Quantifying low-value care in Japan and international comparison

• Project/Area Number: 20K18956
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58030:Hygiene and public health-related: excluding laboratory approach
• Research Institution: The University of Tokyo
• Principal Investigator: Miyawaki Atsushi 東京大学, 大学院医学系研究科(医学部), 助教 (30841928)
• Project Period (FY): 2020-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000); Fiscal Year 2022: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2021: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2020: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
• Keywords: low value care / choosing wisely / 医療政策 / ヘルスサービスリサーチ / Heath Services Reserach / Choosing Wisely / low-value care / 医療の価値 / 医療の無駄 / 医療の質 / value in healthcare / quality of care / wasteful spending

Outline of Research at the Start

不必要な医療サービスを減らし、医療の価値を向上させるために、社会が「低価値医療」（＝健康上のメリットがほとんどない医療）にどれだけ費やしているか、理解する必要がある。本研究では、低価値医療の量・内訳の日本における定量化、さらに日米比較を行う。まず我が国における低価値医療の包括的なリストを作成、さらに、そのリストや先行研究における低価値医療の指標を基に、低価値医療の我が国における概要を、我が国の代表的な保険請求データ（集計データ及び個票データ）を用いて定量化する。最後に、米国のデータを用いて日米比較を行うことで、不必要な低価値医療を減らすための多国間の取組における共通目標を提示することを目指す。

Outline of Final Research Achievements

We attempted to quantify the volume of "low-value care" (i.e., medical services that have little or no effect) as one scientific solution to the structural problem of soaring healthcare spending. Based on a review of prior literature and collaboration with specialist board, we identified 33 low value care services that are measurable using claims data. Using 2015-2019 claims data from 242 acute care hospitals, we found that 5-8% of patients received at least one low-value service.

Academic Significance and Societal Importance of the Research Achievements

今回の研究結果は、わずか33項目の価値の低い医療に注目しても、少なからぬ患者さんが価値の低い医療を受けていたことを示している。また、その額も決して無視できない規模である。粗い試算であるが、推定された1000億円というのは、具体的には、昨今急速にがん化学療法で利用が増加しているPD-1モノクローナル抗体の薬価ベースの売上（商品名キイトルーダ, 1195億円；商品名オプジーボ, 1125億円　[2021年度]）に匹敵する規模である。新しい高額医薬品をいかに公的医療保険の中でカバーしていくか、という観点でも低価値医療に注目する重要性がわかる。

Research Products

• [Int'l Joint Research] UCLA David Geffen School of Medicine/Harvard Medical School(米国)
• [Int'l Joint Research] UCLA(米国)
• [Journal Article] Association Between Emergency Physician’s Age and Mortality of Medicare Patients Aged 65 to 89 Years After Emergency Department Visit (2023)
  • Author(s): Miyawaki Atsushi、Jena Anupam B.、Burke Laura G.、Figueroa Jose F.、Tsugawa Yusuke
  • Journal Title: Annals of Emergency Medicine Volume: Epub ahead of print Issue: 3 Pages: 301-312
  • DOI: 10.1016/j.annemergmed.2023.02.010
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Prevalence and changes of low-value care at acute care hospitals: a multicentre observational study in Japan (2022)
  • Author(s): Miyawaki, A., Ikesu, R., Tokuda, Y., Goto, R., Kobayashi, Y., Sano, K., Tsugawa, Y.
  • Journal Title: BMJ open Volume: 12 Issue: 9 Pages: e063171-e063171
  • DOI: 10.1136/bmjopen-2022-063171
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study (2021)
  • Author(s): Miyawaki A, Tabuchi T, Ong MK, Tsugawa Y.
  • Journal Title: J Med Internet Res Volume: 23 Issue: 7 Pages: e27982-e27982
  • DOI: 10.2196/27982
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Why do homeless women in New York state experience fewer hospital revisits after childbirth than housed women? (2021)
  • Author(s): Miyawaki Atsushi、Tsugawa Yusuke
  • Journal Title: BMJ Quality & Safety Volume: 31 Issue: 4 Pages: 243-246
  • DOI: 10.1136/bmjqs-2021-013746
  • Peer Reviewed / Open Access
• [Journal Article] Association between participation in the government subsidy programme for domestic travel and symptoms indicative of COVID-19 infection in Japan: cross-sectional study (2021)
  • Author(s): Miyawaki Atsushi、Tabuchi Takahiro、Tomata Yasutake、Tsugawa Yusuke
  • Journal Title: BMJ Open Volume: 11 Issue: 4 Pages: e049069-e049069
  • DOI: 10.1136/bmjopen-2021-049069
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Relationships between social spending and childhood obesity in OECD countries: an ecological study (2021)
  • Author(s): Miyawaki Atsushi、Evans Charlotte Elizabeth Louise、Lucas Patricia Jane、Kobayashi Yasuki
  • Journal Title: BMJ Open Volume: 11 Issue: 2 Pages: e044205-e044205
  • DOI: 10.1136/bmjopen-2020-044205
  • Peer Reviewed / Open Access
• [Journal Article] Large decrease in paediatric hospitalisations during the COVID-19 outbreak in Japan (2021)
  • Author(s): Sano Kazuaki、Nakamura Masaki、Ninomiya Hideki、Kobayashi Yasuki、Miyawaki Atsushi
  • Journal Title: BMJ Paediatrics Open Volume: 5 Issue: 1 Pages: e001013-e001013
  • DOI: 10.1136/bmjpo-2020-001013
  • Peer Reviewed / Open Access