慶應義塾研究者情報データベース

その他の所属・職名 【 表示 ／ 非表示 】

その他の所属・職名 【 表示 ／ 非表示 】

• 健康マネジメント研究科

経歴 【 表示 ／ 非表示 】

経歴 【 表示 ／ 非表示 】

• 1998年05月

  -

  2000年03月

  神戸市立中央市民病院, 臨床研修医（内科）

• 2005年04月

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  2007年03月

  甲南大学, 経済学部, 専任講師

• 2007年04月

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  2012年03月

  甲南大学, 経済学部, 准教授

• 2012年04月

  -

  2016年03月

  京都大学, 白眉センター, 准教授

学歴 【 表示 ／ 非表示 】

学歴 【 表示 ／ 非表示 】

• 1992年04月

  -

  1998年03月

  京都大学, 医学部

  大学, 卒業, その他

• 2000年04月

  -

  2005年03月

  京都大学, 経済学研究科

  大学院, 修了, 博士

学位 【 表示 ／ 非表示 】

学位 【 表示 ／ 非表示 】

• 学士（医学）, 京都大学, 課程, 1998年03月

• 博士（経済学）, 京都大学, 課程, 2006年05月

免許・資格 【 表示 ／ 非表示 】

免許・資格 【 表示 ／ 非表示 】

• 医師, 1998年04月

研究分野 【 表示 ／ 非表示 】

研究分野 【 表示 ／ 非表示 】

• 人文・社会 / 経済政策

• 人文・社会 / 公共経済、労働経済

• ライフサイエンス / 医療管理学、医療系社会学

研究キーワード 【 表示 ／ 非表示 】

研究キーワード 【 表示 ／ 非表示 】

• 医療技術評価

• 医療政策

• 医療経済学

• 行動経済学

著書 【 表示 ／ 非表示 】

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• 健康経済学 -- 市場と規制のあいだで

  後藤励, 井深陽子, 有斐閣, 2020年03月

• 医療レジリエンス　－医学アカデミアの社会的責任－

  福原俊一,後藤 励,中山健夫,川上浩司,福間真悟, 医学書院, 2015年

• 日本のお医者さん研究

  森剛志,後藤 励, 東洋経済新報社, 2012年

• 医療経済学講義

  後藤 励橋本英樹・泉田信行, 東京大学出版会, 2011年

  担当範囲: 第１０章　生活習慣と行動変容

• 健康行動経済学

  依田高典,後藤 励,西村周三, 日本評論社, 2009年

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• Cost-effectiveness of AI-based diabetic retinopathy screening in nationwide health checkups and diabetes management in Japan: A modeling study

  Akune Y., Kawasaki R., Goto R., Tamura H., Hiratsuka Y., Yamada M.

  Diabetes Research and Clinical Practice 221 2025年03月

  ISSN  01688227

  　概要を見る

  Aims: We evaluated the cost-effectiveness of artificial intelligence (AI)-based diabetic retinopathy (DR) screening in Japan. This evaluation compared the simultaneous introduction of AI in nationwide health checkups, namely “specific health check-ups in Japan” (SHC), and diabetes complication management (AI-case) with the current situation where AI is not being introduced (conventional-case) from the healthcare payer's perspective. Methods: A cost-effectiveness analysis was conducted using a new individual-based state transition model. Model parameters, including the incidence and progression of DR, health utility values, and costs of screening and treatment, were based on literature data and expert opinion. The analysis estimated quality-adjusted life years (QALYs), cumulative costs, and incremental cost-effectiveness ratios (ICER). Results: The ICER comparing the AI-case with conventional-case was estimated to be JPY 1,598,244/QALY (USD 11,375/QALY), which is below the willingness-to-pay threshold of JPY 5 million/QALY (USD 35,584/QALY). Scenario analyses revealed that ICERs for the AI-based DR screening in SHC-only condition was JPY 1,895,226/QALY (USD 13,488/QALY) and JPY 3,960,839/QALY (USD 28,189/QALY) in diabetes management-only condition. Conclusions: The introduction of AI-based DR screening for SHC and diabetes management was cost-effective compared to the current situation in Japan.

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• The relationship between long COVID, labor productivity, and socioeconomic losses in Japan: A cohort study

  Konishi S., Masaki K., Shimamoto K., Ibuka Y., Goto R., Namkoong H., Chubachi S., Terai H., Asakura T., Miyata J., Azekawa S., Nakagawara K., Tanaka H., Morita A., Harada N., Sasano H., Nakamura A., Kusaka Y., Ohba T., Nakano Y., Nishio K., Nakajima Y., Suzuki S., Yoshida S., Tateno H., Fukunaga K.

  IJID Regions 14 2025年03月

  　概要を見る

  Objectives: We examined shifts in labor productivity and their economic ramifications among adult patients with long COVID in Japan. Methods: A total of 396 patients were categorized into three groups based on symptom progression: non-long COVID, long COVID recovered, and long COVID persistent. Patient-reported outcomes were assessed at three time intervals: 3, 6, and 12 months after COVID-19 diagnosis. Labor productivity was gauged through presenteeism and absenteeism, measured using the World Health Organization Health and Work Performance Questionnaire. Results: Long COVID was observed in 52.7% of patients, and 29.3% of all the patients continued to experience long COVID symptoms 1 year after diagnosis. At all three time points (3, 6, and 12 months after diagnosis), the long COVID persistent group showed a statistically significant difference in absolute presenteeism compared with the non-long COVID and long COVID recovered groups (P <0.01). Economic loss owing to decrease in labor productivity was calculated as $21,659 per year in the long COVID persistent group and $9008 per year in the long COVID recovered group (P <0.01). Conclusion: The study's results revealed a notable decline in labor productivity over time, underscoring the importance of early detection and intervention to mitigate the socio-economic repercussions of long COVID, in addition to its health implications.

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• Utilisation of outpatient care immediately before emergency admission for ambulatory care-sensitive conditions in Japan: a retrospective observational study

  Nagashima R., Kato H., Matsuzaki T., Nagahama T., Goto R.

  BMJ Open 15 （ 1 ）  2025年01月

  　概要を見る

  Objective This study assessed whether patients with potentially preventable emergency admissions had limited access to outpatient care immediately before admission and whether they received appropriate outpatient care during their outpatient visits. Design Retrospective observational study. Setting Linked outpatient and inpatient care records obtained from a nationwide claims database in Japan. Participants Patients who experienced emergency admissions for ambulatory care-sensitive conditions between April 2005 and March 2020. Patient and regional characteristics were examined to assess the types of patients who faced difficulties with outpatient visits and receiving outpatient care related to the disease that resulted in admissions (hereafter referred to as admission-related outpatient care). Main outcome measures (1) Whether patients had an outpatient visit during the 2 weeks preceding admission and (2) whether patients received admission-related outpatient care during the 2 weeks before admission. Results This study included 18 449 emergency admissions for ambulatory care-sensitive conditions, representing 16.3% (18 449/113 669) of all emergency admissions in our data. Among patients with emergency admissions for ambulatory care-sensitive conditions, 37.4% did not have an outpatient visit within the 2 weeks preceding admission and 29.9% did not receive admission-related outpatient care despite having an outpatient visit. In total, 67.4% did not receive admission-related outpatient care during the 2 weeks preceding admission. Patients in their 40s and 50s were less likely to have outpatient visits and receive admission-related outpatient care before admission. No evidence associates regional characteristics with outpatient visits and receiving admission-related outpatient care before admission. Conclusion Most patients who underwent emergency admissions for ambulatory care-sensitive conditions did not have an outpatient visit or receive admission-related outpatient care, despite having an outpatient visit immediately before admission. Our findings suggest that emergency admissions may be prevented by improving access to timely and effective outpatient care.

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• Health utility value of overactive bladder in Japanese older adults

  Yoshioka T., Omae K., Funada S., Minami T., Goto R.

  BJUI Compass 6 （ 1 ）  2025年01月

  　概要を見る

  Objectives: To determine the health utility values (HUVs) of overactive bladder (OAB), defined as urinary urgency, usually accompanied by urinary daytime or nocturnal frequency, with or without urinary incontinence, among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity. Methods: This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each sex and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≤5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol five-dimension five-level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB. We selected eight covariates (age, sex, body mass index, education, income, smoking, alcohol use, and comorbidities) as potential confounders based on previous studies. The sample size was determined based on previous studies without statistical power calculations. Results: Among the 998 participants (51.9% male; mean age, 73.2 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs] and p values) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066, p = 0.014) and −0.0591 (−0.0844 to −0.0339, p < 0.001), respectively. Conclusions: Consistent with previous HUV studies on OAB, our results demonstrated that the prevalence of OAB was associated with substantially lower HUV. The results demonstrate that increased OAB severity is associated with greater disutility.

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• Research Study on the Cost Structure and Break-Even Point of Mechanical Thrombectomy in Japan

  Yamasaki Bumpei, Goto Rei, Imamura Hirotoshi, Sasanuma Jinichi

  脳神経血管内治療 （一般社団法人 日本脳神経血管内治療学会）  19 （ 1 ） n/a 2025年

  ISSN  18824072

  　概要を見る

  <p><b>Objective:</b> Mechanical thrombectomy (MT) is an important procedure in the treatment of acute cerebral infarction, and its effectiveness depends largely on timely intervention after the onset. In the United States, a tiered accreditation system of stoke centers has been established to provide MT efficiently. In Japan, however, despite the large number of medical institutions performing MT, the establishment of a tiered accreditation system has yet to be seen. The low number of cases treated per institution raises concerns about the economic sustainability of MT in Japan because significant capital and human resource investment are required. This study aims to investigate the cost structure of MT procedure and the break-even point in 2 different hospital settings in Japan.</p><p><b>Methods:</b> We conducted a detailed cost analysis of MT at 2 distinct hospitals: Hospital A, a large public hospital in a government-designated city, and Hospital B, a private non-profit hospital in the Tokyo metropolitan area. Data collection involved face-to-face interviews with department heads and a structured survey based on the Japanese Hospital Accounting Standards, focusing on material, labor, and facility-related costs. Break-even points were calculated considering both fixed and variable costs, with adjustments made for the shared use of facilities in Hospital B.</p><p><b>Results:</b> The total cost per case was 349256 yen in Hospital A and 245150 yen in Hospital B, respectively. The total cost per case was elevated to 559866 yen assuming only MT was performed at Hospital B. This figure was significantly higher than the reimbursement price of MT (331500 yen). The number of procedures needed to exceed the break-even point for MT was approximately 290 cases per year in Hospital A and 125 cases per year in Hospital B, respectively.</p><p><b>Conclusion:</b> We conducted a break-even analysis of MT based on an interview survey. The number of cases required to cross the break-even point for MT alone was much higher than the actual number of MT procedures being performed in the 2 hospitals.</p>

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  • CiNii Research

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KOARA（リポジトリ）収録論文等 【 表示 ／ 非表示 】

KOARA（リポジトリ）収録論文等 【 表示 ／ 非表示 】

• 医学部生卒後研修制度がもたらした医療体制の変化と今後の課題 : その検証と理論の拡張

  後藤, 励

  科学研究費補助金研究成果報告書 2022年

• 医療政策評価研究のためのレセプトデータ利用に関する基盤整備

  後藤, 励

  科学研究費補助金研究成果報告書 2017年

総説・解説等 【 表示 ／ 非表示 】

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• Cost-effectiveness comparison between blood biomarkers and conventional tests in Alzheimer's disease diagnosis

  Noda K., Lim Y., Goto R., Sengoku S., Kodama K.

  Drug Discovery Today （Drug Discovery Today）  29 （ 3 ）  2024年03月

  ISSN  13596446

  　概要を見る

  Dementia management has evolved with drugs such as lecanemab, shifting management from palliative care to early diagnosis and intervention. However, the administration of these drugs presents challenges owing to the invasiveness, high cost and limited availability of amyloid-PET and cerebrospinal fluid tests for guiding drug administration. Our manuscript explores the potential of less invasive blood biomarkers as a diagnostic method, with a cost-effectiveness analysis and a comparison with traditional tests. Our findings suggest that blood biomarkers are a cost-effective alternative, but with lower accuracy, indicating the need for multiple specific biomarkers for precision. This underscores the importance of future research on new blood biomarkers and their clinical efficacy.

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• Re: Letter to the Editor of Public Health in response to ‘Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: An ecological study in Japan’

  Ando T., Ibuka Y., Goto R., Haruta J., Le D.D., Fujishima S.

  Public Health （Public Health）  227   e3 - e4 2024年02月

  ISSN  00333506

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• 医療経済評価における小児のQOL値測定法とその課題

  本多 貴実子, 白岩 健, 後藤 励, 福田 敬

  保健医療科学 （国立保健医療科学院）  71 （ 3 ） 264 - 275 2022年08月

  ISSN  1347-6459

  　概要を見る

  適正な医療資源の配分のためのエビデンスを提供することを目的として行われる医療経済評価では,異なった領域の介入の比較を容易にするため,アウトカム指標を質調整生存年(Quality-adjusted life year:QALY)とすることが原則とされている.QALYは生存期間にQOL(Quality of life)を0から1の値に換算したQOL値を重み付けして得られる.QALYにはその国の人々の選好による重みづけが反映されることが望ましいという観点から,QOL値は国内の調査結果を優先的に使用することが推奨されているが,以前から日本人のデータが乏しいことが指摘されていた.近年成人ではその蓄積が進みつつあるが,小児においてはその測定に多くの課題があり,日本ではほぼ行われていないのが現状である.医療経済評価でQOL値測定に用いられる尺度は選好に基づく尺度(Preference-based measure:PBM)である.PBMによってQOL値を得る過程は,評価したい健康状態の「測定」と「価値づけ」に分けられる.これを一度に行うものを直接法,別々に行うものを間接法と呼ぶ.直接法には評点尺度法,時間得失法,基準的賭け法があるが,小児では実施可能性,信頼性,妥当性はまだ十分に検討されていない.成人も含め一般的に現在主流となっている間接法では,multi attribute utility instruments(MAUIs)と呼ばれる尺度を用い,実際にその健康状態にある人(患者)に自らの健康について質問票に記入してもらった後,換算表を用いてQOL値を算出する.一般的に成人を対象に開発されたMAUIsは,小児で使用するにあたって質問の記述の仕方や内容が適していない,さらに換算表が成人の健康についての価値付けになっているなどの問題があり,小児には小児用のMAUIsの使用が望ましいとされる.近年小児用のMAUIsの開発が進んできたが,各国での翻訳や換算表の有無により,どの国でもこれらが使用できるわけではなく,3歳以下の年少児では使用できるものは現在ない.また,どの領域をどのように評価するべきか,誰が記入するべきかなどの「測定」に関する課題,換算表の作成にあたって誰の選好をどの視点を使用して明らかにし,反映するべきなのかという「価値付け」の課題があり,現在あるMAUIsが十分に小児の健康関連QOLをとらえられていない可能性もある.日本ではこれまで小児の使用を想定したMAUIsがなかったが,最近EuroQol 5-dimension Youth version(EQ-5D-Y)日本語版とその換算表が発表され,今後日本人小児のデータの蓄積が期待される.小児のQOL値の測定と解釈にあたっては,その課題や限界を十分に理解しておく必要がある.(著者抄録)

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• 【すぐそこまで来た,医師の働き方改革-課題と実現可能性】医師の働き方改革とお金の問題

  後藤 励

  病院 （(株)医学書院）  81 （ 2 ） 127 - 129 2022年02月

  ISSN  0385-2377

• Comment on “Health and Public Health Implications of COVID-19 in Asian Countries”

  Goto R.

  Asian Economic Policy Review （Asian Economic Policy Review）  17 （ 1 ） 39 - 40 2022年01月

  ISSN  18328105

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競争的研究費の研究課題 【 表示 ／ 非表示 】

競争的研究費の研究課題 【 表示 ／ 非表示 】

• 医療政策評価研究のためのレセプトデータ利用に関する基盤整備

  2015年04月

  -

  2018年03月

  文部科学省・日本学術振興会, 科学研究費助成事業, 後藤　励, 基盤研究(C), 補助金,  研究代表者

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• 経営環境特殊講義

  2024年度

• 経営環境演習

  2024年度

• ＱＯＬと費用の評価

  2024年度

• 健康マネジメント概論

  2024年度

• 健康マネジメント合同演習

  2024年度

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