A study on COVID19 drugs with Gilead has been published in Viruses. (April 30, 2026)

We are pleased to announce that the following study has been published regarding the timing of administration of the COVID19 drug remdesivir with Gilead as a client.

Shindo Y, Piao Y, Berry M, Ramroth H, Yoshida M. Timing of Remdesivir Initiation and Clinical Outcomes in Hospitalized Patients with COVID-19 Who Are at High Risk of Disease Progression in Japan: A Health Insurance Claims Database Study. Viruses. 2026;18:479. doi:10.3390/v18040479

This study used data from DeSC Healthcare to compare the survival and discharge rates of high-risk patients hospitalized for COVID19 reasons by time of administration of remdesivir.

In conclusion, the survival and discharge rates from admission to the 28th day of hospitalization in the early, late, and non-remdesivir groups were 74.9%, 63.1%, and 71.8%.

For more information, please see the link below..

https://www.mdpi.com/1999-4915/18/4/479

If you have any comments or questions, please contact us at the address below.

[email protected]

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About Uplift Modeling (April 9, 2026)

A member of our Eden Prairie (Minnesota) office authored a paper titled "Optimizing Pharmaceutical Costs with Precision Medicine Using Uplift Modeling."

https://www.milliman.com/en/insight/pharmacy-spending-precision-medicine-uplift-modeling

The paper argues that in order to address the rising cost of medicines, precision medicine and uplift modeling should be used to individually identify patients who actually benefit from treatment and optimize drug use. Assuming that the treatment effect is not uniform even for patients with clinical indications and varies from person to person, it is possible to focus treatment only on patients who are truly expected to be effective by estimating the difference in outcomes (incremental effect) with or without treatment. This approach is similar to uplift modeling in marketing, where it is presented as an approach to optimize treatment allocation within existing target populations and improve outcomes while curbing wasteful drug spending.

The effectiveness of health work largely depends on the choice of intervention subjects. Traditionally, based on a prediction model of medical costs, people who are predicted to have high medical costs have often been targeted for intervention, but this is not always reasonable. It is considered more reasonable to predict the impact of health services on health care costs for each individual (the difference between medical costs without intervention and medical costs with intervention minus intervention costs) and select subjects in order of highest value.

If you have any comments or questions, please contact us at the address below.

[email protected]

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About the U.S. Social Insurance Administration's (CMS) ACO New Model "LEAD" (March 13, 2026)

In December 2025, the Innovation Center of the U.S. Social Security Administration (CMS), which oversees Medicare, unveiled a new model for Accountable Care Organizations (ACOs), the Long-term Enhanced ACO Design (LEAD) model. Milliman was one of the first to introduce and announce the mechanism as a white paper. It will be the link below.

https://www.milliman.com/en/insight/cms-aco-lead-medicare-medicaid-integration-opportunity

ACOs are institutionalized as part of Obamacare in 2010 and are centered on U.S. family physicians, who are paid by CMS as bonuses if they can reduce health care costs below the benchmark without compromising the quality of care for the group of insured people they are responsible for. LEAD is a dual eligible. It is known that these people are a large part of the health care expenditure. The ACO model for such high-risk groups is likely to have a variety of intervention methods. The white paper also highlights LEAD as an experimental model for Medicare and Medicaid integration: payment integration, care integration, and data integration.

Regarding ACOs, it seems to give various hints when thinking about Japan's medical insurance system.

If you have any comments or questions, please contact us at the address below.

[email protected]

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Milliman Newsletter Published a paper on the ROI of Nippon Life and Specific Health Guidance　（March 11, 2026）

We have published the following papers co-authored with Nippon Life Insurance and Dr. Igarashi of the University of Tokyo. The content verified whether Japan's specific health guidance has a return on investment (ROI) from the perspective of reducing medical costs using real-world data derived from the health insurance association owned by Nippon Life.

The results showed that in motivational and active support, ROIs were 3.90 and 1.36, respectively, both above 1, suggesting that they were economically beneficial.

Ueda T, Kakinuma A, Kinugawa M, Yajima S, Miyamori Y, Kakoi T, Yamamoto S, Zhang T, Takeshima T, Chida A, Iwasaki K, Igarashi A. Return on investment of national specific health guidance in Japan: an observational study using "Wellness-Star⋆" health insurance claims database. J Med Econ. 2026 Dec; 29(1):688-697. doi: 10.1080/13696998.2026.2631936. Epub 2026 Mar 6. PMID: 41790001.

Please see the original text for details.

https://doi.org/10.1080/13696998.2026.2631936

If you have any comments or questions, please contact us at the address below.

[email protected]

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Milliman Newsletter: Burden of Depression and Alzheimer's Disease Using a General Equilibrium Model (December 16, 2025)

When we think of disease burden, we tend to think of medical expenses. Certainly, from the insurer's point of view, medical expenses (the part of insurance benefits excluding co-payments) are recognized as "burdens". However, from the standpoint of society, if "burden" is defined as something that reduces GDP, medical expenses do not necessarily fall under the burden of disease. This is because medical expenses are the income of doctors, medical institutions, and medical workers, so they are only income transfers from a macroeconomic point of view, and do not reduce GDP itself.

In order to assess the disease burden of society as a whole, it is necessary to distinguish between such income transfer and real production losses. For this purpose, the Computable General Equilibrium (CGE) model is effective. The CGE model quantifies the pure macroeconomic loss remaining in GDP based on the theorem that "health care costs do not reduce GDP, while inability to work and productivity decline due to disease reduce GDP."

Furthermore, the CGE model is characterized by its endogenous view of the impact of the CGE model on the entire economy, rather than the direct impact of productivity decline on individuals and specific industries. Specifically, the interdependence and general equilibrium effect between economic agents is considered, in which a decrease in the supply of labor affects wages, consumption, investment and inter-industrial transactions, which in turn feed back into productive activity. As a result, the impact of disease is evaluated not just as a build-up of productivity losses, but as macroeconomic losses, including synergies and multiplier effects on the economy as a whole.

The analysis based on this framework revealed the following points (Key findings):

• Regarding depression, it was estimated that if all new cases were avoided, Japan's GDP would increase by about $3.22 billion. This is small compared to the broad economic burden estimated by the partial equilibrium model of about $39 billion, but it shows the net macro effect that actually remains as GDP after accounting for the adjustment of the economy as a whole.
• Regarding Alzheimer's disease, it was estimated that if long-term care is shifted from informal care (free nursing care by family members, etc.) to care provided by professionals, Japan's GDP will increase by about $1.94 billion. Of this amount, approximately $1.16 billion will directly contribute to GDP through the expansion of professional care services.

Please see the original text for details.

https://www.milliman.com/en/insight/economic-burden-chronic-disease-cge-model-approach

The white paper was prepared by Milliman's Economics Department in Paris and Health in Tokyo.

If you have any comments or questions, please contact us at the address below.

[email protected]

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Milliman Newsletter – The Position of NDB in Japan’s Policy Hierarchy and Its Strategic Role in Evidence-Based Policy Making (December 12, 2025)

We introduced our independent research using the Ministry of Health, Labour and Welfare’s National Database (NDBβ) in the July 1 issue of Social Insurance Weekly. This time, we reviewed major national policy documents related to the utilization of NDB, clarified its multi-layered and cross-cutting position within Japan’s policy framework, and examined the strategic role of evidence-based policy making (EBPM) leveraging NDB as a core information infrastructure in addressing challenges in Japan’s healthcare and social security systems.

Our paper on this topic was published in the December 11 issue of Social Insurance Weekly. If you are interested, please contact us at the address below.

If you have any comments or questions, please contact us at the address below.

[email protected]

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Milliman Newsletter Paper "NDB Update: From an Actuary's Perspective" Published in JARIP BULLETIN (Nov. 20, 2025)

We are pleased to announce that the paper "Latest Developments in the NDB: An Actuary's Perspective" has been published in Volume 9, Issue 1 of the JARIP BULLETIN (Japan Association for Risk and Insurance Practice).

The National Database (officially named the "Anonymous Medical Insurance and Related Information Database," "NDB") is a database unique in the world, yet its recognition among insurance companies remains relatively low. Milliman has analyzed the NDB relatively early on, primarily in projects with pharmaceutical companies as clients. Recently, the situation has significantly improved, especially with the start of cloud-based provision.

JARIP BULLETIN website
https://www.jarip.org/publication/bulletin/index.html

If you have any comments or questions, please contact us at the address below.

[email protected]

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Poster Presentation at ISPOR Europe 2025 (November 20, 2025)

Milliman presented three posters at ISPOR Europe 2025, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) academic conference held in Glasgow from November 9-12, 2025.

• Method to Estimate Causally Related Cost Savings of a Preventive Intervention: An Analysis Using the Wellness-Star☆ Database. Session 1: Monday, November 10, 2025 | 10:30 AM - 01:30 PM
  To examine whether obesity and sleep deprivation impact healthcare costs, we decomposed healthcare expenditures by disease category to assess causal relationships. This study utilized the "Wellness-Star☆" database provided by Nippon Life Insurance Company. This research is a collaborative effort with Professor Nakamichi Igarashi of the University of Tokyo, colleagues from Nippon Life Insurance Company, and Professor Naoki Ikegami of Keio University.
• Proportion of the Expenses of Over-the-Counter Equivalent Drugs Among Total Healthcare: An Analysis Using the Wellness-Star☆ Database. Session 1: Wednesday, November 12, 2025 | 9:00 AM - 11:30 AM
  In Japan, there is ongoing debate regarding the appropriateness of prescribing OTC equivalent drugs under insurance coverage. Therefore, we estimated the proportion of OTC equivalent drugs within total national healthcare expenses. This study utilized the "Wellness-Star☆" database provided by Nippon Life Insurance Company. This research is a collaborative effort with Professor Naka Igarashi of the University of Tokyo, members of Nippon Life Insurance Company, and Professor Naoki Ikegami of Keio University.
• Was There Off-Label Prescription of Glucagon-like Peptide-1 for Weight Loss in Japan? An Analysis of Health Insurance Claims Data. Session 1: Monday, November 10, 2025 | 10:30 AM - 01:30 PM
  Although GLP-1 inhibitors became approved for obesity treatment in Japan only after February 2024, off-label prescriptions for weight loss purposes may have existed prior to this. This study tracked GLP-1 inhibitor prescription trends using data from DeSC Healthcare.

If you have any comments or questions, please contact us at the address below.

[email protected]

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Milliman Newsletter: Published a paper simulating the waiting period for lecanemab treatment.

Lecanemab is a disease-modifying drug for Alzheimer's disease. We are pleased to announce the publication of a paper co-authored by Milliman, which evaluated through simulation how the diagnostic process required for lecanemab treatment would change in Japan if a blood biomarker (BBM) test were introduced.

Igarashi A, Kimura N, Ataka T, Ito T, Sasaki K, Kobayashi C, Tani M, Sakata Y, Azuma M, Chida A, Takeshima T, Iwasaki K, Matsubara E. Simulation of Alzheimer's diagnostic flows with blood biomarker test options in Japan. Alzheimers Dement (N Y). 2025 Oct 7;11(4):e70157. doi: 10.1002/trc2.70157. PMID: 41070364; PMCID: PMC12504044.

―Summary―

This project was conducted with Eisai as the client.

First, we investigated the Willingness-to-pay (WTP) for the test. We then estimated the total cost of the test, including non-monetary costs (waiting time, travel time, etc.). We assumed individuals would join the testing queue only if their WTP exceeded these total costs. Longer queues increase non-monetary costs and reduce the number of people willing to wait, necessitating dynamic simulation. Additionally, since the distance to hospitals with specialists and transportation costs vary by region, we conducted simulations using nationwide geographic data.

The results showed that introducing BBM reduces waiting times.

The original paper can be downloaded from the following website:

https://pmc.ncbi.nlm.nih.gov/articles/PMC12504044/

If you have any comments or questions, please contact us at the address below.

[email protected]

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A Reflection Paper on Real-World Evidence Issued by EMA (October 20, 2025)

It’s a bit belated, but in March 2025 the European Medicines Agency (EMA) issued a Reflection Paper on the generation of real-world evidence from non-interventional studies (i.e., observational research rather than clinical trials), which I’d like to introduce.

Here is the link: https://www.ema.europa.eu/en/documents/other/reflection-paper-use-real-world-data-non-interventional-studies-generate-real-world-evidence-regulatory-purposes_en.pdf

First, a “Reflection Paper” is a document issued by the EMA to share its current thinking as a regulator on a particular area or new methodology. Unlike a guideline, it is not legally binding. However, in practice it functions as a de facto norm, because it is difficult for applicants (e.g., pharmaceutical companies) to ignore the views expressed in a Reflection Paper when preparing regulatory submissions.

The main structure of the paper is as follows:

1. Introduction: Definitions of non-interventional studies, RWD, and RWE, and how they can play complementary roles in regulation
2. Scope: Which types of studies are and are not covered, and what constitutes “regulatory purposes”
3. Legal obligations and regulatory requirements: Relevant EU regulations, guidance, and data-protection rules; recommendations to seek early interactions with authorities (scientific advice, protocol assistance)
4. Study design: Guidance tailored to research objectives (descriptive vs. causal), feasibility assessments, target trial emulation, etc.
5. Bias, confounding and effect modification: Methods to identify and control selection bias, information bias, time-related bias, confounding, and effect modification
6. Governance and transparency: Ethical and legal obligations, data protection, informed consent, stakeholder engagement, and ensuring transparency via protocol registration and public release of analysis code
7. Data quality: Emphasis on reliability and relevance; issues when using multiple databases such as heterogeneity, data linkage, and data-collection practices
8. Statistical analyses: Guidance on model specification, estimation and precision, time-dependent analyses, stratified analyses, sensitivity analyses, handling missing data, and heterogeneity across multiple databases

Below are several points I found particularly interesting.

First, the study’s primary objective must be clearly identified as descriptive or causal at the outset. Descriptive objectives encompass studies that characterize prevalence, incidence, treatment patterns, healthcare resource utilization, and safety-signal detection—aimed mainly at understanding “what is happening.” Causal objectives evaluate whether a treatment is effective and safe, or how it compares with an alternative, with the goal of estimating treatment effects; this requires appropriate design choices, confounding control, and bias mitigation. ISPOR guidelines likewise propose first distinguishing Exploratory Treatment Effectiveness Studies from Hypothesis-Evaluating Treatment Effectiveness (HETE) Studies. In practice, the complexity of analyses differs markedly between these two types.

Next, regarding the active comparator. When comparing a treatment, the paper advises choosing as the control not “no treatment” or an “untreated” group, but rather another clinically appropriate therapy for the same disease/indication. This is very sensible operationally. For example, when conducting a longitudinal analysis comparing patients diagnosed with a disease to those without it, it is often more appropriate to align the index date in the “non-diseased” group with a healthcare encounter (for whatever reason) to create a better-matched comparison.

I also found the use of Negative/Positive Control Outcomes to be highly practical. Since confounding and bias can never be eliminated entirely, these controls are useful for demonstrating the robustness of results. A negative control outcome—an outcome believed to have no causal relation to the exposure (treatment)—can reveal residual confounding or bias if a spurious association appears. For instance, if the research question is whether SGLT2 inhibitors reduce heart failure in diabetes patients, then observing a significant difference in an event presumed unrelated to the drug (e.g., fractures) would suggest residual confounding in the study design. A positive control outcome is one with a well-established causal relationship to the exposure. For example, in a warfarin study, failing to observe an increased risk of bleeding would point to problems in the study design.

Lastly, the paper is critical of overreliance on p-values. Because p-values are highly dependent on sample size, very large datasets can yield statistical significance for clinically trivial differences. In other words, even if a p-value is significant, a small effect size may offer little clinical relevance. The paper recommends presenting point estimates with their 95% confidence intervals instead of relying on p-values.

If you have any comments or questions, please contact us at the address below.

[email protected]

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We Presented Two Posters at the ISPOR RWE Summit

The Ministry of Health, Labour and Welfare’s National Database (NDB) is an extremely comprehensive database that covers Japan’s medical claims and health checkup data. While the NDB has long been available to the private sector for projects serving the public interest, the drawback has been the time and effort required before the data becomes usable.

On September 29, 2025, at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Real World Evidence Summit held in Tokyo, Milliman—together with Nippon Life, Nissay Information Technology, and Professor Igarashi of the University of Tokyo—presented two posters.

• The first, titled “One Method of Breaking Down Medical Expenses by Illness: Estimating Marginal and Average Burden,” introduced a method developed by Nissay Information Technology to decompose medical costs by disease. In Japanese claims (receipts), diagnoses are not assigned to each service or drug; instead, diagnoses are listed collectively on the monthly claim submitted by the medical provider. Consequently, it is generally not possible to allocate incurred costs to individual diagnoses. Nissay Information Technology developed a technique to apportion medical costs by diagnosis. Using this approach, for example, when a patient with hypertension, diabetes, and dyslipidemia visits a clinic and receives prescriptions for each condition, the resulting costs can be separated into hypertension-, diabetes-, and dyslipidemia-related components.
• The second, titled “The Difference of Cost Savings of National Standardized Health Training Among Health Insurance Societies: A Cohort Study Using the ‘Wellness-Star☆’ Health Insurance Claims Database,” examined the impact of Japan’s Specific Health Guidance program. We have presented various studies on the economic effects of Specific Health Guidance at past ISPOR meetings. This study looked at how much those effects vary across health insurers (health insurance societies). The analysis used the Wellness-Star☆ database owned by Nippon Life.

If you have any comments or questions, please contact us at the address below.

[email protected]

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I Tried Using NDBβ for the First Time

The Ministry of Health, Labour and Welfare’s National Database (NDB) is an extremely comprehensive database that covers Japan’s medical claims and health checkup data. While the NDB has long been available to the private sector for projects serving the public interest, the drawback has been the time and effort required before the data becomes usable.

Compared with the NDB, NDBβ lacks information on dates, regions, and providers, but it contains the same volume of data. Applications can be submitted through a simplified monthly review process, and once approved, access is granted within a few days. The system has been in operation since February of this year. We applied in February and conducted a pilot study. An article describing the process has been published in the July 1 issue of Shakai Hoken Junpo (Social Insurance Weekly Report). If you are interested, please contact us at the address below.

If you have any comments or questions, please contact us at the address below.

[email protected]

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Two papers with Fukuoka University, Kawasaki Medical University, and Otsuka Pharmaceutical were ranked in the top 10% of Neurology and Clinical Neuroscience by views（April 24, 2025）

We are pleased to report that two papers with Dr. Tsuboi of Fukuoka University, Dr. Wada of Kawasaki Medical University, and Otsuka Pharmaceutical have been in the top 10% of papers published in the English journal "Neurology and Clinical Neuroscience" of the Japan Society of Neurology in 2023.

These two papers show the actual treatment of Parkinson's disease in Japan by analyzing data from Medical Data Vision.

It is listed on the Journal's website as Top accessed articles published in 2023.

https://onlinelibrary.wiley.com/page/journal/20494173/homepage/mostaccessed.html

Wada-Isoe K, Tsuboi Y, Kondo H, Kojima Y, Takeshima T, Iwasaki K. Non-ergot dopamine agonist therapy for Parkinson's disease in Japan: A claims database analysis. Neurol Clin Neurosci. 2023; 11: 63-71. doi:10.1111/ncn3.12689

Tsuboi Y, Wada-Isoe K, Kondo H, Kojima Y, Takeshima T, Iwasaki K. Differences in Parkinson's disease treatment between neurology and other departments in Japan. Neurol Clin Neurosci. 2023; 11: 79-89. doi:10.1111/ncn3.12699

 

[email protected]

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A paper using NDB with Dr. Shimizu of the University of Tokyo, Dr. Tamura of Jichi Medical University, and Shionogi Pharmaceutical Co., Ltd. has been published (April 21, 2025)

We are pleased to announce that Iwasaki has published a new paper in a peer-reviewed academic journal as a researcher at the University of Tokyo, together with Dr. Shimizu of the University of Tokyo, Dr. Tamura of Jichi Medical University, and Shionogi Pharmaceutical.

Tamura D, Iwasaki K, Yoshida M, Sato Y, Hiroi S, Shimizu E. Status of diagnostic test, diagnosis, and treatment of influenza using the national database of health insurance claims and specific health checkups of Japan.

J Infect Chemother. 2025 Apr 1;31(5):102692. doi: 10.1016/j.jiac.2025.102692. Epub ahead of print. PMID: 40180118.

https://www.jiac-j.com/article/S1341-321X(25)00089-3/fulltext

This study shows the actual conditions of testing, diagnosis, and prescription of antiviral drugs for influenza patients in Japan using the Ministry of Health, Labor and Welfare's National Database (NDB).

Since NDB is a highly comprehensive database for all citizens, we took advantage of its characteristics to conduct sub-analyses from various perspectives, such as age, insurance type, facility size, and prefecture, and examined the impact.

In this study, we used specially extracted data that allows us to use all the information of the NDB, but the number of NDBs has recently increased, such as NDB-β, which has some limitations on the items of data provided but can be used quickly with a simple review.

Recently, it has become possible to use NDB using clouds. This requires the usual review, but since the researchers directly cut out the necessary data from the entire NDB and use it, the period from the end of the review to the start of data use will be significantly shortened compared to the specially extracted data so far.

If you are interested, please feel free to contact us at the address below.

[email protected]

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A paper using NDB with Prof. Ikegami of Keio University and Prof. Igarashi of the University of Tokyo has been published (April 11, 2025)

We are pleased to announce that a paper by Dr. Naoki Ikegami of Keio University and Dr. Ataru Igarashi of the University of Tokyo entitled "The Actual Situation of Prescription of Therapeutic Drugs for Novel Coronavirus Infections under Insurance Treatment Based on National Database (NDB) Analysis" has been published in Social Insurance Junpo No. 2960 (April 11, 2025).

This paper examines the response to COVID-19 in Japan by showing the actual situation of drug prescription under insurance treatment for COVID-19 treatment from the beginning of the COVID-19 outbreak through an analysis of the NDB.

At the beginning of the outbreak of COVID-19, there were few drugs that were found to be effective, and guidelines and other drug candidates were presented including off-label use of drugs listed in the NHC, and the Ministry of Health, Labor and Welfare supported the prescription of such drugs. The NDB's analysis showed that such non-ineligible prescriptions were actually carried out under health insurance.

In this study, we used specially extracted data that allows us to use all the information of NDB, but the number of NDBs has recently increased, such as NDB-β, which has some limitations in the items of data provided but can be used quickly with simple screening.

If you are interested, please feel free to contact us.

[email protected]

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The research paper using NDB, conducted in collaboration with Professor Igarashi from the University of Tokyo, has been published (March 17, 2025)

We are pleased to inform you that we have published a new paper in a peer-reviewed academic journal in collaboration with Professor Igarashi from the University of Tokyo.

The NDB (National Database) used in this research is a database compiled by the Ministry of Health, Labor and Welfare, containing Japan’s nationwide health insurance claims (receipts) and specific health checkup data.

Igarashi, A., Takeshima, T., Irie, S., & Iwasaki, K. (2025).

Prevalence, incidence, patient characteristics, and treatment trends of valvular heart disease using the national database of health insurance claims of Japan.

Journal of Medical Economics, 28(1), 405–412.

https://doi.org/10.1080/13696998.2025.2474885

-summary-

Valvular heart disease is an important health issue as it can lead to serious conditions such as heart failure; however, information regarding its epidemiology and treatment situation in our country is insufficient.

In this study, we used the comprehensive and highly traceable NDB to investigate the prevalence, incidence, patient characteristics, and recent treatment trends of valvular heart disease patients.

The original paper can be downloaded from the following website.

https://www.tandfonline.com/doi/full/10.1080/13696998.2025.2474885

In this study, we used specially extracted data from the NDB.

The types of NDB have been increasing recently, including options like NDB-β, which, despite having some restrictions on the items of data provided, maintain comprehensiveness and can be accessed quickly with simplified review processes.

If you are interested, please feel free to reach out.

If you have any comments or questions, please feel free to contact us at the address below.

[email protected]

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We presented a poster at the Japanese Association for Mathematical Sociology Conference (March 14, 2025)

On March 13, 2025, we presented a poster titled “Topics in Films and Social Interest: An Analysis Using Topic Modeling” at the 78th Conference of the Mathematical Sociology Society.

This poster was developed under the guidance of Professor Yoshimichi Sato, Dean of the Faculty of Humanities at Kyoto University of Advanced Science. It aims to explore the evolution of societal values by analyzing the synopses of films from 1950 to 2000. Using topic modeling, we identified ten “topics,” each consisting of several keywords, and examined how the prevalence of these topics changed over time.

Indeed, the trend in the prevalence of the topic labeled “Personal Life” closely mirrored the trend in “Future Outlook” as surveyed by the Institute of Statistical Mathematics. This suggests that the other topics identified in the analysis may also reflect shifts in societal values.

If this is the case, it means we have conducted a study of past values that could not be achieved through traditional surveys.

For further details, please feel free to contact us.

We aim to analyze not only so-called real-world data but also various historical data.

If you have any comments or questions, please feel free to contact us at the address below.

[email protected]

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A paper with Prof. Igarashi of the University of Tokyo and Shionogi Pharmaceutical Co., Ltd. has been published (February 14, 2025)

Together with Dr. Igarashi of the University of Tokyo and Shionogi Pharmaceutical Co., Ltd., we have published a new paper in a peer-reviewed journal. We will inform you for your reference.

This paper focuses on how Japanese are resistant to transmitting COVID-19 to others. Under the guidance of Professor Yoshimichi Sato, Dean of the Faculty of Humanities at Kyoto University of Advanced Science, we used the Multidimensional Empathy Scale to analyze various scales of "empathy."

Igarashi A, Kurazono K, Itsumura N, Takeshima T, Iwasaki K. Willingness to pay for the effect of SARS-CoV-2 antivirals in preventing COVID-19 transmission to others in the Japanese population.

J Med Econ. 2025;28(1):260-267.

doi: 10.1080/13696998.2025.2461897.

-Overview-

Given the high infectivity of COVID-19 and the pandemic situation, the ability to prevent the use of therapeutic drugs to infect others is considered important. In addition, the evaluation of this feature is likely to vary from person to person.

In this study, we investigated the willingness to pay (WTP) for the infection prevention function of COVID-19 therapeutic drugs in Japan using an online questionnaire, and examined how much the value is, what kind of distribution it has, and what attributes affect WTP.

The original text can be downloaded from the following website.

https://www.tandfonline.com/doi/full/10.1080/13696998.2025.2461897

If you have any other comments or questions, please contact us at the address below.

[email protected]

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Healthcare Embedded Value Accounting――Management Accounting for Health Service Evaluation and Decision-Making Support（February 3, 2025）

We would like to inform you that the above paper has been published in Social Insurance Bulletin No. 2953.

Currently, the most important challenge for health insurers in Japan is the effective and efficient management of health services.

However, current financial accounting does not map the cost and return of health services to time periods, making it difficult to capture the true outcomes of health projects. One approach to better understanding the outcomes of these projects is through "Healthcare Embedded Value Accounting (HEV Accounting)."

The HEV accounting mechanism is similar to the potential value accounting employed by life insurance companies, which consists of the insurer's net worth and the present value of future profits (the difference between the standard medical expenses if the health services were not carried out and the actual medical expenses if the health services were implemented). By comparing this to insurance business expenses, insurers can more accurately understand their return on investment (ROI).

One benefit of using HEV accounting is that it enables insurers to evaluate the effectiveness of their health services in a timely manner and effectively implement the PDCA cycle. This allows insurers to make better decisions based on detailed information that cannot be obtained through financial accounting alone.

We would like you to refer to this paper for more information on HEV accounting and invite you to contact us at the address below if you have any comments or questions.

[email protected]

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Dr. Igarashi of the University of Tokyo, Eisai's research was presented at the Japan Society for Dementia (December 9, 2024)

Dr. Igarashi of the University of Tokyo, Dr. Matsubara and Dr. Kimura of Oita University, and Eisai Co., Ltd. presented a poster presentation at the Japan Society for Dementia Research on the following study, which predicted the demand for Lecanemab application tests through questionnaire surveys and dynamic simulations.

Milliman is involved in research design, simulation, poster creation, etc., so we will inform you for your information.

Ataru Igarashi, Noriyuki Kimura, Noriaki Ito, Chizuru Kobayashi、Kotaro Sasaki, Yukinori Sakata、Mie Azuma、Etsuro Matsubara

Willing to pay and intangible costs constituting the demand for Lecanemab application testing

The 43rd Annual Meeting of the Japan Society for Dementia　November 21-23, 2024

If you have any other comments or questions, please contact us at the address below.

[email protected]

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A paper on the impact of climate change on winter mortality has been published (December 3, 2024)

We are pleased to announce that one of our offices has published a paper on the subject on our website.

Title of the paper：The impact of climate change on winter mortality: A complex phenomenon with an uncertain future

https://www.milliman.com/en/insight/the-impact-of-climate-change-on-winter-mortality

While there have been many previous studies on the effects of heat waves on the mortality rate of climate change, the impact of low temperatures on mortality has not been fully understood. In this study, we evaluated the impact of low winter temperatures on health and mortality and developed a model to predict the future effects of climate change on the human body.

The impact of low winter temperatures on mortality can be direct due to frostbite and hypothermia, or indirect, such as an increase in cardiovascular disease, respiratory disease, and infectious diseases. To analyze this effect, in addition to the traditional Lee-Carter model, the Distributed Lag Non-Linear Model (DLNM) is used to show the mortality data and incorporate the mortality rate due to winter weather conditions into the dynamic model. DLNM is a model that takes into account the lag of a factor when the effects of a factor appear gradually over time. This lag is nonlinear, so we need to model the nonlinear shape.

If you have any comments or questions, please contact us at the address below.

[email protected]

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Poster presentation at ISPOR Europe 2024 (November 19, 2024)

We gave the following poster presentation at ISPOR Europe 2024, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conference held in Barcelona on November 17-20, 2024.

• Return on Investment of National Standardized Health Training in Japan: A Cohort Study Using “Wellness-Star☆” Health Insurance Claims Database Poster Session 4: Tuesday, 19 November 2024| 16:00 - 19:00 (Discussion Period Time: 18:00 - 19:00) In Japan, there is a system of specific health guidance along with specific health checkups, and support for lifestyle-related diseases is provided to people at risk of metabolic syndrome through behavioral change. In this study, we estimated the ROI of specific health guidance using the "Wellness Star☆" database provided by Nippon Life Insurance Company. This research is a joint research with Professor Ataru Igarashi of the University of Tokyo and members of Nippon Life Insurance Company.
• The Influence of Health Literacy on the Selection of Healthcare Facilities: An Association Between Health Literacy Level and Number of Healthcare Facilities Visited per Patient per Year Using Real World Data in Japan Poster Session 5: Wednesday, 20 November 2024|09:00 - 11:30 CET (Discussion Period Time: 09:00 - 10:00) Since health literacy is the ability to acquire, understand, and use appropriate health information, it is thought that people with high health literacy levels will choose the appropriate medical facility for each disease. In this study, we examined the relationship between health literacy and the number of medical facilities examined relative to the number of diagnosed diseases.
• Exploring the Association Between Health Literacy and Depression Prevalence Through Personal Health Record Associated With Health Insurance Claims Data Poster Session 5: Wednesday, 20 November 2024|09:00 - 11:30 CET (Discussion Period Time: 09:00 - 10:00) Productivity losses due to depression were estimated at about 0.92 trillion yen in Japan in 2005, and this amount has since expanded further. In recent years, there has been a growing awareness of the importance of health literacy, and it is expected that individuals will be able to make decisions based on information that will have an effect on health management and health improvement. In this study, we examined the relationship between health literacy and the prevalence of depression using data from DeSC Healthcare, Inc.

If you have any comments or questions, please contact us at the address below.

[email protected]

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A paper with Shionogi was published (August 28, 2024)

Together with Dr. Shimizu of the University of Tokyo, Dr. Miyashita of Tohoku University, Dr. Saiki of Saitama Medical University, and Shionogi Pharmaceutical Co., Ltd., Milliman's Iwasaki has published a new paper in a peer-reviewed journal as a researcher at the University of Tokyo.

NDB (National Database) is a database held by the Ministry of Health, Labor and Welfare that accumulates data on medical fee statements (receipts) and specific health checkups for health insurance throughout Japan.

Yoshida M, Miyashita M, Saeki T, Hiroi S, Morioka Y, Iwasaki K, Shimizu E.
Opioid prescription status around surgery, bone metastasis, or death events among patients with breast cancer in Japan: an analysis of the Japanese public health insurance comprehensive claims database (the National Database). Jpn J Clin Oncol. 2024 Aug 28:hyae120. doi: 10.1093/jjco/hyae120.

-Overview-
Breast cancer, which is the most common cancer in Japan women, has a relatively good prognosis and is thought to require long-term pain management, and opioids are most often used for pain management.

In this study, we used NDB to show the situation of opioid prescription for breast cancer patients in Japan as a whole, and examined differences by size, type, and region of hospitals.

The original text can be downloaded from the following website. https://academic.oup.com/jjco/advance-article/doi/10.1093/jjco/hyae120/7743189?utm_source=advanceaccess&utm_campaign=jjco&utm_medium=email

If you have any other comments or questions, please contact us at the address below.

[email protected]

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A causal model for climate change and inflation（20th Aug 2024)

Our London office has published a paper titled “Inflation as a major climate-related risk”, so I would like to introduce the summary.

The essence of climate change is that humans have used the Earth’s resources for free. For a sustainable future, we need to stop using them for free, which will cause inflation.

However, how climate change leads to inflation is complex, and Milliman has just created a framework for a causal model. This framework is shown in Figure 1 of this paper.

Compared to the conventional frequency-severity model, the causal model has the advantages of being possible without past data, of having a good understanding of the causal mechanism, and of being able to simulate various policies.

The next step is to estimate the probability of each transition within this causal model framework. After that, validation is performed.

This paper has been published in the journal Insurance ERM. For more information, please see the website link below (registration is required to view).

https://www.insuranceerm.com/analysis/inflation-as-a-major-climate-related-risk.html

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Poster presentation at ISPOR 2024 (May 23, 2024)

We gave the following poster presentation at ISPOR 2024, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conference held in Atlanta on May 5-8, 2024.

• Prescription Patterns for COVID-19 before the Availability of Antiviral Drugs Using the National Database of Health Insurance Claims in Japan This study was conducted using the Ministry of Health, Labour and Welfare's national database (NDB). At the beginning of the COVID-19 epidemic, in the absence of effective therapeutic drugs, treatment with off-label prescriptions of existing drugs was considered, and it was published in guidelines by the Ministry of Health, Labour and Welfare and academic societies. These have been updated from time to time, and several drugs have since been approved for the treatment of COVID-19. In this study, we presented the actual state of drug treatment under insurance treatment since the beginning of the COVID-19 epidemic, and examined the impact of the approval status for COVID-19 and the publication in guidelines and indication approvals on actual prescriptions. https://www.ispor.org/docs/default-source/intl2024/ispor2024hsd77poster137406-pdf.pdf?sfvrsn=405f821_0
• Association between Facilities of First COVID-19 Diagnosis and Previous Outpatient Visits Based on a Claims Database Analysis This is a study using receipt data from DeSC Healthcare, Inc. During the COVID-19 epidemic, many fever patients struggled to find a place to see a doctor, and they were unable to receive medical examinations at the medical institutions they usually attended, so expectations for the family doctor system are increasing. However, the debate about the current family physician system has centered on the definition, requirements, and reimbursement of family doctors, regardless of these expectations. In this study, we examined the relationship between the medical institution where COVID-19 patients received a COVID-19 diagnosis and the medical institution they frequently visited in the past, and examined the circumstances behind the expectations of the family doctor system. https://www.ispor.org/docs/default-source/intl2024/ispor2024sa44poster137419-pdf.pdf?sfvrsn=13a06085_0 If you have any comments about this poster, please feel free to contact us.

If you have any other comments or questions, please contact us at the address below.

[email protected]

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Paper with Novartis Pharma has been published (April 8, 2024)

For your reference, we have recently published a paper on the actual state of treatment in the ophthalmology field in a new peer-reviewed academic journal with Dr. Gomi of Hyogo University of Medicine, Dr. Kawasaki of Osaka University, Dr. Ogura of Nagoya City University, and Novartis Pharma.

Fumi Gomi, Ryo Kawasaki, Yuichiro Ogura, Kosuke Iwasaki, Tomomi Takeshima, Masafumi Yamabe, Kota Imai. Patterns of anti-vascular endothelial growth factor treatment for chorioretinal vascular diseases: Analysis of a nationwide claims database in Japan. Annals of Clinical Epidemiology 2024; 6(2):42?50 https://www.jstage.jst.go.jp/article/ace/6/2/6_24007/_html/-char/ja

Overview-
Anti-VEGF therapy is considered the first choice treatment for chorioretinal vascular diseases such as wet age-related macular degeneration, diabetic macular edema, and retinal vein occlusion, but little research has been conducted on its treatment pattern in Japan. In this study, we used Medical Data Vision's receipt database to examine trends in the dosing interval and treatment continuation rate of anti-VEGF drugs for these diseases over a calendar year.

If you have any other comments or questions, please contact us at the address below.
[email protected]

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News release from Nippon Shinyaku regarding publication of joint research paper with Milliman in an academic journal

A paper on the actual situation of anemia patients in Japan, which was a joint research with Nippon Shinyaku, was published. For your reference, a news release from Nippon Shinyaku regarding the paper has been posted on the company's website.

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If you have any other comments or questions, please contact us at [email protected].

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Milliman Tokyo Healthcare website has been updated.

The Milliman Tokyo Healthcare website has been updated with the following features.

• The solution has been changed to be based on past results.
• Past achievements such as published papers and poster presentations are listed in a list.

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If you have any other comments or questions, please contact us at [email protected].