Although the threshold of cost effectiveness of medical interventions is thought to be 20 000- 30 000 UK pounds in the UK, and $50 000-$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), 23 000 UK pounds (UK), AU$ 64 000 (Australia), and US$ 62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making.

PurposeThe purpose of this study was to measure the population norms for the Japanese versions of preference-based measures (EQ-5D-3L, EQ-5D-5L, and SF-6D). We also considered the relations between QOL score in the general population and socio-demographic factors. MethodsA total of 1143 adult respondents (aged ≥ 20 years) were randomly sampled from across Japan using data from the Basic Resident Register. The health status of each respondent was measured using the EQ-5D-3L, EQ-5D-5L, and SF-6D, and responses regarding socio-demographic data as well as subjective diseases and symptoms were obtained. The responses were converted to a QOL score using Japanese value sets. ResultsThe percentages of respondents with full health scores were 68 % (EQ-5D-3L), 55 % (EQ-5D-5L), and 4 % (SF-6D). The QOL score measured using the SF-6D was significantly lower than those measured using either EQ-5D score. The QOL score was significantly lower among respondents over the age of 60 years, those who had a lower income, and those who had a shorter period of education. Intraclass correlation coefficient showed a poor agreement between the EQ-5D and SF-6D scores. The differences in QOL scores between respondents with and those without any disease were 0.064 for the EQ-5D-3L, 0.061 for the EQ-5D-5L, and 0.073 for the SF-6D; these differences are regarded as between-group minimal important differences in the general population. ConclusionThe Japanese population norms of three preference-based QOL measures were examined for the first time. Such information is useful for economic evaluations and research examining QOL score.

Japanese value sets based on DCE were demonstrated. On comparing the observed cTTO scores, we found that the hybrid model was slightly superior to the simpler methods, including the TTO model.

BackgroundIn economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value?MethodsTo examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values.ResultsThe results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY −1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income.ConclusionThis survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states.

This is the first officially approved guideline for the economic evaluation of drugs and medical devices in Japan. The guideline is expected to improve the quality and comparability of submitted cost-effectiveness data for decision making.

Provision of social support and rehabilitation for patients with physical, mental and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1 and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression and HRQOL at one month (baseline), 6 months, and 1 and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the Functional Assessment of Cancer Treatment scale-General (FACT-G) and the Breast Cancer subscale (FACT-B). Anxiety and depression were rated using the Hospital Anxiety and Depression Scale (HADS).More than 50% of patients had local problems of "tightness", "arm weakness" and "arm lymphedema", and systemic problems of "reduced energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved one year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months and 1 and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery.

No abstract

Background EQ-5D-Y is a preference-based measure for children and adolescents (aged 8–15 y). This is the first study to develop an EQ-5D-Y value set for converting EQ-5D-Y responses to index values. Methods We recruited 1047 respondents (aged 20–79 y) from the general population, stratified by gender and age group, in 5 Japanese cities. All data were collected through face-to-face surveys. Respondents were asked to value EQ-5D-Y states for a hypothetical 10-y-old child from a proxy perspective using composite time tradeoff (cTTO) and a discrete choice experiment (DCE). The discrete choice data were analyzed using a mixed logit model. Latent DCE values were then converted to a 0 (death)/1 (full health) scale by mapping them to the cTTO values. Results The mean observed cTTO value of the worst health state [33333] was 0.20. Analysis of the DCE data showed that the coefficients of the domains related to mental functions (“Having pain or discomfort” and “Feeling worried, sad, or unhappy”) were larger than those for the domains related to physical and social functions. By converting latent DCE values to a utility scale, we constructed a value set for EQ-5D-Y. No inconsistencies were observed. The minimum predicted score was 0.288 [33333], and the second-best score was 0.957 [12111]. Conclusion A value set for EQ-5D-Y was successfully constructed. This is the first survey of an EQ-5D-Y value set. Interpreting the differences between EQ-5D-Y and EQ-5D-5L value sets is a future task with implications for health care policy.