title: Cost Analysis of Transplantation in Japan, Performed With the Use of the National Database.
abstract: BACKGROUND
  When assessing the cost of transplants in Japan, earlier studies have been limited to case series that investigated inpatient cost alone. Few studies have evaluated total cost, which includes inpatient, outpatient, and pharmaceutical costs, or compared costs before and after transplantation. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), we investigated the total cost of major transplantation and contributing factors.
  
  
  METHODS
  We analyzed the cost and complications of patients who underwent a cadaveric renal transplantation (CRT), living renal transplantation (LRT), living-donor liver transplantation (LDLT), allogeneic bone marrow transplantation, autologous bone marrow transplantation, allogeneic peripheral blood stem cell transplantation, or autologous peripheral blood stem cell transplantation (auto-PBSCT) from April 2009 to March 2010.
  
  
  RESULTS
  The highest total cost of the month of transplantation was 4.95 million yen (JPY) for LDLT. Among renal transplantations, the cost of CRT was higher than LRT (3.69 vs 3.55 million JPY). Recipients of auto-PBSCT complicated by graft-versus-host disease, urinary tract infection, sepsis, or pneumonia had a significantly higher average total cost during the month of transplantation and the 2 following months than patients without it, as well as statistically longer total treatment days.
  
  
  CONCLUSIONS
  In Japan, almost all medical services are covered by national health insurance, and the Japan government has begun to allow the use of the NDB for research activities. This is the first study to use the NDB to analyze the cost of transplantation, with technical and institutional limitations.
authors.affiliation: Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kitazawa
authors.affiliation: Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fujita
authors.affiliation: Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Seto
authors.affiliation: Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan. Electronic address: tommie@med.toho-u.ac.jp.
authors.forename: T
authors.initials: T
authors.lastname: Hasegawa
mesh_terms: D016026:Bone Marrow Transplantation / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007564:Japan; D016030:Kidney Transplantation / Q000191:economics* / Q000379:methods; D016031:Liver Transplantation / Q000191:economics* / Q000379:methods; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology