An Evaluation of Clinical Economics and Cases of Cost-effectiveness

Abstract

In order to maintain and develop a universal health insurance system, it is crucial to utilize limited medical resources effectively. In this context, considerations are underway to introduce health technology assessments (HTAs), such as cost-effectiveness analyses (CEAs), into the medical treatment fee system. CEAs, which is the general term for these methods, are classified into four categories, such as cost-effectiveness analyses based on performance indicators, and in the comparison of health technologies, the incremental cost-effectiveness ratio (ICER) is also applied. When I comprehensively consider several Japanese studies based on these concepts, I find that, in the results of the analysis of the economic performance of healthcare systems, Japan shows the most promising trend in the world. In addition, there is research indicating the superior cost-effectiveness of Rituximab against refractory nephrotic syndrome, and it is expected that health economics will be actively applied to the valuation of technical innovations such as drug discovery.

Keywords: QALY; cost-effectiveness analysis; health technology assessments; kidney failure; nephrotic syndrome; value of healthcare.

Figure 1.

The relationship between the health expenditure per capita and the gross national product (1). In order to maintain the medical system, it is necessary to maintain the balance between medical expenses and financial resources. Since fiscal policy is affected by the overall economy, Japan’s sluggish economic growth rate has led to limited public funding for healthcare.

Figure 2.

The basic concepts of health economics and its framework (4). Health economics is the method used to discuss the appropriate distribution of health resources.

Figure 3.

Conception of the value assessment in the quasi-public healthcare system: The balance of the valuation of technical innovations and the guarantee for all patients to have access (5). The public medical marketplace needs a system based on a consideration of both use value and exchange value.

Figure 4.

The concept of economic performance: One of the methods used to discuss the economic value of healthcare (7). ’Value’ in social activities is determined by the balance between the capital investment and its returns. If you pay a certain amount of money to use a certain service (function), its value is determined by the performance, which is equal to the amount of service (function) divided by the cost. For the consumption of one budget item, the greater the result, the higher the value. In the medical fields, the amount in terms of ’restoration of health’ is used as the index of the ’function’.

Figure 5.

The concept of the incremental cost effective ratio (ICER): The result of the cost-effectiveness analysis is shown in four quadrants (8). The cost-effectiveness threshold represents the additional cost that must be imposed on the system to forgo one QALY of health through displacement; the cost-effectiveness threshold depends on a person’s willingness to pay for an improved quality or length of life.

Figure 6.

For the advancement of healthcare, both allocation of limited resources and total healthcare expenditure resources should be considered. The evaluation on an absolute scale is as important as a comparative assessment for the progress of health technology assessments. In other words, when conducted evaluations on a comparative scale using clinical indicators, such as a cost-effectiveness analysis or a cost-minimization analysis, it is also important to conduct evaluations on an absolute scale using benefit as the outcome so that we can discuss the state of social resources (such as the scale of health insurance finances).

Figure 7.

An international comparison of the relationship between total expenditure on health and total burden of disease (12). This figure shows the economic performance of the healthcare system in each OECD country. The dots at the lower left represent good cost-effectiveness, while those in the upper right represent lower cost-effectiveness.