2019 Volume 68 Issue 1 Pages 27-33
In Japan, annual medical expenditure reached 40 trillion yen in 2013 and it continues to increase under public health insurance scheme. One of the reason of increasing medical expenditure is population aging. However, another big reason is increasing technologies in health care, such as advanced medical devices and new pharmaceuticals. Insurance coverage and reimbursement prices are discussed and determined by the Ministry of Health, Labour, and Welfare. The Ministry has to consult with Central Social Insurance Medical Council (Chuikyo). Chuikyo has own rules for pricing pharmaceuticals and medical devices.
From fiscal year 2012, discussions on economic evaluation began within a subcommittee of the Chuikyo, Several issues were discussed in the subcommittee, such as target products to be evaluated, methods for evaluation, use of evaluation results. Based on the discussion in the subcommittee, in 2016, a pilot program of cost-effectiveness evaluation started for 7 pharmaceuticals and 6 medical devices. In the evaluation process, manufacturers of selected products were asked to submit cost effectiveness analysis, according to the guideline for cost effectiveness analysis. Then, submitted data were reviewed and re-analysed, if necessary, by expert groups. The results were discussed in the expert committee of cost effectiveness to make final decision. Based on the results, prices of some products were adjusted.
From 2019, economic evaluation of pharmaceuticals and medical devices will be fully implemented in order to provide efficient health care. To make the new evaluation system meaningful , “Center for Outcomes Research and Economic Evaluation for Health (CORE2-Health)” was established in the National Institute of Public Health to provide good evidence on cost effectiveness.
