Objective: This study aims to estimate the cost-effectiveness of combined physical and cognitive programs designed to prevent community-dwelling healthy young-old adults from developing dementia. Methods: The analysis was conducted from a public healthcare and long-term care payer’s perspective. Quality-adjusted life years (QALYs) and expenses for health services and long-term care services were described in terms of effectiveness and cost, respectively. A thousand community-dwelling healthy adults aged 65 years were generated through simulation and analyzed. The incremental cost-effectiveness ratio (ICER) of adults with preventive program intervention compared to those with nonintervention was simulated with a 10-year cycle Markov model. The data sources for the parameters to build the Markov models were selected with priority given to higher levels of evidence. The threshold for assessing cost-effectiveness was set as less than 5,000,000 Japanese yen/QALY. Results: The ICER was estimated as −5,740,083 Japanese yen (US$−57,400)/QALY. Conclusion: A program targeting community-dwelling healthy young-old adults could be cost-effective.
Objective: The purpose of this study was to investigate the outcomes of physiotherapy on patients in psychiatric long-term care wards in Japan and to identify the characteristics of patients who have been discharged to the community. Methods: The subjects comprised 50 patients who were admitted to the psychiatric long-term care wards at four different hospitals in Japan and prescribed physiotherapy. General physiotherapy for the patients’ diseases was provided. The main outcome was whether a patient was discharged to the community (discharged group) or remained hospitalized (hospitalized group) at the end of physiotherapy. Basic subject characteristics, including age, sex, F-code, classification of the diagnosis that led to physiotherapy, length of hospital stay, and length of physiotherapy, were collected from medical records. The Functional Independence Measure (FIM) tool was administered at the initial and final evaluations. Results: At the end of physiotherapy, there were 14 subjects in the discharged group and 36 subjects in the hospitalized group. There were significant differences in the classification of diagnosis, length of stay (LOS), and classification of LOS between the two groups. Two-way analysis of variance showed interactions between the FIM subitems of self-care, transfer, and locomotion. Conclusion: The discharged group had higher FIM scores at the start of physiotherapy and a greater FIM gain.
Clinical research based on epidemiological study designs requires a good understanding of statistical analysis. This paper discusses the common misconceptions of p-values so that researchers and readers of research papers will be able to properly present and understand the results of null hypothesis significance testing (NHST). The p-values calculated by NHST are categorized as three different types: “significant at p <0.05,” “significant at p <0.01,” or “not significant.” If specified, they may be written as p = 0.124. The 95% confidence interval (CI) of the supplementary statistics is presented regardless of the p-value, and the range of the CI is observed and discussed to determine whether the results are clinically valid. The effect size (ES), which is a measure of the magnitude of the effect, is also referenced and discussed. However, the ES should not be overestimated. It is important to examine the actual descriptive statistics and consider them comprehensively as much as possible. A high detection power of 80% or more indicates that NHST with high accuracy was applied. However, even when it falls below 80%, it is important to consider the limitations of the study, because the results are not completely useless.