内容紹介
Economic Evaluation for the Prevention of Cervical Cancer by Vaccination―From Perspective of Health Insurance Society and Industry
Summary
Objective: The aim of this study is to estimate the budget impact in a health insurance society and an industry of promoting decision-making for endowing grants for vaccination as prophylaxis against cervical cancer(CC)by the health insurance society for employees. Methods: The target population was Japanese female employees aged 20 to 34 and partners and daughters of male employees working for an overseas IT industry. By using a prevalence-based model, the author estimated expected costs in non-vaccination and vaccination scenarios and evaluated the10-year financial impact on the industry after vaccination by employing a cost-benefit analysis. The incidence of CC in a target group was derived from the actual number of patients with CC in addition to data from JMDC's receipt database and estimated by a Bayesian method. The epidemiological parameters such as mortality rate, screening rate, detailed exam rate and detailed exam consultation rate were taken from epidemiology statistics and published articles available in Japan. Healthcare costs for cancer treatment, screening, detailed exam and vaccination estimated based on medical fee points were input into the model, but the analysis did not consider side effect-related costs. In addition, productivity costs for mortality in employees and their families due to CC, estimated by the national employee's statistics, were also input into the model. An annual discount was unconsidered. Results: From the perspective of the healthcare insurance society, expenditure of approximately 129 million yen in the non-vaccination scenario was expected for ten years, but healthcare-related costs were saved by expenditure of approximately 73 million yen with 100% of employees and their families being vaccinated at expenses of approximately 55 million yen. The insurance society lost approximately 1.8 million yen in total if subsidy for vaccination was set at ten thousand yen. In the case of a 100% vaccination rate, the company can save losses in productivity of approximately 563 million yen in ten years as compared with non-inoculation. Furthermore, family finance can save approximately 2.6 million yen, based on our analysis. Sensitivity analyses suggested that subsidy expenses, the uptake rate of vaccination, and time horizon influenced the mortality cost from the perspectives of the company and the employees' families. Conclusion: A grant for vaccinating women, who are an untargeted population for a public grant, by the health insurance society is meaningful for the prevention of CC. It was deemed that a grant for vaccination of women by the health insurance society would be approximately ten thousand yen.
要旨
目的: 被用者健康保険組合による子宮頸がん予防ワクチンの接種費用助成のための意思決定を促すために,被用者健康保険組合ならびに企業への財政影響を推計した。方法: 外資系製造業に勤務する20～34歳の日本人女性社員および男性社員の配偶者や女児を分析の対象とした。Prevalence-based modelを用いて非接種および接種のシナリオにおける期待費用を推計し,費用便益分析により接種後の10年間の財政に与える影響を評価した。対象集団において子宮頸がんが発生する割合は,A社の子宮頸がん患者数にJMDC社のデータを加味し,ベイズ推定法により推定した。死亡率,検診受診率,要精検率ならびに精検受診率などの疫学的パラメータは,国内で入手可能な疫学統計や公表論文より数値を得た。費用項目は,保健関連費用(直接医療費,検診費と精検費ならびに接種費用とした。ただし,副反応関連費用は考慮せず)および間接費用(社員ならびに社員の家族に対する死亡損失費用)とし,国内で入手可能な疫学統計や公表論文より数値を得た。結果: 被用者健康保険組合の立場から,保健関連費用に関する検討を行った結果,非接種では10年間で約1.29億円の支出が見込まれたが,社員ならびに家族に100%接種させた場合約0.55億円と支出が約7,300万円に抑制された。そして,1人10,000円の補助費用を必要とした場合,約180万円の損失と推計される。企業の立場から間接費用に関する検討を行った結果,非接種に対して100%接種率の場合,10年間で約5.63億円の損失抑制が見込まれた。また,家族の場合損失は約2,600万円の抑制が見込まれた。感度分析の結果,先の分析結果は保険組合の立場ではワクチン助成費用,ワクチン接種率,そして分析期間に企業および社員家族の立場では死亡損失費用に影響することが示唆された。結論:公費助成の対象者以外の女性に被用者健康保険組合による接種費用助成は,子宮頸がんの発生予防に意義のあることである。またその場合,被用者健康保険組合として10,000円程度の接種補助が妥当と考える。
目次
Summary
Objective: The aim of this study is to estimate the budget impact in a health insurance society and an industry of promoting decision-making for endowing grants for vaccination as prophylaxis against cervical cancer(CC)by the health insurance society for employees. Methods: The target population was Japanese female employees aged 20 to 34 and partners and daughters of male employees working for an overseas IT industry. By using a prevalence-based model, the author estimated expected costs in non-vaccination and vaccination scenarios and evaluated the10-year financial impact on the industry after vaccination by employing a cost-benefit analysis. The incidence of CC in a target group was derived from the actual number of patients with CC in addition to data from JMDC's receipt database and estimated by a Bayesian method. The epidemiological parameters such as mortality rate, screening rate, detailed exam rate and detailed exam consultation rate were taken from epidemiology statistics and published articles available in Japan. Healthcare costs for cancer treatment, screening, detailed exam and vaccination estimated based on medical fee points were input into the model, but the analysis did not consider side effect-related costs. In addition, productivity costs for mortality in employees and their families due to CC, estimated by the national employee's statistics, were also input into the model. An annual discount was unconsidered. Results: From the perspective of the healthcare insurance society, expenditure of approximately 129 million yen in the non-vaccination scenario was expected for ten years, but healthcare-related costs were saved by expenditure of approximately 73 million yen with 100% of employees and their families being vaccinated at expenses of approximately 55 million yen. The insurance society lost approximately 1.8 million yen in total if subsidy for vaccination was set at ten thousand yen. In the case of a 100% vaccination rate, the company can save losses in productivity of approximately 563 million yen in ten years as compared with non-inoculation. Furthermore, family finance can save approximately 2.6 million yen, based on our analysis. Sensitivity analyses suggested that subsidy expenses, the uptake rate of vaccination, and time horizon influenced the mortality cost from the perspectives of the company and the employees' families. Conclusion: A grant for vaccinating women, who are an untargeted population for a public grant, by the health insurance society is meaningful for the prevention of CC. It was deemed that a grant for vaccination of women by the health insurance society would be approximately ten thousand yen.
要旨
目的: 被用者健康保険組合による子宮頸がん予防ワクチンの接種費用助成のための意思決定を促すために,被用者健康保険組合ならびに企業への財政影響を推計した。方法: 外資系製造業に勤務する20～34歳の日本人女性社員および男性社員の配偶者や女児を分析の対象とした。Prevalence-based modelを用いて非接種および接種のシナリオにおける期待費用を推計し,費用便益分析により接種後の10年間の財政に与える影響を評価した。対象集団において子宮頸がんが発生する割合は,A社の子宮頸がん患者数にJMDC社のデータを加味し,ベイズ推定法により推定した。死亡率,検診受診率,要精検率ならびに精検受診率などの疫学的パラメータは,国内で入手可能な疫学統計や公表論文より数値を得た。費用項目は,保健関連費用(直接医療費,検診費と精検費ならびに接種費用とした。ただし,副反応関連費用は考慮せず)および間接費用(社員ならびに社員の家族に対する死亡損失費用)とし,国内で入手可能な疫学統計や公表論文より数値を得た。結果: 被用者健康保険組合の立場から,保健関連費用に関する検討を行った結果,非接種では10年間で約1.29億円の支出が見込まれたが,社員ならびに家族に100%接種させた場合約0.55億円と支出が約7,300万円に抑制された。そして,1人10,000円の補助費用を必要とした場合,約180万円の損失と推計される。企業の立場から間接費用に関する検討を行った結果,非接種に対して100%接種率の場合,10年間で約5.63億円の損失抑制が見込まれた。また,家族の場合損失は約2,600万円の抑制が見込まれた。感度分析の結果,先の分析結果は保険組合の立場ではワクチン助成費用,ワクチン接種率,そして分析期間に企業および社員家族の立場では死亡損失費用に影響することが示唆された。結論:公費助成の対象者以外の女性に被用者健康保険組合による接種費用助成は,子宮頸がんの発生予防に意義のあることである。またその場合,被用者健康保険組合として10,000円程度の接種補助が妥当と考える。