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 】

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• 医療技術評価

• 医療政策

• 医療経済学

• 行動経済学

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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 behavioural counselling intervention compared with non-intervention for adult patients with metabolic syndrome to prevent cardiovascular diseases and type 2 diabetes in Japan: a microsimulation modelling study

  Akune Y., Anezaki H., Nakao Y.M., Goto R.

  BMJ Open （BMJ Open）  14 （ 4 ）  2024年04月

  　概要を見る

  Objectives Nationwide lifestyle intervention—specific health guidance (SHG) in Japan—employs counselling and education to change unhealthy behaviours that contribute to metabolic syndrome, especially obesity or abdominal obesity. We aimed to perform a model-based economic evaluation of SHG in a low participation rate setting. Design A hypothetical population, comprised 50 000 Japanese aged 40 years who met the criteria of the SHG, used a microsimulation using the Markov model to evaluate SHG’s cost-effectiveness compared with non-SHG. This hypothetical population was simulated over a 35-year time horizon. Setting SHG is conducted annually by all Japanese insurers. Outcome measures Model parameters, such as costs and health outcomes (including quality-adjusted life-years, QALYs), were based on existing literature. Incremental cost-effectiveness ratios were estimated from the healthcare payer’s perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to evaluate the uncertainty around the model input parameters. Results The simulation revealed that the total costs per person in the SHG group decreased by JPY53 014 (US$480) compared with that in the non-SHG group, and the QALYs increased by 0.044, wherein SHG was considered the dominant strategy despite the low participation rates. PSA indicated that the credibility intervals (2.5th–97.5th percentile) of the incremental costs and the incremental QALYs with the SHG group compared with the non-SHG group were −JPY687 376 to JPY85 197 (−US$6226 to US$772) and −0.009 to 0.350 QALYs, respectively. Each scenario analysis indicated that programmes for improving both blood pressure and blood glucose levels among other risk factors for metabolic syndrome are essential for improving cost-effectiveness. Conclusions This study suggests that even small effects of counselling and education on behavioural modification may lead to the prevention of acute life-threatening events and chronic diseases, in addition to the reduction of medication resulting from metabolic syndrome, which results in cost savings.

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• Cost-effectiveness Analysis of Nivolumab Plus Ipilimumab Combination Therapy as First-line Treatment for Advanced Renal Cell Carcinoma in Japan

  Maeda T., Moriwaki K., Morimoto K., Mo X., Yoshioka T., Goto R., Shimozuma K.

  Value in Health Regional Issues （Value in Health Regional Issues）  40   118 - 126 2024年03月

  ISSN  22121099

  　概要を見る

  Objectives: The purpose of this study is to examine the cost-effectiveness of nivolumab (NIVO) plus ipilimumab (IPI) combination therapy (NIVO + IPI) compared with the sunitinib (SUN) therapy for Japanese patients with advanced renal cell carcinoma from the perspective of a Japanese health insurance payer. Methods: A lifetime horizon was applied, and 2% per annum was set as the discount rate. The threshold was set as $ 75 000 per quality-adjusted life-year (QALY) gained. For the analytical method, we used a partitioned survival analysis model to estimate the incremental cost-effectiveness ratio (ICER), which is calculated by dividing incremental costs by incremental QALYs. Progression-free survival, progressive disease, and death were set as health states. Additionally, cost parameters and utility weights were set as key parameters. We set the intermediate/poor-risk population as the base case. Scenario analysis was conducted for the intention-to-treat population and the favorable risk population. Furthermore, one-way sensitivity analysis and probabilistic sensitivity analysis were conducted for each population. Results: In the base-case analysis, the QALYs of NIVO + IPI and SUN were 4.32 and 2.99, respectively. NIVO + IPI conferred 1.34 additional QALYs. Meanwhile, the total costs in the NIVO + IPI and SUN were $692 288 and $475 481, respectively. As a result, the ICER of NIVO + IPI compared with SUN was estimated to be $162 243 per QALY gained. The parameter that greatly affected the ICER was the utility weight of progression-free survival in NIVO + IPI. Conclusions: NIVO + IPI for advanced renal cell carcinoma seems to be not cost-effective compared with the SUN in the Japanese healthcare system.

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• Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan

  Honda K., Akune Y., Goto R.

  JAMA Network Open （JAMA Network Open）  7 （ 2 ）  2024年02月

  　概要を見る

  IMPORTANCE The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer's perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2%per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1). INTERVENTIONS School urinary screening for IgA nephropathy was compared with no screening. MAIN OUTCOMES AND MEASURES Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093). RESULTS In the base case analysis, the ICERwas ¥4 186 642 (US $39 127)/QALY, whichwas less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Costeffectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, -¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY). CONCLUSIONS AND RELEVANCE This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.

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• Protocol digest of a randomized controlled Phase III study comparing surgery alone versus adjuvant nivolumab versus adjuvant S-1 for locally advanced oesophageal squamous cell carcinoma with no pathological complete response after neoadjuvant chemotherapy followed by curative esophagectomy: Japan Clinical Oncology Group study JCOG2206 (SUNRISE Trial)

  Kita R., Matsuda S., Nomura M., MacHida R., Sasaki K., Kato K., Goto R., Yoshioka T., Yamamoto S., Tsushima T., Fukuda H., Takeuchi H., Kitagawa Y.

  Japanese Journal of Clinical Oncology （Japanese Journal of Clinical Oncology）  54 （ 2 ） 212 - 216 2024年02月

  ISSN  03682811

  　概要を見る

  Although the efficacy of postoperative therapy with nivolumab after preoperative chemoradiotherapy for locally advanced oesophageal cancer has been proven in Western countries, the survival benefits of postoperative therapy after preoperative chemotherapy with docetaxel, cisplatin and 5-FU or cisplatin plus 5-FU as the Japanese standard therapy remain controversial. This randomized Phase III trial was designed to confirm the superiority of postoperative therapy with nivolumab over observation alone and S-1 over observation alone in patients with locally advanced oesophageal squamous cell carcinoma with no pathological complete response after preoperative chemotherapy followed by curative esophagectomy. A total of 450 patients will be enrolled from 56 hospitals in Japan over 5.5 years. The primary endpoint is relapse-free survival, and the secondary endpoints are disease-free survival, overall survival, adverse events and incremental cost-effectiveness ratio. This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031230219 (https://jrct.niph.go.jp/latest-detail/jRCTs031230219).

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• Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis

  Uno S., Goto R., Honda K., Uchida S., Uwamino Y., Namkoong H., Yoshifuji A., Mikita K., Takano Y., Matsumoto M., Kitagawa Y., Hasegawa N.

  Clinical Infectious Diseases （Clinical Infectious Diseases）  78 （ 1 ） 57 - 64 2024年01月

  ISSN  10584838

  　概要を見る

  Background: An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing. Methods: We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY). Results: The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. The incremental cost-effectiveness ratio fell below 5 000 000 JPY/QALY only when the test-positive rate exceeded 0.739%. However, when the probability of developing a postoperative pulmonary complication among SARS-CoV-2-positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became. Conclusions: Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced.

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• 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

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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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• 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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