations and subsidy. Methods Using a data from a questionnaire survey sent to municipalities, the varying and constant elasticity models were applied to estimate the demand function. The response variable is the uptake rate. Explanatory variables are: subsidy supported shot price, operating years of the program, target population size for vaccination, shot location intensity, income and various public relations tools. The best model is selected by c-AIC, and varying and constant price elasticities are calculated from estimation results. Results The vaccine uptake rate and the shot price have a negative relation. From the results of varying price elasticity, the demand for vaccination is elastic at municipalities with a shot price higher than 3,708 JPY (35.7 USD). Effects of public relations on the uptake rate are not found. Conclusions It can be suggested that municipalities with a shot price higher than 3,708 JPY (35.7 USD) could subsidize more and reduce price to increase the demand for vaccination. Effects of public relations are not confirmed in this study, probably due to measurement errors of variables used for public relations, and studies at micro level exploring individual’s response to public relations would be required.

Objective: A new opportunistic community-based strategy was launched in Japan in April 2014 to detect lifestyle-related diseases, including diabetes, by creating Specimen Measurement Offices (SMOs). SMOs offer walk-in fingertip HbA1c testing. This article aimed to assess the value-for-money of HbA1c testing services at SMOs by conducting a cost-effectiveness analysis.Research Design and Methods: We compared two scenarios: 1) status quo, defined as HbA1c testing that is available only through conventional screening, and 2) HbA1c testing available at SMOs as a complement to the status quo scenario. The model consisted of a screening module with a decision tree and a disease progression module with a Markov model. We calculated incremental cost-effectiveness ratios (i.e., cost per quality-adjusted life-years [QALYs]) over the lifetime analytic horizon as the primary end point of the cost-effectiveness analysis. In this model, we assumed the participant cohort to be people 40-74 years of age who sought walk-in fingertip HbA1c testing at SMOs on the premises of community pharmacies. Costs and outcomes were discounted at a rate of 3%. The cost-effectiveness was analyzed from a societal perspective.Results: The incremental cost per individual for those 40-74 years of age was estimated to be -527 U.S. dollars (USD) (-52,722 Japanese yen [JPY]) for HbA1c testing at SMOs compared with the status quo. Incremental effectiveness was estimated to be 0.0203 QALYs for HbA1c testing at SMOs compared with the status quo. Therefore, this cost-effectiveness analysis showed that compared with the status quo, HbA1c testing at SMOs was more effective and had lower cost for the population studied.Conclusions: We consider our results to be robust because most simulations were under the threshold of USD 50,000 (JPY 5,000,000) per QALYs gained, by sensitivity analysis. These results will be useful to managers of pharmacies or other health institutions and/or policy makers in local government. [ABSTRACT FROM AUTHOR]

The 21-gene signature is validated as a good predictor of recurrence for lymph node-negative/positive, hormone receptor-positive, early-stage breast cancer in Japanese patient population. This study evaluates the cost-effectiveness of two scenarios designed to include the assay into Japan's social health insurance benefit package: one for LN−, ER+, ESBC and another for LN−/+, ER+, ESBC. An economic decision tree and Markov model under Japan's health system from the societal perspective is constructed with new evidence from the Japanese validation study. Incremental cost-effectiveness ratios are estimated as ¥384,828 (US$3,848) per QALY for the indication for LN− scenario and ¥568,533 (US$5,685) per QALY for the indication for LN−/+ scenario. Both are not more than the suggested social willingness-to-pay for one QALY gain from an innovative medical intervention in Japan, ¥5,000,000/QALY (US$50,000/QALY). Sensitivity analyses show that this result is plausibly robust, since ICERs do not exceed the threshold by various changes of assumptions made and values employed. In conclusion, the inclusion of the assay in Japan's social health insurance benefit package for not only LN− diseases but also LN+ diseases is cost-effective. Such a decision can be justifiable as an efficient use of finite resources for health care. [ABSTRACT FROM AUTHOR]

In Japan, influenza vaccination is offered to children and pregnant women at clinics or hospitals as an elective, self-funded treatment, as the vaccination is not included in the national vaccination subsidy program. However, some Japanese municipalities offer a discretionary subsidy for seasonal influenza vaccination of children and pregnant women as a local policy. We identified these local subsidy programs during 2019/2020 seasonal influenza season by conducting a cross-sectional survey across Japan. Out of a total of 1741 municipalities, responses were received from 1732; therefore, the response rate was 99.5%. The local influenza vaccine subsidy programs for children were offered in 45.7%, and for pregnant women in 10.2%, of Japanese municipalities. This is the first survey of subsidy programs for pregnant women. While policy diffusion of subsidy programs for children was observed during the 9 years since a previous study, such programs for pregnant women remain limited. Despite many municipalities having subsidy programs, we found that their provision still remains limited when viewed as a whole.

Background: Pneumonia is common in nursing home residents and is a leading cause of hospitalization and death. Nursing home residents with cerebrovascular diseases and impaired consciousness are at high risk of aspiration pneumonia. Professional and mechanical oral care by dentists and hygienists in addition to daily oral care by caregivers was shown to be effective in preventing pneumonia in nursing home residents. However, professional and mechanical oral care has not been widely provided in Japan, while daily oral care by caregivers has been widely provided as a basic service in nursing homes. This study aimed to evaluate the cost-effectiveness of providing professional and mechanical oral care for preventing pneumonia in nursing home residents., Methods: Using a decision tree and Markov modeling, we conducted a cost-effectiveness analysis from the payer's perspective (social insurers and patients) in Japan., Results: The incremental cost-effectiveness ratio for professional and mechanical oral care compared with daily oral care only was calculated as 4,079,313 Japanese yen (¥; 33,994 United States dollars [US$], US$1 = ¥120) per quality-adjusted life year., Conclusions: Using the official value of social willingness to pay for a one-quality-adjusted life year gain in Japan of ¥5 million (US$41,667) as the threshold to judge cost-effectiveness, providing professional and mechanical oral care is cost-effective. Our results suggest professional and mechanical oral care for preventing pneumonia in nursing home residents could be justifiable as efficient use of finite healthcare resources. The results have implications for oral care in nursing homes both in Japan and worldwide., (© 2022 The American Geriatrics Society.)

Objective: A new opportunistic community-based strategy was launched in Japan in April 2014 to detect lifestyle-related diseases, including diabetes, by creating Specimen Measurement Offices (SMOs). SMOs offer walk-in fingertip HbA 1c testing. This article aimed to assess the value-for-money of HbA 1c testing services at SMOs by conducting a cost-effectiveness analysis., Research Design and Methods: We compared two scenarios: 1 ) status quo, defined as HbA 1c testing that is available only through conventional screening, and 2 ) HbA 1c testing available at SMOs as a complement to the status quo scenario. The model consisted of a screening module with a decision tree and a disease progression module with a Markov model. We calculated incremental cost-effectiveness ratios (i.e., cost per quality-adjusted life-years [QALYs]) over the lifetime analytic horizon as the primary end point of the cost-effectiveness analysis. In this model, we assumed the participant cohort to be people 40-74 years of age who sought walk-in fingertip HbA 1c testing at SMOs on the premises of community pharmacies. Costs and outcomes were discounted at a rate of 3%. The cost-effectiveness was analyzed from a societal perspective., Results: The incremental cost per individual for those 40-74 years of age was estimated to be -527 U.S. dollars (USD) (-52,722 Japanese yen [JPY]) for HbA 1c testing at SMOs compared with the status quo. Incremental effectiveness was estimated to be 0.0203 QALYs for HbA 1c testing at SMOs compared with the status quo. Therefore, this cost-effectiveness analysis showed that compared with the status quo, HbA 1c testing at SMOs was more effective and had lower cost for the population studied., Conclusions: We consider our results to be robust because most simulations were under the threshold of USD 50,000 (JPY 5,000,000) per QALYs gained, by sensitivity analysis. These results will be useful to managers of pharmacies or other health institutions and/or policy makers in local government., (© 2018 by the American Diabetes Association.)

Purpose: The number of municipalities that offer a pneumococcal pneumonia vaccine (PPV) to their aged inhabitants has been increasing. In this study, a complete count survey of the practice of municipality-organized PPV vaccination programs was carried out to explore co-payment/subsidy levels and uptake rates., Method: A questionnaire inquiring into the price charged to the vaccinee, the subsidy provided by the municipality, the size of the target population, and the numbers of individuals vaccinated from 2001 to 2007 was sent to 63 municipal authorities which had organized PPV vaccination programs. Annual changes of co-payment/subsidy and uptake rates are examined with analysis of variance (excluding the year with n < or = 2)., Results: The number of municipalities that provided a subsidy was 1 in 2001, 2 in 2002, 18 in both 2003 and 2004, 24 in 2005, 41 in 2006, and 56 in 2007. Average levels of subsidy were 3233 yen in 2003, 3225 yen in 2004, 3168 yen in 2005, 3158 yen in 2006, and 3351 yen in 2007. Average levels of co-payment are 3899 yen in 2003, 3928 yen in 2004, 3979 yen in 2005, 3891 yen in 2006 and 3672 yen in 2007. No significant differences were found among average levels of subsidy/co-payment between consecutive years (F = 0.195, p = 0.964/F = 0.271, p = 0.949). Average uptake rates by number of years since the beginning of the program (response rate 68.1%, 109/160) were 17.7% for the 1st-year, and 5.4%, 3.7%, 3.4%, 4.6% for the 2nd- to 5th-years, respectively. Statistically significant differences were observed between the 1st- and each of the following years (Dunnett T3, p < 0.001). Average uptake rates in the first year of the program (response rate 80.9%, 51/63) were 32.1% in 2003, 8.5% in 2005, 13.6% in 2006 and 16.5% in 2007. Significant differences were observed between 2003 and 2005 (Tukey's HSD, p = 0.03), and 2003 and 2006 (Tukey's HSD, P = 0.015)., Conclusion: Our results revealed levels of co-payment/subsidy and uptake rates of municipality-organized PPV vaccination programs for the first time.

Purpose: In 2001, Japan launched a nationwide subsidy program for influenza immunization of the elderly, whose implementation was devolved to municipalities. Rapid appraisal of the financial impact and utilisation are helpful for evaluating public programs. The government appraised uptake rate with a resource-consuming complete survey. In the present study, the authors carried out a simple and easy sample survey, with a simple random sampling method, to estimate averages of co-payment, subsidy, and total price for one vaccination. The utility of a simple random sampling method for a nationwide survey is also discussed., Method: A total of 300 individuals were randomly selected from about 22 million senior citizens in the 2001/2 season. A questionnaire is sent to their municipal authorities, inquiring about the price of vaccination, the target population size, and the numbers of vaccinated seniors from 2001/2 to 2004/5. Annual changes and the differences between urban and rural areas were examined with analysis of variance and regression analysis., Results: The response rate is 94.0%. Nationwide average prices of vaccination in terms of co-payment, subsidy, and total price changes from 2001/2 to 2004/5 were as follows: the co-payments were yen 1134, yen 1136, yen 1139, yen 1129 and yen 1148; the subsidies were yen 2972, yen 2955, yen 2966, yen 2954 and yen 2941; and the total prices are yen 4194, yen 4169, yen 4178, yen 4156 and yen 4142. No statistically significant differences were found in the annual rates. Vaccine uptake rates from 2001/2 to 2003/4 were 29.9%, 37.8%, 46.1%, 49.6%, showing a statistically significant increase., Conclusion: These are the first estimates of price and uptake rates of influenza vaccination for the elderly in Japan by a sample survey method. The results demonstrate that the co-payment, subsidies, and the total price have not changed significantly since the program started, but that uptake has improved. The results also suggest that simple random sampling methods are useful for rapid appraisal of the nationwide trends with public programs devolved to municipalities.