Exploration of statistical methods for improving cost-effectiveness analysis

• Project/Area Number: 19K22750
• Research Category: Grant-in-Aid for Challenging Research (Exploratory)
• Allocation Type: Multi-year Fund
• Review Section: Medium-sized Section 58:Society medicine, nursing, and related fields
• Research Institution: Niigata University
• Principal Investigator: Kohei Akazawa 新潟大学, 医歯学総合病院, 教授 (10175771)
• Co-Investigator(Kenkyū-buntansha): 石川 卓 新潟大学, 医歯学総合病院, 准教授 (70586940) ; 齋藤 翔太 新潟大学, 医歯学総合研究科, 客員研究員 (60739465) ; 中澤 香子 新潟大学, 医歯学総合病院, 薬剤師 (40816964)
• Project Period (FY): 2019-06-28 – 2022-03-31
• Project Status: Completed (Fiscal Year 2021)
• Budget Amount: ¥6,240,000 (Direct Cost: ¥4,800,000、Indirect Cost: ¥1,440,000); Fiscal Year 2021: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000); Fiscal Year 2020: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000); Fiscal Year 2019: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
• Keywords: 費用対効果分析 / マルコフモデル / 生存時間モデル / 遷移確率 / ハザード関数 / 感度分析 / 生存時間解析 / 医療経済評価 / 統計理論

Outline of Research at the Start

医療資源が限られている中で, 真に必要な医療サービスを分配する方策を客観的に評価する
必要がある。評価手法のひとつとして, 費用対効果分析(Cost Effective Analysis; 以下、CEA)が
ある。しかしながら、現在のCEA手法は理論的なあいまいさを残しており, その改善により
精度の高いCEAが可能となる。本研究では, 現在のCEAの問題点を見出し, 統計学的理論
に基づき解決策を導き出すことを目的とする。

Outline of Final Research Achievements

The aim of this study is to elucidate the problems of current cost-effectiveness analysis (CEA) and to explore the solutions from a statistical view of point. The results obtained from this study are as follows: (1) Some potential causes which induce biases and ambiguity for results of CEA were detected from real clinical dataset: a dataset of randomized controlled trial of breast cancer showed that the transition probabilities from n-cycle to (n+1)-cycle in Morkov model used in CEA are not constant. Therefore, the current CEA based on Morkov model has the possibility of misleading results and alternative models instead of Morkov model should be suggested. (2) To overcome the problem of (1), this study improved more comprehensive semi-parametric model to estimate accurate transition probability for each n-cycle state.

Academic Significance and Societal Importance of the Research Achievements

限られた医療資源の中で、真に必要な医療サービスをどのように展開していくのかを客観的に評価する必要がある。一定の医療サービス効果（生存率A％や有効率B％の上乗せなど）を得るために必要な費用はどれくらいかを推定する際に、費用対効果分析(Cost Effective Analysis; 以降ではCEA)が頻用されている。新薬の薬価を決める際にも重要な指標となっているが、現行のCEAでは正しい推定結果を得ることができない可能性が示された。より正確なCEAを行い国民医療費を適正に配分するために、CEAの改良が必要不可欠である。本研究成果はその基礎的な理論を構築したものであり、この点に社会的意義がある。

Research Products

• [Journal Article] Relationship between body mass index and masticatory factors evaluated with a wearable device (2022)
  • Author(s): Yoshimura Shogo、Hori Kazuhiro、Uehara Fumiko、Hori Shoko、Yamaga Yoshio、Hasegawa Yoko、Akazawa Kohei、Ono Takahiro
  • Journal Title: Scientific Reports Volume: 12 Issue: 1 Pages: 4117-4117
  • DOI: 10.1038/s41598-022-08084-5
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Impact of Masticatory Behaviors Measured With Wearable Device on Metabolic Syndrome: Cross-sectional Study (2022)
  • Author(s): Uehara Fumiko、Hori Kazuhiro、Hasegawa Yoko、Yoshimura Shogo、Hori Shoko、Kitamura Mari、Akazawa Kohei、Ono Takahiro
  • Journal Title: JMIR mHealth and uHealth Volume: 10 Issue: 3 Pages: e30789-e30789
  • DOI: 10.2196/30789
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Determinant Factors on Differences in Survival for Gastric Cancer Between the United States and Japan Using Nationwide Databases (2021)
  • Author(s): Ito Yuri、Miyashiro Isao、Ishikawa Takashi、Akazawa Kohei、Fukui Keisuke、Katai Hitoshi、Nunobe Souya、Oda Ichiro、Isobe Yoh、Tsujitani Shunichi、Ono Hiroyuki、Tanabe Satoshi、Fukagawa Takeo、Suzuki Satoshi、Kakeji Yoshihiro、Sasako Mitsuru、Bilchik Anton、Fujita Manabu
  • Journal Title: Journal of Epidemiology Volume: 31 Issue: 4 Pages: 241-248
  • DOI: 10.2188/jea.JE20190351
  • NAID: 130008021553
  • ISSN: 0917-5040, 1349-9092
  • Year and Date: 2021-04-05
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Determinant factors on differences in survival for gastric cancer between the US and Japan using nationwide databases. (2021)
  • Author(s): Ito Y, Miyashiro I, Ishikawa T, Akazawa K, Fukui K, Katai H, Nunobe S, Oda I, Isobe Y, Tsujitani S, Ono H, Tanabe S, Fukagawa T, Suzuki S, Kakeji Y, Sasako M, Bilchik A, Fujita M; Registration Committee of the Japanese Gastric Cancer Association.
  • Journal Title: J Epidemiol Volume: 31(4) Pages: 241-248
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prediction of Postoperative Infection for PatientsUndergoing Gastrointestinal Surgery: Findings from Electronic Health Records (2021)
  • Author(s): Nakazawa K, Ishikawa T, Toyama A, Wakai T,Akazawa K
  • Journal Title: Gastroenterol Volume: 11 Pages: 18-22
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Accuracy of Japanese claims data in identifying diabetes‐related complications. (2021)
  • Author(s): Fujihara K, Yamada‐Harada M, Matsubayashi Y, Kitazawa M, Yamamoto M, Yaguchi Y, Seida H, Kodama S, Akazawa K, Sone H.
  • Journal Title: Pharmacoepidemiol Drug Saf Volume: 30(5) Pages: 594-601
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Impact of the Relative Dose Intensity of Neoadjuvant Chemotherapy With Anthracycline Followed by Taxane on the Survival of Patients With Human Epidermal Growth Factor Receptor 2-negative Breast Cancer: The JONIE1 Study. (2021)
  • Author(s): Yamada A, Nakazawa K, Akazawa K, Narui K, Endo I, Hasegawa Y, Kohno N, Ishikawa T and THE JONIE STUDY GROUP.
  • Journal Title: Anticancer Res Volume: 41(2) Pages: 1063-1068
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] 特定保健指導の最適介入法の同定を目指した前向き研究 ―新潟方式の試作とそのパイロットスタディによる効果の評価― (2021)
  • Author(s): 加藤公則,田代 稔,鈴木沙織,大塚政人,小林隆司,三木扶久子,春木 匠,小松原祐介,藤原和哉,津下一代,赤澤宏平,曽根博仁
  • Journal Title: 人間ドック Volume: 35(5)
  • NAID: 130008059225
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Site-Specific Variation in Familial Cancer as Suggested by Family History, Multiple Primary Cancer, Age at Onset, and Sex Ratio Associated With Upper, Middle, and Lower Third Esophageal and Gastric Cardia Carcinoma (2020)
  • Author(s): Wen Denggui、Wen Junpeng、Zou Wendi、Yang Yi、Wen Xiaoduo、Chen Yuetong、Akazawa Kohei、Geng Cuizhi、Shan Baoen
  • Journal Title: Frontiers in Oncology Volume: 10 Pages: 1-9
  • DOI: 10.3389/fonc.2020.579379
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prediction of Postoperative Infection for Patients Undergoing Gastrointestinal Surgery: Findings from Electronic Health Records (2020)
  • Author(s): Nakazawa Kyoko、Ishikawa Takashi、Toyama Akira、Wakai Toshifumi、Akazawa Kohei
  • Journal Title: Gastroenterology Insights Volume: 11 Issue: 2 Pages: 36-46
  • DOI: 10.3390/gastroent11020007
  • Peer Reviewed / Open Access
• [Journal Article] Surgical Outcomes of Elderly Patients With Stage I Gastric Cancer From the Nationwide Registry of the Japanese Gastric Cancer Association (2020)
  • Author(s): Nunobe S, Oda I, Ishikawa T, Akazawa K, Katai H, Isobe Y, Miyashiro I, Tsujitani S, Ono H, Tanabe S, Fukagawa T, Suzuki S, Kakeji Y
  • Journal Title: Gastric Cancer Volume: 23(2) Issue: 2 Pages: 328-338
  • DOI: 10.1007/s10120-019-01000-3
  • Peer Reviewed
• [Journal Article] Emotional effects on factors associated with chronic low back pain (2019)
  • Author(s): Ouchi K, Watanabe M, Tomiyama C, Nikaido T, Oh Z, Hirano T, Akazawa K, Mandai N
  • Journal Title: Pain Res Volume: 12 Pages: 3343-3353
  • DOI: 10.2147/jpr.s223190
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Cost-effectiveness of BRCA1/2 mutation profiling to target olaparib use in patients with metastatic breast cancer. (2019)
  • Author(s): Saito S, Nakazawa K, Nagahashi M, Ishikawa T, Akazawa K.
  • Journal Title: Per Med. 2019 Nov;16(6):439-448. Volume: 16(6) Issue: 6 Pages: 439-448
  • DOI: 10.2217/pme-2018-0141
  • Peer Reviewed / Open Access / Int'l Joint Research