2024 Volume 28 Issue 1 Pages 62-71
This study identified the most cost-effective pattern of long-term care (LTC) services for older individuals newly certified as eligible for LTC insurance benefits by municipalities.We followed 1,567 older individuals who were newly certified as requiring support using the five-year medical and LTC claims data, and categorized service use within one year of being newly certified as requiring support. To measure the pattern of LTC service use within one year of new certification, most effective in reducing the burden of disability-adjusted life years (DALYs) and a cost-effectiveness analysis was conducted. In a cost-effectiveness analysis, the costs were defined as the insurance expenditures over five years, and the effects were defined as DALYs. During the cost-effectiveness analysis, bootstrap simulations were performed to evaluate reliability. We categorized LTC service use into four patterns: [a] low-use, [b] adult day service for disability prevention (ADS-DP), [c] personal assistance for disability prevention, and [d] mixed-use. After five years, the mean DALYs of the ADS-DP pattern was 1.97 years. The cost-effectiveness acceptability probability was 0.49 for the five-year willingness to pay (WTP) for total LTC insurance expenditures of 7.74 million Yen. As WTP further increased, the probability also increased and was higher for the other patterns. Thus, the ADS-DP pattern was the most cost-effective. Cost-effectiveness analysis becomes increasingly important in LTC insurance because of evidence based policymaking. The use of the ADS-DP pattern services during the new certification of requiring support was found to reduce DALYs among older individuals at a low cost.
