title: Regional differences in performance of bone marrow transplantation, care-resource use and outcome for adult T-cell leukaemia in Japan.
abstract: BACKGROUND
  Japan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region. Regional differences in prevalence might cause regional differences in physicians' experiences and the efficiency of care-resource use. This study investigated regional differences in the performance of bone marrow transplantation (BMT), outcome and care-resource use in patients with ATL in Japan.
  
  
  METHODS
  This was a cross-sectional study using a Japanese hospital administrative database in 2010, with a diagnostic-procedure combination/per diem payment system. We examined the association between BMT performance, resource use, outcomes and region.
  
  
  RESULTS
  We analysed data for 712 subjects of whom 60.5% were Kyushu/Okinawa residents. Significantly more patients with ATL underwent BMT in Kanto (p = 0.018) and Kansai (p < 0.001) regions compared with the Kyushu/Okinawa regions. The lengths of hospital stay were longer in Kanto (p = 0.002) and Kansai (p = 0.006) regions than in the Kyushu/Okinawa region. Total health-care costs were higher in Kanto (p = 0.001) and Kansai (p = 0.005) regions than the Kyushu/Okinawa region. The risks of in hospital mortality were not significantly different between regions.
  
  
  CONCLUSIONS
  There were significant regional differences in BMT performance and resource use within Japan. ATL prevalence was not related to the performance of BMTs, resource use or outcomes. Factors related to regional socioeconomics might affect the performance of BMTs and care resource use within Japan.
authors.affiliation: Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. toshikimaeda1216@gmail.com.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Maeda
authors.forename: Akira
authors.initials: A
authors.lastname: Babazono
authors.forename: Takumi
authors.initials: T
authors.lastname: Nishi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D016896:Treatment Outcome
references.citation: Br J Haematol. 1991 Nov;79(3):428-37
references.pmid: 1751370
references.citation: Health Policy. 2008 Feb;85(2):196-206
references.pmid: 17825454
references.citation: N Engl J Med. 1995 Jun 29;332(26):1744-8
references.pmid: 7760890
references.citation: Blood. 1977 Sep;50(3):481-92
references.pmid: 301762
references.citation: Bone Marrow Transplant. 2008 Aug;42 Suppl 1:S7-S10
references.pmid: 18724308
references.citation: J Clin Oncol. 2009 Jan 20;27(3):453-9
references.pmid: 19064971
references.citation: Br J Haematol. 2002 May;117(2):451-68
references.pmid: 11972533
references.citation: J Clin Epidemiol. 2004 Dec;57(12):1288-94
references.pmid: 15617955
references.citation: Retrovirology. 2005 Mar 02;2:16
references.pmid: 15743528
references.citation: Lancet. 2007 Oct 20;370(9596):1453-7
references.pmid: 18064739
references.citation: Bone Marrow Transplant. 2004 Jun;33(12):1191-9
references.pmid: 15122310
references.citation: N Engl J Med. 2010 Feb 4;362(5):460-5
references.pmid: 20054039
references.citation: Haematologica. 2007 Dec;92(12):1679-86
references.pmid: 18055992
references.citation: Oncogene. 2005 Sep 5;24(39):6058-68
references.pmid: 16155612
references.citation: Lancet. 2011 Sep 17;378(9796):1106-15
references.pmid: 21885107