Nagano Mitsuhiro, Hyokai Sachiko, Togo Kanae, Mugwagwa Tendai, Yuasa Akira
Japan Access & Value, Pfizer Japan Inc., Tokyo, Japan.
Medical Affairs, Pfizer Japan Inc., Tokyo, Japan.
Expert Rev Pharmacoecon Outcomes Res. 2025 Feb;25(2):215-225. doi: 10.1080/14737167.2024.2410963. Epub 2024 Oct 4.
In Japan, medical expenses for COVID-19 treatment transitioned from full public funding support to out-of-pocket (OOP) payment by patients plus partial public support in October 2023, and public support fully ended in March 2024. This study evaluated the clinical and economic impacts of initiating OOP payments.
To assess the impact on prescription rates, we compared the prescription rates of antivirals from the 4-month pre- to post-OOP payment initiation period using a claims database. Subsequently, a budget impact model assessed the impacts of a hypothetical decline in the prescription rates on COVID-19-related hospitalizations, deaths, and direct medical costs for antiviral prescription and hospitalization.
The antiviral prescription rate per 100 patients decreased from 17.5 for the pre-OOP payment initiation period to 11.5 for the post-OOP payment initiation period, that is, a change of - 34.3%. With prescription rate decreases of 40%, 60%, and 80%, the hospitalizations would increase annually by 22,533 (3.3%), 33800 (5.0%), and 45,066 (6.6%), respectively. The total costs would increase by JPY9.5 billion (USD67.3 million; 0.7%), JPY14.3 billion (USD100.9 million; 1.0%), and JPY19.0 billion (USD134.5 million; 1.3%), respectively.
Higher OOP payment decreased the antiviral prescription rate, potentially leading to clinical and economic loss.
在日本，2023年10月，新冠病毒病（COVID-19）治疗的医疗费用从完全由公共资金支持转变为患者自付费用加部分公共支持，2024年3月公共支持完全结束。本研究评估了启动自付费用支付的临床和经济影响。
为评估对处方率的影响，我们使用索赔数据库比较了自付费用支付启动前4个月至启动后4个月的抗病毒药物处方率。随后，一个预算影响模型评估了假设的处方率下降对COVID-19相关住院、死亡以及抗病毒药物处方和住院的直接医疗费用的影响。
每100名患者的抗病毒药物处方率从自付费用支付启动前的17.5降至启动后的11.5，即变化了-34.3%。处方率分别下降40%、60%和80%时，住院人数每年将分别增加22,533例（3.3%）、33,800例（5.0%）和45,066例（6.6%）。总成本将分别增加95亿日元（6730万美元；0.7%）、143亿日元（1.009亿美元；1.0%）和190亿日元（1.345亿美元；1.3%）。
更高的自付费用降低了抗病毒药物处方率，可能导致临床和经济损失。
