Medical care costs according to the stage and subtype of breast cancer in a municipal setting: a case study of Hachioji City, Japan.

BACKGROUND: It is important to assess whether the early detection of breast cancer affects medical care costs. However, research remains scant on the actual medical care costs associated with breast cancer treatment in Japan. This study aimed to determine the medical care costs of breast cancer treatment based on its stage using national health insurance claims data. METHODS: This was an observational study including patients with breast cancer who had undergone breast cancer treatment, as defined by the disease name and related treatment codes. Between August 2013 and June 2016, patients who underwent surgical treatment without axillary lymph node dissection and other radical treatment were classified as the curable group, while those who underwent palliative treatment were classified as the non-curable group. Patients were further stratified by subtype. The total and treatment-specific medical care costs for the five years were calculated using the national health insurance claims data of Hachioji City between August 2013 and May 2021. RESULTS: The mean total medical care costs for the curable and non-curable groups for the 5 years were JPY 3958 thousand (standard deviation 2664) and JPY 8289 thousand (8482), respectively. The mean medical care costs for specific breast cancer treatment for the curable and non-curable groups were JPY 1142 (728) thousand and JPY 3651 thousand (5337), respectively. Further, human epidermal growth factor receptor 2 + , Hormone + patients had the highest mean cost over the 5 years. CONCLUSIONS: The results suggest that the early detection of breast cancer may reduce medical care costs at the patient level.

[A report of five cancer screening rates and the related measures for cancer control in the workplace, surveyed by the Corporate Action to Promote Cancer Control].

OBJECTIVES: Most cancer control measures in the workplace have limited supporting evidence. This study aimed to identify highly effective cancer control measures, based on a survey by the Corporate Action to Promote Cancer Control. METHODS: The firms and organizations that responded to the web survey were included. The questionnaire comprised five cancer (stomach, lung, colorectal, breast, and cervical) screening rates and their countermeasures to promote cancer control. We conducted a non-hierarchical cluster analysis according to the degree of the measures and compared the screening rates among each group using an analysis of variance. Then, we performed two multiple regression analyses with the mean screening rates for stomach/lung/colorectal cancer and breast/cervical cancer as dependent variables, the implementation of each countermeasure as an independent variable, and the size and industry as control variables. RESULTS: We obtained responses from 704 firms and organizations. The three groups classified by cluster analysis were defined as active, moderate, and negative. For all cancer screenings, the main effects were significant, and multiple comparisons revealed that the difference between the active and negative groups (ts > 3.30, ps < .01, Hedges' ds > 0.73) and the moderate and negative groups (ts > 3.70, ps < .01, Hedges' ds > 0.88) were significant. For the four cancers other than lung, the difference between the active and moderate groups was not significant (ts < 0.21, ps < .84, Hedges' ds < 0.02), and for lung, the difference was significant, but the effect size was small. The multiple regression analyses revealed that "distribution of colorectal cancer test kits to all subjects" (ß = 0.14) was significant for stomach, lung, and colorectal cancer, while "financial supports for cancer screening" (ß = 0.24), "screening as part of employment" (ß = 0.18), and "careful screening of female subjects" (ß = 0.17) were significant for breast and cervical cancer, respectively. CONCLUSIONS: We identified effective countermeasures for cancer control in the workplace, and these measures will help increase cancer screening rates.

Medical costs according to the stages of colorectal cancer: an analysis of health insurance claims in Hachioji, Japan.

BACKGROUND: Although the effect of the early detection of colorectal cancer (CRC) on medical costs needs to be clarified, there are few reports on the actual medical costs of CRC patients in Japan. We aimed to identify medical costs according to CRC stage, using health insurance claims. METHODS: This observational study included CRC patients who had received specific treatment for CRC, which was defined by the procedure code and the claim computer processing system code associated with the treatment of CRC. CRC patients who underwent endoscopic or radical surgical treatment were defined as the curable group and those with palliative treatment, including palliative chemotherapy, as the non-curable group. Total medical costs and medical costs of specific treatments for CRC for 3 years were measured using the claims held by Hachioji City from May 2014 to July 2019. RESULTS: This study included 442 patients in the curable group, including 267 patients who underwent endoscopic treatment, and 175 patients who underwent radical surgical treatment, and 161 patients in the non-curable group. The mean (standard deviation) total medical costs in the curable and non-curable groups were 2,130 (2,494) and 8,279 (5,600) thousand Japanese Yen (JPY), respectively. The mean (standard deviation) medical costs for the specific treatment of CRC in the curable and non-curable groups were 408 (352) and 3,685 (3,479) thousand JPY, respectively. CONCLUSIONS: We clarified the actual medical costs of CRC in curable and non-curable groups. These results suggest the effect of early detection of CRC in reducing medical costs.

Increasing hepatitis virus screening uptake at worksites in Japan using nudge theory and full subsidies.

BACKGROUND: Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites. METHODS: 1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models. RESULTS: The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder. CONCLUSIONS: While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.

Correction to: Cost-effectiveness of a tailored intervention designed to increase breast cancer screening among a non-adherent population: a randomized controlled trial.

An amendment to this paper has been published and can be accessed via the original article.

Correction to: Tailored message interventions versus typical messages for increasing participation in colorectal cancer screening among a non-adherent population: A randomized controlled trial.

An amendment to this paper has been published and can be accessed via the original article.

Recommendations from primary care physicians, family, friends and work colleagues influence patients' decisions related to hepatitis screening, medical examinations and antiviral treatment.

Identification and screening of patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) is important to prevent liver cancer. Comprehensive antiviral treatments should follow three sequential steps: Hepatitis screening (step 1; examination of HB surface antigen and HCV antibody), medical examination (step 2; examination of HBV-DNA and/or HCV-RNA and performance of abdominal ultrasonography) and antiviral treatment (step 3). Patients who underwent these three steps were studied to determine effective information sources (factors) for raising awareness of comprehensive treatments. A total of 182 patients from 11 medical institutions were who were undergoing antiviral treatment were investigated. The number of patients who accessed each of the 18 information sources in each of the three steps and the percentage of these information sources that directly influenced the participants to make treatment-related decisions were calculated. 'Recommendation from a primary care physician' was the most common information source (64.3, 77.5, and 75.8% at steps 1, 2, and 3, respectively). 'Recommendation from a public health nurse (PHN),' 'recommendation from friends or family,' and 'recommendation from work colleagues' were the next most common human factors (3.3-19.8%). 'Recommendation from a primary care physician' had the greatest influence (76.9, 73.0, and 77.5% at steps 1, 2, and 3, respectively). 'Recommendation from a PHN' (50.0, 26.3 and 64.3%), 'recommendations from friends and family' (58.3, 38.9 and 58.3%), and 'recommendations from work colleagues' (33.3, 33.3 and 42.9%) were highly influential factors. Media such as TV commercial messages and programs also had high recognition, but were not directly influential. The findings of the present study indicated that recommendations from primary care physicians, friends, family and work colleagues influenced patients' decision-making regarding hepatitis screening, examination and treatment.

Cancer Prevention Using Machine Learning, Nudge Theory and Social Impact Bond.

There have been prior attempts to utilize machine learning to address issues in the medical field, particularly in diagnoses using medical images and developing therapeutic regimens. However, few cases have demonstrated the usefulness of machine learning for enhancing health consciousness of patients or the public in general, which is necessary to cause behavioral changes. This paper describes a novel case wherein the uptake rate for colorectal cancer examinations has significantly increased due to the application of machine learning and nudge theory. The paper also discusses the effectiveness of social impact bonds (SIBs) as a scheme for realizing these applications. During a healthcare SIB project conducted in the city of Hachioji, Tokyo, machine learning, based on historical data obtained from designated periodical health examinations, digitalized medical insurance receipts, and medical examination records for colorectal cancer, was used to deduce segments for whom the examination was recommended. The result revealed that out of the 12,162 people for whom the examination was recommended, 3264 (26.8%) received it, which exceeded the upper expectation limit of the initial plan (19.0%). We conclude that this was a successful case that stimulated discussion on potential further applications of this approach to wider regions and more diseases.

Tailored message interventions versus typical messages for increasing participation in colorectal cancer screening among a non-adherent population: A randomized controlled trial.

BACKGROUND: The purpose of this study was to examine the effectiveness and cost-efficiency of a tailored message intervention compared with a non-tailored message intervention for increasing colorectal cancer (CRC) screening rates among a non-adherent population, in a community-based client reminder program. METHODS: After a baseline survey for psychological segmentation, 2140 eligible individuals were randomly assigned either to a group with a tailored matched-message condition (N = 356), a group with a non-tailored unmatched-message condition (N = 355), or to two control groups, one using a typical message with a professional design (N = 717) and one without a professional design (N = 712). The main outcome measure was attendance rates in a community-organized CRC screening program within five months of receiving a print reminder. RESULTS: There was a significant difference in fecal occult blood test (FOBT) attendance rates at follow-up assessments between the tailored matched-message condition (14.0 %) and the control (9.9 %; OR = 1.48, p = 0.026), while there was no significant difference between the unmatched-message condition (11.0 %) and the control (OR = 1.12, p = 0.558), and between the matched-message condition and the unmatched-message condition (OR = 1.32, p = 0.219). The cost of a one-person increase in FOBT screening was 3,740 JPY for the tailored matched-message condition, while it was 2,747 JPY for the control. CONCLUSIONS: A tailored-message intervention for segmented individuals designed to increase CRC screening rates in a community-based client reminder program was significantly effective compared to a usual reminder, but not more effective than an unmatched message in a randomized controlled trial, and was not sufficiently effective to highlight its value from a cost perspective. Therefore, the tailored intervention including target segmentation needs to be improved for future implementation in a CRC screening program for a non-adherent population. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000004384 . Date of Registration: March 2011.

Evaluation of a free-coupon program for cervical cancer screening among the young: a nationally funded program conducted by a local government in Japan.

BACKGROUND: Finding ways to improve the cervical cancer screening rates among young women has been seen as a critical national health problem in many countries, including Japan. The aim of the present study was to evaluate the effects of a free-coupon program for cervical cancer screening conducted by a local government under financial support from the Japanese national government. METHODS: The personal cervical cancer screening information was analyzed for all female residents of Toyonaka City, including any past screening history and clinical results since the year 2009, when a free-coupon program for screening was started. These results were compared to results from 2008, prior to implementation of the free-coupon screening program. RESULTS: The screening rates of women eligible for the free-coupon peaked dramatically compared to women of similar age who paid for their screening; however, the rates for the ineligible-age population also increased significantly in parallel to those in the free-coupon program, possibly by indirect peer and publicity effects. In women aged 20 to 25 years, the consecutive screening rate after a free-coupon screening was significantly lower than for those women who received a regular residential screening. After a free-coupon screening, the rate for participating in consecutive screenings depended significantly on the institution where the participant received her first screening test. CONCLUSIONS: These results suggest that, for a generation of young women 20-25 years of age, a free-coupon program for cervical cancer screening was effective in increasing the first-time participation rate for screening; however, the increase in first-time participation did not lead to the expected increase in consecutive screenings.

Worry and intention among Japanese women: implications for an audience segmentation strategy to promote mammography adoption.

We examined the predictive validity of a segmentation strategy based on intention and cancer worry for mammography adoption and explored key factors for promoting mammography adoption in each segment. A questionnaire survey was completed by 641 women aged 40-59 years. Among them, 559 answered a follow-up survey after 15 months. They were categorized into five segments: maintenance group (S5), higher implementation intention group (S4), higher goal intention group (S3), higher worry group (S2), or lower worry group (S1). The odds of participants in each segment adopting mammography during the follow-up period were calculated. Logistic regression analysis was conducted to identify psychological predictors (five attitudes to mammography and perceived health competence) of transition to upper segments (S1 vs. S2, S2 vs. S3, S3 vs. S4, S4 vs. S5). Compared to S5, other segments did not undertake mammography at significant rates during the follow-up. The following were significant predictors for inclusion in upper segments: Lack of importance and perceived health competence were associated with inclusion in S2; lack of importance and barriers to screening were associated with inclusion in S3; perceived health competence was associated with inclusion in S4; and lack of importance was associated with inclusion in S5. These results confirm the predictive validity of a segmentation strategy, and indicate that there might be specific key factors for each segment in promoting mammography adoption.

Cost-effectiveness of a tailored intervention designed to increase breast cancer screening among a non-adherent population: a randomized controlled trial.

BACKGROUND: Although the percentage of women who initiate breast cancer screening is rising, the rate of continued adherence is poor. The purpose of this study was to examine the effectiveness and cost-effectiveness of a tailored print intervention compared with a non-tailored print intervention for increasing the breast cancer screening rate among a non-adherent population. METHODS: In total, 1859 participants aged 51-59 years (except those aged 55 years) were recruited from a Japanese urban community setting. Participants were randomly assigned to receive either a tailored print reminder (tailored intervention group) or non-tailored print reminder (non-tailored intervention group). The primary outcome was improvement in the breast cancer screening rate. The screening rates and cost-effectiveness were examined for each treatment group (tailored vs. non-tailored) and each intervention subgroup during a follow-up period of five months. All analyses followed the intention-to-treat principle. RESULTS: The number of women who underwent a screening mammogram following the reminder was 277 (19.9%) in the tailored reminder group and 27 (5.8%) in the non-tailored reminder group. A logistic regression model revealed that the odds of a woman who received a tailored print reminder undergoing mammography was 4.02 times those of a women who had received a non-tailored print reminder (95% confidence interval, 2.67-6.06). The cost of one mammography screening increase was 2,544 JPY or 30 USD in the tailored intervention group and 4,366 JPY or 52 USD in the non-tailored intervention group. CONCLUSIONS: Providing a tailored print reminder was an effective and cost-effective strategy for improving breast cancer screening rates among non-adherent women.