Current activities and future directions of comprehensive hepatitis control measures in Japan: The supportive role of the Hepatitis Information Center in building a solid foundation

Abstract

In Japan, hepatitis B or C virus infection has been a major health issue. For the prevention of liver‐related deaths, multifaceted strategies have been taken against hepatitis virus. In fiscal year (FY) 2002, nationwide screening for hepatitis was started as a part of health examinations provided by municipal governments. From FY2007, the hepatitis treatment network has been strengthened by the nationwide establishment of regional government‐based hepatitis treatment systems, comprising linked regional core centers, specialized institutions for hepatitis treatment, primary care physicians, and regional governments. Special subsidy program for patients with viral hepatitis was started at FY2008. The range of coverage has been expanding from patients treated with interferon to those on nucleotide analogs or interferon‐free therapies, including drug prices and examination expenses. The Basic Act on Hepatitis Measures was established in 2009. The Basic Guidelines for Promotion of Control Measures for hepatitis was issued in 2011, comprising nine principles in order to promote measures for hepatitis B and C. The Hepatitis Information Center was established in 2008. Its mission is to provide up‐to‐date hepatitis‐related information, supporting collaboration between regional core centers, and training medical personnel. The revision of the above‐mentioned Basic Guidelines in 2016 set the target as the reduction of patients progressing to cirrhosis and/or liver cancer. Achieving this goal definitely requires active collaboration among the national and local governments, regional core centers, and the Hepatitis Information Center, and participation by medical personnel, patients, and people with awareness.

Trends in the total numbers of HBV and HCV carriers in Japan from 2000 to 2011

“…The nationwide hepatitis virus screening system was first implemented in 2002 funded by the municipal government, which mainly targeted women aged 40 years and older. Since 2007, regional government has established well‐coordinated and collaborated hepatitis treatment systems with regional core centres, specialized institutions for hepatitis treatment and primary care doctors . The alleviation of medical costs, ie the medical expense aid system, was launched in 2008.…”

“…Moreover, the “Basic Act on Hepatitis Measures” was established to address hepatitis virus infection, and it was adopted by the whole country in 2009 . This act is unique and not found in other countries.…”

“…Since 2000, the Japanese government has pursued an aetiology‐based hepatitis and HCC control health policy and strategy based on large‐scale epidemiologic or clinico‐pathological studies . In accordance with the national health policy, the hepatitis epidemiological research groups of The Ministry of Health, Labor, and Welfare (MHLW) in Japan estimate the number of undiagnosed hepatitis virus carriers and patients with hepatitis virus‐related disease with respect to sex‐specific and age‐specific groups using the data collected by the Japanese Red Cross Blood Center in the same year .…”

Treatment of hepatitis C virus leads to economic gains related to reduction in cases of hepatocellular carcinoma and decompensated cirrhosis in Japan

“…At present within Japan, all types of treatment for hepatitis C covered by national insurance are subsidized including interferon‐based and interferon‐free regimens . With this in mind, it has become increasingly essential for patients to seek treatment with DAA's as the cost to patients is quite low; with hepatitis patients generally pay only ¥10 000‐20 000 per month due to heavy subsidies . Furthermore, it is important to note that in Japan, the government and social support for workers has become an increasingly important topic, specifically concerning worker productivity and well‐being .…”

Nationwide survey on activities of regional core centers for the management of liver disease in Japan: Cumulative analyses by the Hepatitis Information Center 2009–2017

“…Viral hepatitis poses a major public health problem in Japan. The national government is therefore undertaking comprehensive measures for hepatitis, which currently consist of the following five strategies: (i) promotion of hepatitis virus testing; (ii) introduction of the subsidy system for medical care for hepatitis; (iii) establishment of medical care system for hepatitis, (iv) enlightenment and dissemination of the need for early detection and treatment, and (v) promotion of research on hepatitis …”