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Cost-effectiveness of minimally invasive surgery using multicenter DPC data analysis and its development into optimal treatment strategies.

Research Project

Project/Area Number 18K08764
Research Category

Grant-in-Aid for Scientific Research (C)

Allocation TypeMulti-year Fund
Section一般
Review Section Basic Section 55030:Cardiovascular surgery-related
Research InstitutionSaga University

Principal Investigator

Yunoki Junji  佐賀大学, 医学部, 准教授 (00728363)

Co-Investigator(Kenkyū-buntansha) 古舘 晃  佐賀大学, 医学部, 助教 (30448477)
西田 誉浩  佐賀大学, 医学部, 教授 (50284500)
伊藤 学  佐賀大学, 医学部, 講師 (50555084)
藤井 進  慶應義塾大学, 政策・メディア研究科(藤沢), 特任講師 (60535748)
森田 茂樹  佐賀大学, 医学部, 客員研究員 (70243938)
野上 英次郎  佐賀大学, 医学部, 助教 (70766534)
高松 正憲  佐賀大学, 医学部, 助教 (90594656)
Project Period (FY) 2018-04-01 – 2023-03-31
Project Status Completed (Fiscal Year 2022)
Budget Amount *help
¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000)
Fiscal Year 2020: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2018: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
KeywordsDPCデータ / 低侵襲治療 / 費用対効果 / TAVI / SAVR / 低侵襲手術
Outline of Final Research Achievements

Various minimally invasive treatments are evolving, and the cost-effectiveness of such interventions is crucial. Using transcatheter aortic valve implantation (TAVI) as a model for minimally invasive surgery in severe aortic valve stenosis, we compared it with the conventional open-heart surgery known as surgical aortic valve replacement (SAVR) using multi-center DPC data. Employing our protocol, we utilized DPC data from the Ministry of Health, Labour, and Welfare to examine 12,534 SAVR cases and 14,744 TAVI cases in three years. The treatment outcomes showed favorable in-hospital mortality rates of 1.0% for SAVR and 0.6% for TAVI, with TAVI demonstrating significantly shorter hospital stays. Although TAVI had lower non-material costs, its total hospitalization costs were approximately 1 million yen higher due to expensive materials. We believe that if the material costs of TAVI can be reduced, its cost-effectiveness can be further enhanced.

Academic Significance and Societal Importance of the Research Achievements

厚労省の有する多施設DPCデータを用いることで、比較的最近のビッグデータにて個々の治療行為の治療成績とその費用を検証できることが分かった。その中で重症大動脈弁狭窄症の低侵襲手術である経皮的大動脈弁留置術(TAVI)が従来の開胸手術と同等の治療成績を担保しつつ、短い在院日数で治療可能であることが分かった。治療が低侵襲であることで、注射料や入院料、検査料などの入院費はTAVIが低かったが、高い材料費のため総入院費はTAVIの方が約100万円高いことが分かった。今後TAVIが普及する中で、材料費が下がればその費用対効果はさらに期待できるが、今後はより長期的な治療成績と費用対効果の検証が必要である。

Report

(6 results)
  • 2022 Annual Research Report   Final Research Report ( PDF )
  • 2021 Research-status Report
  • 2020 Research-status Report
  • 2019 Research-status Report
  • 2018 Research-status Report
  • Research Products

    (15 results)

All 2023 2022 2021 2020 2019

All Journal Article (1 results) (of which Peer Reviewed: 1 results) Presentation (14 results) (of which Invited: 2 results)

  • [Journal Article] Early results of expanding the anatomical indications for using a Gore Iliac branch endoprosthesis to treat aortoiliac and iliac aneurysms2020

    • Author(s)
      Yunoki Junji、Kamohara Keiji、Koga Shugo、Tanaka Atsuhisa、Takeuchi Yuki、Uchino Motonori、Nogami Eijiro、Morokuma Hiroyuki、Koga Yuichi、Yoshitake Syuichiro、Itoh Manabu
    • Journal Title

      Surgery Today

      Volume: Online Issue: 6 Pages: 1-8

    • DOI

      10.1007/s00595-020-02183-4

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Presentation] 非ハイボリューム施設での局所麻酔鎮静下TAVRの導入とその成績2023

    • Author(s)
      柚木 純二
    • Organizer
      第53回心臓血管外科学会学術総会
    • Related Report
      2022 Annual Research Report
  • [Presentation] A clinical outcomes and cost effectiveness of SAVR and TF-TAVI for AS using DPC data in Japan2022

    • Author(s)
      柚木 純二
    • Organizer
      第86回日本循環器学会学術集会
    • Related Report
      2022 Annual Research Report
  • [Presentation] 偽腔開存型B型解離へのCTAGを用いたTEVARの中期成績-下行遠位、腹部解離拡大症例の検討-2022

    • Author(s)
      柚木 純二
    • Organizer
      第50回日本血管外科学会学術総会
    • Related Report
      2022 Annual Research Report
  • [Presentation] 両側経皮アプローチEVARの工夫とその短期成績-Cutdown EVAR症例と比較して-2022

    • Author(s)
      柚木 純二
    • Organizer
      第52回心臓血管外科学会学術総会
    • Related Report
      2022 Annual Research Report 2021 Research-status Report
  • [Presentation] A clinical outcomes and cost effectiveness of SAVR and TF-TAVI for AS using DPC data in Japan.2022

    • Author(s)
      柚木 純二
    • Organizer
      第86回日本循環器学会学術集会
    • Related Report
      2021 Research-status Report
  • [Presentation] 狭小末梢大動脈症例にExcluder IBE(lliac Branch Endoprosthesis)は対応可能か?2021

    • Author(s)
      柚木 純二
    • Organizer
      第49回日本血管外科学会学術総会
    • Related Report
      2021 Research-status Report
  • [Presentation] 低心機能超重症ASに対するTAVI治療の変遷2021

    • Author(s)
      柚木 純二
    • Organizer
      第54回日本胸部外科学会九州地方会
    • Related Report
      2021 Research-status Report
  • [Presentation] TAVI術後、抜管時にショック状態となった1例2020

    • Author(s)
      柚木 純二
    • Organizer
      第84回日本循環器学会学術集会
    • Related Report
      2020 Research-status Report
  • [Presentation] 総腸骨動脈瘤にExcluderIBEはどこまで適応拡大可能か?2020

    • Author(s)
      柚木 純二
    • Organizer
      第48回日本血管外科学会学術集会
    • Related Report
      2020 Research-status Report
  • [Presentation] 新たなActive control deployment systemを有するCTAGの初期使用経験2020

    • Author(s)
      柚木 純二
    • Organizer
      第48回日本血管外科学会学術集会
    • Related Report
      2020 Research-status Report
  • [Presentation] ENDURANT BodyとEXCLUDER Legを組み合わせて行ったEVARの中期成績2019

    • Author(s)
      柚木純二
    • Organizer
      第47回日本血管外科学会学術総会
    • Related Report
      2019 Research-status Report
  • [Presentation] 当科でのDebranching TEVARにおける脳梗塞予防2019

    • Author(s)
      柚木純二
    • Organizer
      International Symposium of Endovascular Aortic Arch Repair in Osaka;ENDO-ARCH OSAKA 2019
    • Related Report
      2019 Research-status Report
    • Invited
  • [Presentation] 外科手術術式概論2019

    • Author(s)
      柚木純二
    • Organizer
      ストラクチャークラブ・ジャパン ライブデモンストレーション2019
    • Related Report
      2019 Research-status Report
    • Invited
  • [Presentation] CKD患者へのBalloon expandable TF TAVRにおける術中Cone-beam CTの有用性2019

    • Author(s)
      柚木純二
    • Organizer
      第10回日本経カテーテル心臓弁治療学会学術集会
    • Related Report
      2019 Research-status Report

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Published: 2018-04-23   Modified: 2024-01-30  

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