JMA Journal

Recent Debate over How to Tackle Rapid Increases in Pharmaceutical Expenditure in Japan

2020-03-19T08:30:02+09:00

Pharmaceutical expenditure has been rapidly increasing since 2000 in Japan mainly due to successive introduction and diffusion of high-priced new pharmaceuticals (thereafter, drugs). The share of drug expenditure in the national healthcare expenditure rose from 19.6% in 2000 to 22.3% in 2013, a 2.7% point rise in 13 years. In the same period, the share of healthcare personnel's income dropped 3.8% points from 50.2% to 46.4%. Further, in 2016 national healthcare expenditure rose for 3.8%, which is exceptionally high by Japanese standard (roughly 2%), and the main culprit was the rapid increase in drug expenditure due to successive introduction of extremely high-priced drugs. 　Due to these changes, drugs have become the main target in current healthcare cost containment policy.　In this article, I briefly explain two debates relating to drug cost and cost control that occurred in 2016 and 2017, respectively, in Japan, based on my two articles that I wrote when I participated in these debates. Although two debates are independent, the first debate that was triggered by an introduction of extraordinary high-priced drug (Opdivo) substantially affected the second debate on how to introduce official cost-effectiveness appraisal of new drugs in Japan.

Association between Syphilis Incidence and Dating App Use in Japan

2020-03-19T08:30:01+09:00

The cause of the syphilis resurgence in Japan is still unknown. In this study, we hypothesized that the spread of mobile dating software for use on mobile phones might have contributed to it. We investigated possible contributing factors of the syphilis resurgence in Japan.　 We retrieved the number of reported cases of syphilis, human immunodeficiency virus infection, carbapenem-resistant 　 infection, invasive 　 infection, general population, foreign national residents, international overnight guests, detachment-type sex trade shops, physician density, and smartphone penetration rate at the prefectural level in 2017. We also obtained the number of three major dating app users in each prefecture. Using them, we performed association analyses.　: The median of syphilis incidence per 100,000 prefectural population was 2.34 (range 0.72 to 12.90). The values of Spearman’s rank correlation coefficients between syphilis incidence and app penetration rates were 0.59 (p < 0.001) for app 1, 0.57 (p < 0.001) for app 2, and 0.56 for app 3 (p < 0.001). The values of correlation coefficient between syphilis incidence and prefectural population (0.50, p < 0.001), foreign national residents per prefectural population (0.46, p = 0.001), and smartphone penetration rate (0.54, p < 0.001) were significant, while international overnight guests per prefectural population (0.19, p = 0.19), sex trade shops (0.24, p = 0.10), and physician density (0.10, p = 0.52) were not. In the multiple regression analyses, the contents of an optimized model included the following two factors: for app 1 penetration rate (0.39, p < 0.001) and the number of sex trade shops per prefectural population (0.18, p = 0.008) with the adjusted R-squared value 0.49 and F value 22.97 (p < 0.001).　 Dating app penetration rate was significantly associated with syphilis incidence. The popularization of social media is a possible contributing factor in the syphilis resurgence in Japan. Information concerning the use of social media should be included in future studies on transmission and prevention of sexually transmitted infections.

Clinical Management of Sarcopenia: Secondary Publication of Geriatrics ＆ Gerontology International 2018;18 S1:1-44

2020-03-06T08:30:01+09:00

In aging societies, sarcopenia is considered to be a significant threat for the elderly and for people with multimorbidities. Although several diagnostic algorithms are currently available, no guidelines are so far available for the prevention and intervention of sarcopenia. Therefore, we decided to publish clinical sarcopenia guidelines by collaboration with the Japanese Association on Sarcopenia and Frailty, the Japan Geriatrics Society, and the National Center for Geriatrics and Gerontology to provide tools for clinical practice. We published a Japanese version in December 2017 and an English version in May 2018. This article is a summary of these clinical sarcopenia guidelines. As the disease code of sarcopenia is available in Japan, these guidelines would be useful for many healthcare professionals and can be used for the prevention of disabilities in the elderly.