A cost-effectiveness analysis of revaccination and catch-up strategies with the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older adults in Japan

Objective: In Japan, the National Immunization Program (NIP) includes PPV23 as the primary vaccination for adults and catch-up cohorts. The Japanese Association for Infectious Diseases recommends revaccination for older adults who received primary vaccination ≥5 years earlier. The cost-effectiveness of adding revaccination and/or continuing catch-up vaccination in the NIP was evaluated from the public payer perspective in Japan.

Methods: The Markov model included five health states: no pneumococcal disease, invasive pneumococcal diseases (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae, and death. Cohorts of adults aged 65–95 were followed until age 100 or death: 2014 cohort (aged 65–95, vaccinated: 2014); 2019 cohort (aged 65: 2019); and 2019 catch-up cohort (aged 70–100: 2019, unvaccinated: 2014). Strategies included: (1) vaccinate 2014 and 2019 cohorts; (2) vaccinate 2014 and 2019 cohorts and revaccinate both; (3) strategy 1 and vaccinate 2019 catch-up cohort; (4) strategy 2 and vaccinate 2019 catch-up cohort; and (5) strategy 4 and revaccinate 2019 catch-up cohort. Parameters were retrieved from global and Japanese sources, costs and QALYs discounted at 2%, and incremental cost-effectiveness ratios (ICERs) estimated.

Results: Strategy 1 had the highest number of IPD and NBPP cases, and strategy 5 the lowest. Strategies 3–5 dominated strategy 1 and strategy 2 was cost-effective compared to strategy 1 (ICER: ¥1,622,153 per QALY gained). At a willingness-to-pay threshold of ¥5 million per QALY gained, strategy 2 was cost-effective and strategies 3–5 were cost-saving compared to strategy 1.

Conclusions: Strategies including revaccination, catch-up, or both were cost-effective or cost-saving in comparison to no revaccination and no catch-up. Results can inform future vaccine policies and programs in Japan.     

Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation

Aims: The Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) are validated treatment satisfaction patient-reported outcome (PRO) instruments. The ACTS includes two domains: Burdens and Benefits; the TSQM-II includes four: Effectiveness, Side Effects, Convenience, and Global Satisfaction. Japanese-language versions of the ACTS and TSQM-II have been developed and linguistically validated. This study aimed to assess their psychometric properties in Japanese patients with atrial fibrillation (AF).

Materials and methods: ACTS and TSQM-II data from 534 patients with AF were collected in a Japanese post-marketing surveillance study of a direct oral-anticoagulant, rivaroxaban. Four key psychometric properties, in line with best practice guidelines from the US Food and Drug Administration, were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (i.e. internal consistency reliability, test-retest reliability), and construct validity (i.e. convergent validity and known groups).

Results: ACTS Burdens and Benefits and TSQM-II Effectiveness, Convenience, and Global Satisfaction scales were found to be acceptable (e.g. item-level missing data at baseline <4%), with all scales having good internal consistency (Cronbach’s alpha > 0.80). test-retest reproducibility intraclass correlation coefficients for the ACTS Burdens and Benefits were 0.59 and 0.65, respectively, and between 0.54–0.61 for the TSQM-II scales. Known-groups validity for the ACTS and TSQM-II was supported by differences in scale scores by positive and negative impact (p?<?0.05). Correlations between the ACTS and TSQM-II (convergent validity) were lower than expected (range r?=?0.09–0.48), but in line with the original ACTS development study.

Limitations: Evaluation of test-retest reproducibility was limited by assessment period, which was longer (3 months) than recommended guidelines (usually up to 2 weeks).

Conclusions: Overall, Japanese versions of ACTS and TSQM-II scales satisfied internal consistency reliability and traditional validity criteria. Our study supports the ACTS and TSQM-II as appropriate PRO instruments to measure satisfaction with anticoagulant treatment in Japanese patients with AF.

Trial registration: NCT01598051, clinicaltrials.gov; registered April 20, 2012.     

The development of the group accounts disclosure system in Japan

The Japanese disclosure system of consolidated statements was introduced in 1977 and extensively revised in 1997. The role of the bureaucracy has been significant in these developments and seems to be part of Japan's closed culture. However, other explanations could also be applied. In particular, although Japanese firms opposed such disclosures on the basis of preparation costs, the Japanese government had to modernize the disclosure system, including consolidation, in order to develop the securities market regardless of an individual company's interests.     

日本政府新世纪的农业策略与启示

新世纪伊始，日本政府出台了一系列承前启后的农业策略，主要体现在农业保护、农业立法、粮食安全、比较优势、有机农业和饮食结构等方面，鉴于中日两囤三农领域较多的相似之处，这些策略对当前我国政府发展农业、改造农村、扶助农民等极富有启示意义，     

日本主银行制度演变的路径分析

日本主银行制度源于战前的银行体制和二战期间的“军需企业指定金融机关”制度。战后，日本金融体制基本被保留下来，在日本经济恢复和高速增长期，日本企业与银行通过相互持股紧密结合起来，形成了企业和银行相互促进、共同发展的良性循环．但是，在20世纪90年代日本泡沫经济崩溃以后，紧密的银企关系加剧了企业危机与银行危机的连锁反应，导致银行与企业相互羁绊的恶性循环．     

日本泡沫经济制度性原因分析及启示

20世纪90年代被称为日本经济“失去的10年”。日本经济一蹶不振,丧失了整整10年的发展。不少学者认为,90年代日本经济萧条意味着日本“又一次战败”即在经济战场上的“战败”。日本经济战败是败在了“制度”或“体制”方面,败给了成功地实行了“制度创新”或“体制创新”的美国。分析引发日本泡沫经济的制度性原因、探索日本经济走出衰退的途径,从中可寻找出对我国经济发展的有益启示。     

浅析90年代以来日本"流通革命"的原因

90年代以后日本流通业进入激烈变革时期，这种变革是二战以来的第二次流通革命。流通革命改变了日本流通体系和结构，流通企业和生产企业之间的重组日益流行，流通运营方式正在发生变化，因此流通革命将对日本经济产生重要影响。导致日本流通革命的原因很多，主要表现在价格破坏、定价体制改变、进口增加、购买方式变化、流通自由化、产销同盟和信息化等方面的原因。对这些原因及其背景的分析也反映了当今日本经济的概貌和面临的课题。     

跨海通道与日本经济

日本由于岛国的独特地理特征，为了促进其经济和社会的发展，在二战之后进行了大规模的跨海桥梁以及海底隧道建设，从而实现了四大主岛陆路交通的联结。日本一系列跨海通道的建设，对促进其经济腾飞、实现地区均衡发展，起到了积极的推动作用。这对我国当前的五大跨海交通工程，具有重要的启示和借鉴。     

从日本环境问题对策的变迁看我国的环境政策

环境问题可以区分为“公害型”环境问题与“扩展型”环境问题，文章在分析了日本在解决这些环境问题方面积累的经验和教训的同时，提出解决我国的环境问题，要完善我国的环境政策体系，加强环境执法检查和行政执法，建立绿色核算体系和制度，彻底确立“环境保护优先”的方针，大幅度地增加环境支出，提高公众的环保意识的对策建议。     

日本循环经济的运作方式及启示

日本是世界上最早探索循环经济发展模式的国家之一,也是循环经济立法最全、资源循环利用率最高的国家。日本发展循环经济是客观资源条件、经济快速增长和实现可持续发展的要求,多年来,在循环经济的实践中取得了很大的成绩,积累了丰富的经验。目前我国已充分认识到发展循环经济的重要性,日本在建立循环型社会方面的运作方式给我们提供了经验和启示。