| アブストラクト | OBJECTIVES: The study aimed to assess the provider-side financial viability of antiamyloid disease-modifying therapies for early Alzheimer's disease in Japan, we developed a linear hospital-provider model that separates a short inpatient diagnostic phase from an outpatient infusion phase. METHODS: Using public National Health Insurance tariffs, official 2025 drug prices, and workflow-based labor costing with time-driven activity-based costing, we estimated per-case outpatient margins and program-level break-even case volumes. Scenarios examined fee-for-service versus diagnosis procedure combination/per-diem payment system hospitals, magnetic resonance imaging surveillance intensity, purchase discounts, wage growth, routine-workflow staff time, and the scheduled 15% lecanemab price reduction effective November 1, 2025. RESULTS: At 1.5 T with no assumed wage growth, donanemab yielded positive outpatient margins from + 37,670JPY at no purchase discount to + yen110 777 at a 2.6% discount. Lecanemab at 50 kg yielded - yen9048 at no discount and broke even at a discount of 0.304% before the scheduled price reduction and 0.358% after it. At 55 to 60 kg, the equal-discount threshold at which lecanemab overtook donanemab shifted from about 6.2% before the price reduction to 20.9% after it. Sensitivity analyses showed purchase discounts were the dominant driver, whereas labor and workflow inputs affected lecanemab more because it requires more infusions per year. CONCLUSIONS: Under Japan's fee schedule, both therapies were financially viable across typical purchase-discount ranges in scenario analyses, but findings should be interpreted as provider-margin estimates rather than comparative clinical judgments. |
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| ジャーナル名 | Value in health regional issues |
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| Pubmed追加日 | 2026/7/17 |
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| 投稿者 | Makita, Kotaro; Nishihara, Takuto; Arakaki, Yuta; Ohida, Tomoya; Goto, Kosei; Kutsuna, Nobuo |
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| 組織名 | Department of Neurosurgery, Fukujukai Adachi Tobu Hospital, Tokyo, Japan.;Department of Neurosurgery, Fukujukai Adachi Tobu Hospital, Tokyo, Japan;;Department of Stress and Invasiveness Control, Toho University School of;Medicine, Tokyo, Japan. Electronic address: nobuo.kutsuna@med.toho-u.ac.jp. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/42467046/ |
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