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Poster presentation:
Policy research for establishing nicotine dependence treatment services in Japan
Masakazu Nakamura
Abstract
As a ministry research group, we have been conducting a policy research to establish nicotine dependence treatment services at clinical setting reimbursed by the national health insurance system by smoking cessation. In July 2005, we had submitted the proposal to the Japanese Ministry of Health, Labor and Welfare for reimbursement of nicotine dependence treatment services. For the proposal, we developed standard treatment protocol for health insurance coverage, consisting of five sessions for 12 weeks. The treatment targets were dependent smokers in preparation stage.
For the proposal of the reimbursment, we estimated the effects of the treatment services on medical costs and smoking prevalence for the next 15 years using Japanese published data on smoking prevalence, medical costs by smoking status, smoking intervention effects. We assumed percentage of these who utilized the services would gradually increase from 1 % to 5 % for the first five years and would be constant. We found out that if we start the nicotine dependence treatment services, the reduced medical costs would start to exceed treatment costs after eight years. It would lead to savings annual medical expenditures of 184.6 billion yen after 15 years. Smoking prevalence would decrease to a half (46.9% to 19.7%) for men and two thirds (13.2% to 7.7%) for women after 15 years.
Starting in November 2005, the Central Social Meical Council has been discussing the health insurance coverage to the nicotine dependence treatment. On Feburary 15, the Ministry of Health, Labor and Welfare decided to start the helath insurance coverage to the treatment from April 2006.
The outline of the reimbursed program is as folows; Smoking cessation treatment consists of 5 time consultations by doctors for 12 weeks(initial consulatation and follow-ups at the 2nd, 4th, 8th and 12th week). Self-reported smoking status of clients will be monitored by use of a carbon monoxide monitor. The cost of smoking cessation treatments except NRT will be covered by health insurance. Targeted smokers are the smokers who satisfy all of the following conditions. 1) who are willing to quit immediately, 2) who are diagnosed as a nicotine dependent by TDS(Tobacco Dependence Screener) developed based on ICD-10 and DSM-IV criteria (Kawakami, et al: Addictive Behaviors, 24: 155-166, 1999), 3) who smoke more than 10 pack-year, 4) who made an agreement for the reimbursed treatment.
As a part of our research, we are now developing a manual for the reimbursed program and an evidence-based clinical guideline for nicotine dependence treatment. We are also conducting medical economy studies to examine cost-effectiveness and cost-benefit of nicotine dependence treatment based on Japanese data. We will evaluate the effects and cost-effectiveness of the reimbursed program in Japan.
Biography
Dr. Nakamura is Director of the Department of Health Promotion and Education of Osaka Medical Center for Health Science and Promotion, Osaka, Japan.
Dr. Nakamura is currently the Director of the Japanese Society of Health Education and Health Promotion, and is a member of the board of councilors of the Japanese Epidemiological Association, the Japanese Society of Public Health, and the Japan Medical-Dental Association for Tobacco Control.
Dr. Nakamura is the author of papers that have been published in peer-reviewed journals including the Japanese Journal of Public Health, the Tobacco Control, the Environmental Health and Preventive Medicine , the Journal of Epidemiology, the American Journal of Health Promotion and the British Journal of Clinical Pharmacology.
Dr. Nakamura completed his medical degree at the Jichi Medical School, Togichi, Japan. He served his residency in internal and pediatric medicine at Osaka Prefectural Hospital and did postgraduate research at the Osaka Medical Center for Cancer and Cardiovascular Diseases.
Dr Nakamura has been mainly working on program development and evaluation on tobacco control. He has developed various programs for tobacco control, including smoking cessation, smoking prevention, and smoking restriction at public places and workplace. He has also been developing training programs for health professionals to learn nicotine dependence treatment. Since 2004, he has been conducting a research to establish nicotine dependence treatment services in Japan as a part of gThird Term Comprehensive Control Research for Cancerh granted by the Japanese Ministry of Health, Labor and Welfare. His research group and medical societies have just submitted the proposal to the Ministry for reimbursement of nicotine dependence treatment in routine medical practice.
Author 1: Masakazu Nakamura, MD
Director Dpt of Health Promotion and Education, Osaka Medical Ctr. for Health Science and Promotion
1-3-2, Nakamichi
Higashinari-ku
Osaka
537-0025
Japan
Author 2: Takako Morita, PhD
Author 3: Shizuko Masui
Author 4: Akira Oshima, MD
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