Return on investment of national specific health guidance in Japan: an observational study using "Wellness-Star⋆" health insurance claims database

Abstract

Background: In Japan, healthcare insurers are required to conduct Specific Health Checkups (SHC) and Specific Health Guidance (SHG) for insured individuals and their dependents aged 40-74 to mitigate the risk of metabolic illnesses. This study aims to calculate the return on investment (ROI) of the SHG among individuals insured under employment-based health insurance in Japan by using real-world data (RWD).

Methods: This observational study used RWD from the Wellness-Star⋆ database provided by Nippon Life Insurance Company. Individuals who received SHG were categorized into two intervention groups: motivational support (MS) and active support (AS). Corresponding control groups of individuals who did not receive SHG were identified by matching with each intervention subgroup based on baseline parameters such as metabolic levels and healthcare costs. Healthcare costs were tracked and compared over a 4-year follow-up period between each intervention group and its respective control group. The ROI was calculated by dividing the returns by the investments. Returns were defined as the difference in healthcare costs between the control and SHG intervention groups over the 4-year period and investments were the costs associated with SHG interventions.

Results: During the follow-up period, the mean per-member-per-month (PMPM) difference in healthcare costs between the control and intervention groups was 1,107 JPY for MS and 1,171 JPY for AS. The ROI for SHG was estimated to be 3.90 (95% confidence intervals [CIs] = -1.97, 9.77) for MS and 1.36 (-0.73, 3.44) for AS.

Limitations: The evaluation was conducted over a relatively short period. The representativeness may be limited due to characteristics of the data, such as being derived from health insurance mainly associated with large corporations. Unmeasured confounders may also have influenced the outcome.

Conclusions: The mean ROI of SHG is greater than 1, suggesting potential economic benefit, though uncertainty remains.

Keywords: I00; I10; I18; Specific Health Guidance; healthcare expense; metabolic syndrome; real world data; return of investment.