2022 Fiscal Year Final Research Report

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

Research Project

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Project/Area Number	18K08764
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 55030:Cardiovascular surgery-related
Research Institution	Saga 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
Keywords	DPCデータ / 低侵襲治療 / 費用対効果 / TAVI / SAVR
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.
Free Research Field	心臓血管外科
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。