ABSTRACT
Objective : To estimate the cost-effectiveness of using statins to prevent coronary heart disease (CHD) in men and women with hypercholesterolemia. Methods : A cost-effectiveness analysis of statins (such as, cerivastatin and pravastatin), by using “do-nothing” as a comparator, was conducted from a payer's point of view, based on a randomized controlled trial. By using a Markov model, life-time benefits (life-year gained) and costs were estimated. In the basic analysis, men and women of 50 years old with hypercholesterolemia (TC level ; 275 mg/ dl) were used. Both benefits and costs were discounted by 5% annually. The robustness of the model was tested by a sensitivity analysis.<BR>Results : The cost per life-year gained with cerivastatin was ¥ 3, 480, 000 for men and ¥ 6, 340, 000 for women, respectively. The cost per life-year gained with pravastatin was ¥ 4, 650, 000 for men and¥ 8, 200, 000 for women, respectively. The incremental cost-effectiveness of cerivastatin compared with pravastatin was negative, indicating a low-cost and high-effect. A sensitivity analysis demonstrated the robustness of these results.<BR>Conclusions : According to the Laupacis's criteria, cholesterol-lowering treatment by statins demonstrated the moderate evidence for adoption and appropriate utilization. Since this study is based on a small randomized controlled trial, several post-marketing surveillance studies will be necessary to confirm the validity.
ABSTRACT
Clinical Epidemiology has been increasingly recognized as a basic science of clinical medicine as well as a prerequisite discipline necessary in practicing evidence-based medicine. However, no formal curriculum has been formulated for teaching clinical epidemiology to undergraduate medical students in Japan.<BR>We, as the Education on Clinical Epidemiology Working Group of Japan Society for Medical Education, here propose a curriculum of clinical epidemiology consisting of 15 sessions of 90 minute lectures, small group discussions, and practice. Learning such basic concepts as study design, bias, chance, and confounding factors is to be followed by case-based discussions and practicing on-line reference retrieval using MEDLINE. Our proposal awaits further refinement after its implementation at ambitious medical schools.
ABSTRACT
High economic growth since the late 1950's has brought about a severe labour shortage in Japan. Japanese industry sought migrant workers as one reliable source of labour. As seasonal and unskilled workers, they were employed in a wide variety of trades ; for example, construction, manufacturing, forestry and transportation. However, some of the migrant work was becoming a principal and nonseasonal occupation, and specialized. Migrant forestry and tunnel-construction work are two examples of such specialized work.<BR>To identify health problems among them, we examined the factors affecting workers' entry into migrant forestry and tunnel-construction work, working conditions, and health care services at the workplace by interviewing 65 migrant wokers identified at Hayama Village in Kochi Prefecture, one of the areas well known for providing migrant wokers. Moreover, we carried out health examinations for vibration disease and pneumoconiosis. In this report, we show the results of analysis on 35 migrant forestry workers.<BR>The main factors affecting their entry into migrant forestry work were unstable and poor socioeconomic conditions in the area and the strong demand for a workforce during the rapid economic growth from the late 1950's in Japan. Most of the wage configuration was for piece and contracted work, which promoted long working hours and above-average consecutive work days. They engaged in cutting down, collecting and transporting trees, using vibrating tools such as chain saws, bush cutters, collecting machines and so on. High levels of vibration-exposure quite exceeded the limit of the Ministry of Labour and lasted continuously over 17 years. A difference in labor conditions and working situations was observed between migrant workers who devoted themselves to migrant forestry work and those who did not. Health care administration including health examinations was inadequate. There had been no case of vibration disease identified at the workplace. However, 68 percent among 25 examinees were diagnosed as suffering from vibration disease. Moreover, 40 percent of the subjects experienced absences of more than 4 days due to occupational accidents.