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Neurological Surgery No Shinkei Geka Volume 41, Issue 1 （January 2013）

Neurological Surgery 脳神経外科 41巻1号（2013年1月発行）

Japanese English

研究

頚動脈内膜剝離術あるいはステント留置術を施行された入院患者のコスト比較 Cost Comparison of Carotid Endarterectomy versus Carotid Stenting in Japan 定政信猛 ¹ , 小柳正臣 ¹ , 岩室康司 ¹ , 沈正樹 ¹ , 半田明 ¹ , 山形専 ¹ Nobutake SADAMASA ¹ , Masaomi KOYANAGI ¹ , Yasushi IWAMURO ¹ , Masaki CHIN ¹ , Akira HANDA ¹ , Sen YAMAGATA ¹ ¹財団法人倉敷中央病院脳神経外科 ¹Department of Neurosurgery, Kurashiki Central Hospital キーワード： carotid endarterectomy , carotid artery stenting , cost , health insurance system Keyword: carotid endarterectomy , carotid artery stenting , cost , health insurance system pp.31-35

発行日 2013年1月10日 Published Date 2013/1/10

DOI https://doi.org/10.11477/mf.1436101906

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Ⅰ．はじめに

　本邦における国民皆保険制度は，国民の医療費負担の低減に大きく貢献している．2009年の統計ではOECD加盟国において本邦の総医療費の対GDP比は24位であり，1位である米国の約半分である⁶⁾．また，本邦では高額療養費制度が存在するため，手術治療を受けた場合の患者負担が少ない．しかしながら，国民医療費は年々上昇しており，医療費を含めた社会保障費の増大は社会問題の1つとなっている．先述の高額療養費制度により，実際に医療にかかるコストが患者側から見えにくい側面もある．

　頚動脈ステント留置術（carotid artery stenting：CAS）は2008年4月より保険収載となり，2010年4月に頚動脈内膜剝離術（carotid endarterectomy：CEA）とともに保険点数に上乗せの改定が認められたが，改定後の両者のコスト面からの検討は渉猟し得た限り認められない．

　今回われわれは2010年4月の保険点数改定後に，入院加療中にCEAまたはCASを施行された患者について，コスト面からの比較検討を行ったので報告する．

　Carotid artery stenting (CAS) has been covered by the health insurance system in Japan since 2008. There have been few studies concerning medical costs and charges for patients who received CEA or CAS in Japan. The aim of this study was to elucidate the difference in the costs between the patients who received CEA and those who received CAS in Japan.

　Between 2010 and 2011, 19 patients who received CEA and 20 patients who received CAS were retrospectively reviewed. Age, sex, symptomatic/asymptomatic, emergent/scheduled, length of stay, outcome, cost for the procedure (professional fee), supply for the operation, the total medical service fee, and copayment of the patients was compared between the two treatment groups.

　No significant difference was detected between the two groups except for the supply of the operation and the total medical service fee (CEA:mean 1,565,580 yen vs CAS 2,758,360 yen, p＝0.0001). On the other hand, no significant difference was obtained in the copayment of the patients (CEA 71,895 yen, CAS 72,458 yen). Even when limited to the scheduled cases, similar results were obtained.

　There is a monthly copayment limit in the health insurance system in Japan, which results in a reasonable charge for patients who received CAS, despite the fact that the rest of the fee including high costs for the supplies was paid by the company and the nation. To reduce the medical costs, Japanese have to be aware of the high costs in CAS, most of which is due to the supplies.