Recently, there have been reports in Japan of measles infection among individuals who had been vaccinated against the disease in their childhood. Possible reasons for such reinfection are : 1) primary vaccine failure (PVF), the failure to develop immunity after vaccination; and/or 2) secondary vaccine failure (SVF), a decrease in immunity due to waning antibodies after vaccination. In response to these cases, the Japanese government has decided to provide supplemental measles immunization for non-infected children in the 7^th grade and 12^th grade for 5 years starting in 2008. Vaccines are one of the most cost-effective interventions in health programs, and this policy is expected to reduce the number of measles patients. However, the cost-effectiveness of supplemental immunization greatly depends on the age at which it is administered. The present study aims to evaluate the cost-effectiveness of supplemental measles immunization at the 7^th and 12^th grades compared with the absence of supplemental immunization.
In the present study, cost-effectiveness is measured by the incremental cost effectiveness ratio (ICER), which denotes the necessary cost of 1 year of good health. Costs are measured in terms of the social health expenditures , and health effects are represented by quality adjusted life years (QALYs). A decision tree and a Markov model were developed to estimate the costs and health effects associated with the supplemental immunization. The time horizon was set at 50 years, and a discount rate was adopted. We then adopted the criterrion that the intervention is costeffective if the ICER is less than the willingness to pay (WTP), which was 5 million yen per QALY gained.
In the base-case analyses, the ICER at 7^th grade was estimated to be 56.51 million yen per QALY gained, and that at 12^th grade was 283.23 million yen per QALY gained. In both cases, the costs per QALY gained remained over the cost-effectiveness threshold. The sensitivity analyses confirmed the robustness of these results.
The present study thus indicates that supplemental measles immunization vaccine at the 7^th and 12^th grades is not a cost-effective public health intervention in Japan.

Background：Following the implementation of a new Postgraduate Medical Education Program in April 2004, it is now up to the resident physicians to decide which hospital they would like to work. Their reluctance to work in hospitals in rural areas is one of the main factors that triggered the physician shortages in rural areas during the past five years. It is useful to investigate residents’ preferences for job characteristics and try to find a way to attract residents to medical institutions in rural areas, as few empirical studies have measured residents’ preferences quantitatively.
Objective：To clarify preferences for job characteristics and to identify the most important job attributes among resident physicians in Japan.
Methods：A postal questionnaire for a discrete choice experiment was sent to 1,227 residents at 31 hospitals. Seven job attributes were defined：daytime hours worked; presence of advising physicians; number of night shifts; opportunities to attend academic meetings; number of beds; location; and income. Respondents were asked to answer five or six questions about the choice between two medical institutions with different attributes. A random parameter logit model was estimated to represent a utility function on job attributes, and willingness to pay（WTP）for each job attribute was calculated.
Results：The response rate was 29.1% （357/1,227）. The sign was positive for three job attributes：subsidies to attend academic meetings, a location in a large city（as compared with a small or medium-sized city location）, and annual income. The sign was negative for the following five attributes; the number of daytime hours worked, absence of advising physicians, the number of night shifts, work in a clinic（rather than in a hospital）, and location in a rural area（as compared with a small or medium-sized city location）. With respect to WTP, residents on average had the highest WTP at 24.1 million yen for advising physicians. A change from a rural area to a large city represented the second-highest WTP, at 16.5 million yen.
Conclusions：The present study suggests that the presence of advising physicians and geographical conditions are extremely important factors in the residents’ choice of workplace. Restructuring medical institutions to include more advising physicians and securing access to advising physicians to institutions in rural areas will be effective in attracting residents to medical institutions in rural areas.

Despite enormous investments in research and development （R&D）, the number of new drugs introduced into the market by major pharmaceutical companies began to decline as the golden age of the pharmaceutical industry（1996-1999）ended. The so-called “year 2010 problem”, with the patents for many blockbuster drugs expiring in the year, is presenting a very urgent managerial challenge for them. Many of them are trying to find an answer in life cycle management（LCM）to extend the product life cycles of the existing patent drugs. Typical tools for the LCM include development of new formulations, new combinations of drugs, and addition of new indications.
In this study, we examine the development of combination drugs in the US market and in Japanese market, on the basis of FDA and JAPIC database. Combination drugs have natural advantages for consumers; they tend to cost less than individual drugs, have less adverse effects to and lower compliance costs. In fact, in the US, development of combination drugs is regarded as one of the most powerful tools for LCM. It has been adopted by a wide range of companies, from generic-drug manufacturers to leading pharmaceutical companies. In contrast, in Japan where strict regulations on combination drugs had remained in effect until 2005, product developments had began only after 2005, and they started to result in approval around 2009 and 2010. But the number of such drugs is still very small, and multi-national companies who had brought in products that sold well abroad dominate the small Japanese market.
We also examine the stage of the product cycle at which new combination drugs was developed for these two markets during the 10-year period from 2000 to 2009. The stage of the product cycle is measured by the length of time from the approval of drugs with a single active substance to the approval of new combination drugs. Our analysis of the US market reveals that the combination drugs have been developed not just toward the end of the product cycle, but frequently in its growth stage to promote early increases in sales. We also provide the prevalence of the new combination drugs by the main indications of these drugs in Japan and the US. Based on the result of this comparison, we considered the differences in the development of new combination drugs between Japan and the US and the reasons for these differences.