Examining the association of smoking with work productivity and associated costs in Japan

Aims: Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment.

Materials and methods: The data source was the 2011 Japan National Health and Wellness Survey (n?=?30,000). Respondents aged 20–64 were used in the analyses (n?=?23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs.

Results: Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs.

Limitations and conclusions: Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers. This report highlights the workplace benefits of smoking cessation across productivity markers and cost-savings.     

A multi-division efficiency evaluation of U.S. electric power companies using a weighted slacks-based measure

Prior to the 1990s, the electric power industry was highly regulated across the world. Under a liberalization policy to open markets and to grow competition commenced in the early 1990s, efficient management has become a necessity for companies in this industry. The current study examines the divisional efficiencies of multi-functional, vertically integrated companies seeking to optimize their overall management efficiency. For this purpose, divisional cost data are used as input into a slacks-based measure (SBM) model. This provides divisional efficiency indices based on slacks, as well as one for the larger firm-level management function. Further, given the important role of cost structure, we introduce a modified SBM, named the weighted SBM (WSBM), which directly incorporates division-specific weights into the objective function. Results reveal that the power generation divisions of the companies studied have significant influence on the overall cost, whereas the impact of the other four divisions - transmission, distribution, sales and general administrative - is limited.     

Technology policy in Japan: A short review

This paper examines technology policy in Japan. Following a brief introduction, we review trends in Japanese technology policy: in the 1950's and through to the mid-1960's, the main policy concern was to facilitate the importation of technology. However, in the mid-1960's, the emphasis had shifted to promote domestic R & D, and various policy measures like tax breaks, subsidies and research contracts were employed to encourage R & D in private firms. In the 1970's, public policy became more selective, and R & D on pollution control, energy, space and ocean resources was encouraged. Currently, the policy discussion is centered around the problem of how to enhance Japan's technology base in basic technologies in order to promote a shift to high-technology production. The third section examines the various policy measures in detail; preferential tax treatment, subsidies, research contracts, low interest loans, public research institutions, public corporations, and research associations. It is argued that Japanese technology policy worked alongside market forces rather than replacing them with the political process. This approach was successful in the sense that it contributed to the promotion of technological progress and a high rate of economic growth. However, as the promotion of basic research becomes more important, a new approach must be devised. The brief concluding comments discuss current and future problems to be addressed by technology policy in Japan.     

Business groups in a market economy

The purpose of this paper is to examine the nature and significance of the interfirm relationship called the business group. First, the nature of the Japanese business group is discussed. It is then pointed out that the business group is not a phenomenon unique to Japan, and an effort is made to explain the significance of the business group in the context of a market economy, using the Williamsonian approach to questions of internal organization and the market. Finally, the relationship between the input-output relationship of the firms and their group affiliation is tested.     

THE OPTIMAL MINIMUM WAGE FOR POVERTY MINIMIZATION

This paper characterizes the poverty minimizing minimum wage, and shows how it varies as productivity, inequality and market competitiveness change. We show that the optimal minimum wage is equal to the competitive wage only in special cases. In general, the former is higher than the latter. Thus, poverty minimization does not coincide with employment maximization. We also show that the optimal minimum wage always rises with productivity and, under certain conditions, falls with competitiveness and inequality. Furthermore, the higher the competitiveness and inequality, the more the optimal wage rises with productivity.     

The Bounds of Classical Risk Management and the Importance of a Behavioral Approach

Decisions under uncertainty can be influenced by individual subjective risk perceptions and biases. Subjective biases interfere with the ability or willingness of a decision-maker to evaluate even objective probabilities, and can be even more detrimental when dealing with uncertain events. The effects of subjective bias are termed judgmental risk. Successful risk management must confront judgmental risk. There is no agreement on best practices to do this. This article suggests ways of controlling employee-subjective biases and judgmental risk. Because the biases and risk are aspects of behavior, the approach is called "behavioral risk management."     

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

Abstract

Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer’s perspective.

Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis.

Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (€1,011.11) per patient (1 JPY = 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 (€24,446.42) per QALY.

Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases.

Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY.     

The impact of anti-vascular endothelial growth factor agents on visual impairment/blindness prevention in patients with diabetic macular edema and on associated patient and caregiver burden in Japan

Aims: To estimate the impact of anti-vascular endothelial growth factor (VEGF) agents on visual impairment and blindness avoided in patients with diabetic macular edema (DME) and on associated patient and caregiver productivity loss in Japan.

Methods: This study compared the impact of current care (estimated at 53.8% utilization of anti-VEGF agents using current data) with that of hypothetical care (characterized by a higher utilization of anti-VEGF agents [80.0%], as estimated by an expert panel) of DME patients. A population-based Markov model (two-eye approach) simulated visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] letters) transitions over 5 years with DME treatments (intravitreal aflibercept, ranibizumab, and triamcinolone acetonide, and grid/focal laser) in patients with DME. Patient and caregiver productivity loss was determined using the human capital method.

Results: In total, 570,000 DME patients were included in the model over 5 years. Increased utilization of anti-VEGF agents resulted in 6,659 fewer cases of severe visual impairment (SVI; 26–35 ETDRS letters) or blindness (0–25 ETDRS letters) compared with the current care approach (26,023 vs 32,682 cases; 20.38% reduction) over this period. Increased utilization of anti-VEGF agents also contributed to productivity loss savings of ¥12.58 billion (US $115.64 million) (i.e., 17.01%) at the end of year 5. The total overall saving over 5 years was ¥45.83 billion (US $421.27 million) (13.45%).

Limitations: Few Japanese data were available, and assumptions were made for some inputs. Vision changes dependent on the function of both eyes were not studied. Only intravitreal (not sub-Tenon’s) injections of triamcinolone were considered in this model. Direct costs were not considered.

Conclusions: Increased utilization of anti-VEGF agents can reduce SVI and legal blindness in patients with DME in Japan. This would also be associated with substantial savings in patient and caregiver productivity loss.     

Multi-valued Document Classification Based on Generalized Bradley-Terry Classifiers Utilizing Accuracy Information

Due to the development of computer network, a large amount of documents are treated in many fields. The number of digital document data stored in databases is enormous, accordingly it is difficult for analysts to read all documents and classify it by hand. Therefore, it is necessary to develop the technology of automatic document classification by using computers these days. From the above needs, many classifiers with good performance have been proposed, i.e., Relevance Vector Machine （RVM） and Support Vector Machine （SVM） that are known as good binary classifiers. For multi-valued document classification problems, it is known that a multi-valued classifier by combining several binary classifiers has a good performance. In this study, the method to construct an efficient combination of binary classifiers based on improving Generalized Bradley-Terry （GBT） model, which has high extensibility, is focused. This model is an expansion of Bradley-Terry （BT） model. Though the BT model has a limitation on combination of classes, the GBT model enables us to utilize any binary classifier which classifies into two arbitrary subsets in the class set. Generally, when several binary classifiers learn from the training dataset, there would be the difference of accuracy between these binary classifiers, due to the existence of categories that cannot be easily classified. However, the conventional method of multi-valued classification by GBT binary classifiers does not take the accuracy of each classifier into consideration. To avoid this problem, a new way of multi-valued classification method by considering each classifier＇s accuracy is proposed. The purpose of this study is to construct a good multi-valued classifier by calculating the accuracy of each classifier and utilizing it as the weight. In order to verify the effectiveness of the proposed method, the simulation experiment by using newspaper articles is conducted.