Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor)

Abstract

We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21–50 patients compared to those treating 1–10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan.

Current trend in treatment of glioblastoma in Japan: a national survey using the diagnostic procedure combination database (J-ASPECT study-glioblastoma)

“…This trend was similar to our previous report, which summarized malignant brain tumors between April 2013 and March 2014 (Fig. 2 b) [ 14 ]. A total of 1,229 (69.3%) patients with GBM underwent RT at the first hospitalization.…”

“…In this study, we analyzed the current trend of GBM treatment using the DPC database in Japan. The advantage of using the DPC database is that patient and hospital information, diagnosis, procedures, and administrative claim data are completely enumerated for all patients in the participating hospitals [ 14 ]. We hypothesized that an increase in the treatment complexity due to diversification of treatment modalities can lead to acceleration of treatment centralization.…”

“…Using the DPC database, we have previously reported current trends and healthcare resource usage in the treatment of primary malignant brain tumors in Japan (J-ASPECT study-brain tumor) [ 14 ]. Although in the previous study, the most serious limitation was the lack of information on various histologically different tumors, detailed diagnosis codes have been available since 2016, and only cases diagnosed with GBM could be extracted.…”

History and Profile of Diagnosis Procedure Combination (DPC): Development of a Real Data Collection System for Acute Inpatient Care in Japan

“… 7 Yoshimoto et al used DPC data from 370 hospitals participating in the Japanese Neurosurgical Society Training Program and showed the data from patients with a malignant brain tumor: breakdown of treatment methods performed, including surgery, chemotherapy, radiotherapy, and combination therapy; implementation status of chemotherapy regimen patterns; length of hospital stay; and medical care costs. 8 …”

Update on Chemotherapeutic Approaches and Management of Bevacizumab Usage for Glioblastoma

“…In 2002, the Japanese government introduced a per diem prospective payment system with a diagnosis-related group-like grouping, termed Diagnostic Procedure Combination (DPC) [ 53 ]. Using the DPC database, we have previously reported on the current trends and healthcare resource usage in the treatment of primary malignant brain tumors in Japan (J-ASPECT study-Brain Tumor) [ 54 ]. In addition, the Japan Neurosurgical Society established the Japan Neurosurgical Database, a nationwide, hospital-based, multi-center registry in 2016; thus, analysis of real-world clinical practice in Japan is expected to develop further in the near future [ 55 ].…”