2015ᖺ6᭶27᪥(ᅵ)@㕲㛛グᛕㅮᇽ䝦䝹䝇䜰䜴䝖䜹䝮䝸䝃䞊䝏ᨭ᥼஦ᴗ ➨䠕ᅇ CSP-HOR ᖺ఍䛂䝦䝹䝇䝔䜽䝜䝻䝆䞊䜰䝉䝇䝯䞁䝖(HTA)䛻䛚䛡䜛 Real World Data 䛾ᛂ⏝䛾ྍ⬟ᛶ䛃DPC䝕䞊䝍䜟䛜ᅜ䛷䛿ᖺ㛫ᘏ䜉⣙1500୓ே䛜⣙8000䛾⑓㝔䛻ධ㝔

DPC䝕䞊䝍䜢ά⏝䛧䛯HTA䛾ྍ⬟ᛶ

DPC⑓㝔䠄኱Ꮫ⑓㝔䜢ྵ䜐኱䞉୰つᶍ䛾⑓㝔䠅䛿1000᪋タ㉸→䛣䜜䜙䛾⑓㝔䛷ධ㝔ᝈ⪅䛾⣙50䠂䜢䜹䝞䞊
DPC䝕䞊䝍䠙DPC⑓㝔䛷ᐇ᪋䛥䜜㟁Ꮚⓗ䛻グ㘓䛥䜜䛯ධ㝔デ⒪䛾ヲ⣽䝕䞊䝍䚹ᮾி኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉බඹ೺ᗣ་Ꮫᑓᨷ㻌 ⮫ᗋ␿Ꮫ䞉⤒῭ᏛᗣỌ㻌 ⚽⏕12DPC䝕䞊䝍䝧䞊䝇ᖺᗘㄪᰝ᭶ᮇ㛫㻞㻜㻜㻞ᖺᗘ㻞㻜㻜㻟ᖺᗘ㻞㻜㻜㻠ᖺᗘ㻞㻜㻜㻡ᖺᗘ㻞㻜㻜㻢ᖺᗘ㻞㻜㻜㻣ᖺᗘ㻞㻜㻜㻤ᖺᗘ㻞㻜㻜㻥ᖺᗘ㻞㻜㻝㻜ᖺᗘ㻞㻜㻝㻝ᖺᗘ㻞㻜㻝㻞ᖺᗘ㻞㻜㻝㻟ᖺᗘ㻣᭶䇷㻝㻜᭶㻣᭶䇷㻝㻜᭶㻣᭶䇷㻝㻜᭶㻣᭶䇷㻝㻜᭶㻣᭶䇷㻝㻞᭶㻣᭶䇷㻝㻞᭶㻣᭶䇷㻝㻞᭶㻣᭶䇷㻝㻞᭶㻣᭶䇷㻟᭶㻠᭶䇷㻟᭶㻠᭶䇷㻟᭶㻠᭶䇷㻟᭶㻠䛛᭶㻠䛛᭶㻠䛛᭶㻠䛛᭶㻢䛛᭶㻢䛛᭶㻢䛛᭶㻢䛛᭶㻥䛛᭶㻝㻞䛛᭶㻝㻞䛛᭶㻝㻞䛛᭶ཧຍ᪋タᩘ㻤㻞㻝㻤㻡㻝㻣㻠㻞㻠㻥㻞㻢㻞㻤㻥㻤㻤㻡㻡㻥㻜㻝㻥㻤㻜㻝㻜㻣㻡㻝㻜㻡㻣㻝㻜㻢㻝DPC䝕䞊䝍䜢⏝䛔䛯ඹྠ◊✲䛾䝣䝺䞊䝮ྛᑓ㛛㡿ᇦ

඲㏥㝔ᝈ⪅ᩘ㻞㻢୓㻠㻠୓㻠㻡୓㻣㻟୓㻝㻜㻤୓㻞㻢㻡୓㻞㻤㻝୓㻞㻣㻤୓㻠㻥㻡୓㻣㻝㻠୓㻢㻤㻡୓㻣㻝㻝୓᪥ᮏ䛾୍⯡⑓ᗋධ㝔ᝈ⪅䛾⣙50䠂䜢䜹䝞䞊䠠䠬䠟◊✲⌜◊✲䛾䜰䜲䝕䜰⤖ᯝ䛾ゎ㔘䝕䞊䝍ᢳฟ䝕䞊䝍䞉䜽䝸䞊䝙䞁䜾⤫ィゎᯒㄽᩥ34㻰㻼㻯㻌 ᵝᘧ䠍䛛䜙ᚓ䜙䜜䜛㡯┠㻌㻌㻝㻚 ⑓㝔ᒓᛶ➼㻌᪋タ䝁䞊䝗䚸デ⒪⛉䝁䞊䝗㻌㻞㻚 䝕䞊䝍ᒓᛶ➼㻌䝕䞊䝍㆑ู␒ྕ䚸ᛶู䚸ᖺ㱋㻌㻟㻚 ධ㏥㝔᝟ሗ㻌ணᐃ䞉ᩆᛴධ㝔䚸ᩆᛴ㌴䛻䜘䜛ᦙ㏦䚸㏥㝔᫬㌿ᖐ䚸ᅾ㝔᪥ᩘ㻌㻠㻚 デ᩿᝟ሗ㻌୺യ⑓ྡ䚸ධ㝔䛾ዎᶵ䛸䛺䛳䛯യ⑓ྡ䚸་⒪㈨※䜢᭱䜒ᢞධ䛧䛯യ⑓ྡ䚸㻌ධ㝔᫬ేᏑ⑕ྡ䚸ධ㝔ᚋⓎ⑕⑌ᝈྡ㻌㻡㻚 ᡭ⾡᝟ሗ㻌ᡭ⾡⾡ᘧ䚸㯞㓉㻌㻢㻚 㻌デ⒪᝟ሗ㻌㌟㛗䞉య㔜䚸ႚ↮ᣦᩘ䚸ධ㝔᫬䞉㏥㝔᫬㻶㻯㻿䚸ධ㝔᫬䞉㏥㝔᫬㻭㻰㻸㻌䝇䝁䜰䚸㻌䛜䜣㼁㻵㻯㻯㻌⑓ᮇศ㢮䞉㻿㼠㼍㼓㼑ศ㢮䚸ධ㝔᫬䞉㏥㝔᫬㼙㼛㼐㼕㼒㼕㼑㼐㻌㻾㼍㼚㼗㼕㼚㻌㻿㼏㼍㼘㼑䚸㻌⬻༞୰䛾Ⓨ⑕᫬ᮇ䚸㻴㼡㼓㼔㻙㻶㼛㼚㼑㼟㻌ศ㢮䚸㻺㼅㻴㻭㻌ᚰᶵ⬟ศ㢮䚸㻌⊃ᚰ⑕㻯㻯㻿㻌ศ㢮䚸ᛴᛶᚰ➽᱾ሰ㻷㼕㼘㼘㼕㼜㻌ศ㢮䚸⫵⅖䛾㔜⑕ᗘ䚸㻌⫢◳ኚ㻯㼔㼕㼘㼐㻙㻼㼡㼓㼔㻌ศ㢮䚸ᛴᛶ⮅⅖䛾㔜⑕ᗘ䚸㻌⢭⚄ಖ೺⚟♴ἲ䛻䛚䛡䜛ධ㝔ᙧែ䞉㝸㞳᪥ᩘ䞉㌟యᣊ᮰᪥ᩘ䚸ධ㝔᫬㻳㻭㻲㻌ᑻᗘ㻌㻌• 䠡䠢䝣䜯䜲䝹
– E䝣䜯䜲䝹䠖デ⒪⾜Ⅽ䛾኱ᯟ䜢⾲䛩䝣䜯䜲䝹• デ⒪⾜Ⅽྡ⛠䚸ᐇ᪋᪥䚸⾜ⅭⅬᩘ䚸⾜Ⅽᅇᩘ䛺䛹– F䝣䜯䜲䝹䠖E䝣䜯䜲䝹䛾ྛ䝺䝁䞊䝗䛾᫂⣽• デ⒪᫂⣽ྡ⛠䚸౑⏝㔞䚸ᇶ‽༢఩䚸⾜Ⅽ᫂⣽Ⅼᩘ䛺䛹– ⸆๣䞉≉ᐃಖ㝤་⒪ᮦᩱ䚸᳨ᰝฎ⨨䛻䛴䛔䛶ᶆ‽䝁䞊䝗䛜䛒䜛䜒䛾䛿ᐇ᪋ᅇᩘ㔞䞉ᐇ᪋᪥䛜ྠᐃྍ⬟56

་⒪㈝䛾䝕䞊䝍
ᇶᮏデ⒪ᩱึ䞉෌デᩱ䚸ධ㝔ᩱ➼DPC䝕䞊䝍䜢⏝䛔䛯◊✲౛≉ᥖデ⒪ᩱ་Ꮫ⟶⌮➼䚸ᅾᏯ་⒪䚸᳨ᰝ䚸⏬ീデ᩿䚸ᢞ⸆䚸ὀᑕ䚸䝸䝝䝡䝸䝔䞊䝅䝵䞁䚸⢭⚄⛉ᑓ㛛⒪ἲ䚸ฎ⨨䚸ᡭ⾡䚸㯞㓉䚸ᨺᑕ⥺἞⒪䚸⑓⌮デ᩿э་⒪㈝䛾ヲ⣽䛺ෆヂ䛜ศ䛛䜛
78䠘◊✲౛䠍䠚ᛴᛶ⮅⅖䛻ᑐ䛩䜛䝯䝅䝹㓟䜺䝧䜻䝃䞊䝖䛾ຠᯝ䛸䝁䝇䝖
Effect and Cost of Treatment for Acute Pancreatitis With or Without Gabexate Mesilate
Pancreas 2013;42(2):260-4DPCᵝᘧ䠍䛻䛂ᛴᛶ⮅⅖䛾㔜⑕ᗘ䛃䛾㡯┠䛒䜚ᮇ㛫䠖2010ᖺ7-12᭶
ᑐ㇟䠖DPC⑓㝔䛻ධ㝔䛧䛯ᛴᛶ⮅⅖䛾ᝈ⪅䛾䛖䛱䚸䝯䝅䝹㓟䜺䝧䜻䝃䞊䝖䜢౑⏝䛧䛯䜾䝹䞊䝥2483ே䚸ྠ⸆䜢ྵ䜐䛔䛪䜜䛾⺮ⓑศゎ㓝⣲㜼ᐖ⸆䜒౑⏝䛧䛺䛛䛳䛯890ே⫼ᬒ⺮ⓑศゎ㓝⣲㜼ᐖ⸆䞉䝯䝅䝹㓟䜺䝧䜻䝃䞊䝖䠙ᛴᛶ⮅⅖䛾἞⒪⸆
䜟䛜ᅜ䛾⮫ᗋ⌧ሙ䛷䛿䚸ಖ㝤཰㍕䛥䜜䛶䛔䜛⸆䛸䛧䛶䝹䞊䝏䞁䛻౑⏝䚹䛧䛛䛧䚸ⱥ⡿䛷䛿౑⏝䛥䜜䛺䛔䚹ᛴᛶ⮅⅖䛾㔜⑕ᗘ䝇䝁䜰䛚䜘䜃CT䝇䝁䜰䚸䛚䜘䜃ᝈ⪅䛾ᖺ㱋䞉ᛶู䞉ేᏑ⑌ᝈ䛺䛹䜢⏝䛔䛯ഴྥ䝇䝁䜰䞉䝬䝑䝏䞁䜾(propensity score matching)䛻䜘
䜚䚸䝯䝅䝹㓟䜺䝧䜻䝃䞊䝖౑⏝⩌䛸㠀౑⏝⩌䛭䜜䛮䜜䛛䜙1ᑐ䛪䛴䚸707䝨
䜰(n=1414)䛾⑕౛䜢㑅ᢥ䚹

1980ᖺ௦ᚋ༙䛛䜙90ᖺ௦๓༙䛻Ⓨ⾲䛥䜜䛯ⱥ⡿䛷䛾」ᩘ䛾RCT (n=42䛛䜙᭱኱䛷n=223䛾ᑠつᶍRCT)䛻䛚䛔䛶䚸䛭䛾ຠᯝ䛜୙༑ศ䛺䛔䛧ྰᐃⓗ䛸ุ᩿䛥䜜䛯䚹2001ᖺ௨㝆䚸ྠ⸆䛻㛵䛩䜛RCT䜢ྵ䜐኱つᶍ䛺⮫ᗋ◊✲䛾ሗ࿌䛿ⓙ↓䚹
9ᅾ㝔Ṛஸ⋡䛾ẚ㍑

10ᅾ㝔᪥ᩘ䛸ධ㝔་⒪㈝䛾ẚ㍑

GM, gabexate mesilate; AP, acute pancreatitis
GM, gabexate mesilate; AP, acute pancreatitis
1112䠘◊✲౛䠎䠚Ἢᒀჾ⛉ᡭ⾡䛻⭠⟶๓ฎ⨨䛿ᚲせ䛛䠛⭠⟶๓ฎ⨨䠖polyethylene glycol electrolyte (䝙䝣䝺䝑䜽)magnesium citrate (䝬䜾䝁䝻䞊䝹P )sodium picosulfate (䝷䜻䝋䝧䝻䞁ᾮ)ᑐ㇟䠖2008ᖺ―2010ᖺ䛻T1-T3⭈䛜䜣䛻ᑐ䛩䜛⭡⭍㙾ୗ⭈᦬⾡䜢⾜䛳䛯ᝈ⪅2740ྡ

Does Mechanical Bowel Preparation Improve Quality ofLaparoscopic Nephrectomy? Propensity Score-matchedAnalysis in Japanese Series. Urology 2013;81(1):74-9.

ഴྥ䝇䝁䜰䝬䝑䝏䞁䜾䛻䜘䜚䠍䠖䠍䛷䝬䝑䝏䛧䛯⭠⟶๓ฎ⨨ᐇ᪋⩌䛸㠀ᐇ᪋⩌䠍䠍䠍䠌䝨䜰(2220ྡ)䜢ศᯒᑐ㇟䛸䛧䛯1314䠘◊✲౛䠏䠚
⭠⟶๓ฎ⨨ ⭠⟶๓ฎ⨨
ᐇ᪋⩌
㠀ᐇ᪋⩌

pᡭ⾡᫬㛫(ศ)

278

268

0.257

⾡ᚋྜే⑕Ⓨ⏕⋡

11.8䠂

11.4䠂

0.586

ᖹᆒᅾ㝔᪥ᩘ

10.3

10.0

0.674

䛔䛪䜜䜒᭷ពᕪ䛺䛧15ୗ኱㟼⬦䝣䜱䝹䝍䞊␃⨨䛿⫵ሰᰦᝈ⪅䛾ᅾ㝔Ṛஸ⋡䜢పୗ䛥䛫䜛䛛䠛
Effectiveness of inferior vena cava filters on in-hospital mortality as
an adjuvant to antithrombotic therapy for pulmonary embolism:
propensity score and instrumental variable analyses. Am J Med2015 ;128(3):312.e23-3116ᑐ㇟䠖⫵ሰᰦ䛷ᩆᛴධ㝔䛧ᶆ‽ⓗ䛺⾑ᰦ⁐ゎ⒪ἲ䛚䜘䜃ᢠ
จᅛ⒪ἲ䜢ཷ䛡䛯13125 ྡ䛾ᝈ⪅䠄2007䠉2012ᖺ䠅ഴྥ䝇䝁䜰ศᯒ௓ධ⩌䠖IVC䝣䜱䝹䝍䞊␃⨨ᐇ᪋ᑐ↷⩌䠖IVC䝣䜱䝹䝍䞊␃⨨㠀ᐇ᪋

㻌Filter groupṚஸᩘ㻌%/ ᝈ⪅ᩘᮍㄪᩚ㻌(n = 13125)

97/3948

2.5%

⤫ィศᯒ䠖
ഴྥ䝇䝁䜰ศᯒ(propensity score analysis)᧯సኚᩘἲ(instrumental variable analysis)

1:1 ഴྥ䝇䝁䜰䝬䝑䝏䞁䜾㻌(n = 6948)

91/34742.6%㏫☜⋡䛻䜘䜛㔜䜏௜䛡(n = 26230)

354/13106

2.7%

No-filter groupṚஸᩘ㻌%/ ᝈ⪅ᩘ

㻌㻌

䝸䝇䜽ẚ㻌
(95% CI)
0.43
522/9177 5.7% <0.001(0.35 to 0.53)
0.55
164/3474 4.7% <0.001(0.43 to 0.71)
0.50
704/13124 5.4% <0.001(0.44 to 0.57)
P1718䠘◊✲౛䠐䠚᧯సኚᩘἲ៏ᛶ◳⭷ୗ⾑⭘ᡭ⾡⑕౛䛻ᑐ䛩䜛஬ⱎᩓ䛾෌Ⓨண㜵ຠᯝ䛸㈝⏝᪋タู䛾IVC䝣䜱䝹䝍䞊ᐇ᪋⋡䜢᧯సኚᩘ䛸䛩䜛஧ẁ㝵᭱ᑠ஧஌ἲIVC䝣䜱䝹䝍䞊㠀ᐇ᪋⩌䛻ᑐ䛩䜛ᐇ᪋⩌䛾ᅾ㝔Ṛஸ⋡䛾䝸䝇䜽ᕪ[95%ಙ㢗༊㛫]䛿

Effect of Japanese Herbal Kampo Medicine Goreisan on Reoperation Rates afterBurr-Hole Surgery for Chronic Subdural Hematoma: Analysis of a National Inpatient
Database. Evidence-Based Complementary and Alternative Medicine. 2015, Article
ID 817616−2.5% [−4.6% to −0.4%]

19៏ᛶ◳⭷ୗ⾑⭘㻌20᪉ἲ㻌㧗㱋⪅䛻ከ䛔䚹㢌㒊䛾ᡴ᧞䛾䛒䛸䚸㻞㐌㛫䇷㻟䞄᭶䛾ᮇ㛫䛻Ⓨ⑕䚹㢌⵹ෆ䛾◳⭷䛸䛟䜒⭷䛾㛫䛾◳⭷ୗ⭍䛻⾑ᾮ䛜㈓␃䚹㻌
἞⒪䛿✸㢌⾑⭘㝖ཤ⾡㻌ᮇ㛫䠖㻞㻜㻝㻜ᖺ㻣᭶䇷㻞㻜㻝㻟ᖺ㻟᭶㻌ᑐ㇟䠖៏ᛶ◳⭷ୗ⾑⭘䛻ᑐ䛩䜛✸㢌⾑⭘㝖ཤ⾡᪋⾜㻌 㻟㻢㻘㻜㻞㻜㻌ྡ㻌₎᪉⸆䛂஬ⱎᩓ䛃฼Ỉస⏝䚹Ỉᵝᛶୗ⑩䚸ᛴᛶ⫶⭠⅖䚸ᬬẼ䛒䛯䜚䚸㢌③䚸䜐䛟䜏䚸஧᪥㓉䛺䛹䛻౑⏝䚹៏ᛶ◳⭷ୗ⾑⭘䛻ᑐ䛩䜛✸✸㢌⾑⭘㝖ཤ⾡ᚋ䛾⾑ᾮ෌㈓␃㜵Ṇ䜢┠ⓗ䛸䛧䛶䚸⬻⚄⤒እ⛉㡿ᇦ䛷౑⏝䛥䜜䜛䛣䛸䛜䛒䜛䚹㻌஬ⱎᩓ౑⏝⩌䠖3,889ྡ஬ⱎᩓ㠀౑⏝⩌䠖32,131 ྡ↓䠄䠍䠅ഴྥ䝇䝁䜰䝬䝑䝏䞁䜾䠖౑⏝⩌䞉㠀౑⏝⩌䛛䜙1:1䛷3879ྡ䛪䛴ᢳฟ䠄䠎䠅᧯సኚᩘἲ䠖᪋タู䛾஬ⱎᩓ౑⏝⋡䜢᧯సኚᩘ䛸䛧䛯䜰䜴䝖䜹䝮ᣦᶆ䐟✸㢌⾑⭘㝖ཤ⾡䛾෌ᡭ⾡䚸䐠⥲ධ㝔་⒪㈝21⤖ᯝ22䠘◊✲౛䠑䠚෌ᡭ⾡⋡䝎䞉䞂䜱䞁䝏ᡭ⾡䛾Ᏻ඲ᛶ䛸㈝⏝䠄䠍䠅ഴྥ䝇䝁䜰䝬䝑䝏䞁䜾஬ⱎᩓ౑⏝⩌㻌 4.8%䚸㠀౑⏝⩌㻌 6.2䠂 (p=0.001)
䝸䝇䜽ᕪ−1.4% (95% ಙ㢗༊㛫−2.4% ;−0.38%)
䠄䠎䠅᧯సኚᩘ䝸䝇䜽ᕪ−2.2% (95%ಙ㢗༊㛫−3.8%; −0.67%)

Robot-assisted versus other types of radical prostatectomy: Population-based
safety and cost comparison in Japan, 2012–2013. Cancer Sci 2014;105:1421–1426⥲ධ㝔་⒪㈝ഴྥ䝇䝁䜰䝬䝑䝏䞁䜾஬ⱎᩓ౑⏝⩌㻌 㻌 ᖹᆒ䠄ᶆ‽೫ᕪ䠅64.3୓෇ (46.5୓෇)஬ⱎᩓ㠀౑⏝⩌㻌 ᖹᆒ䠄ᶆ‽೫ᕪ䠅 67.1୓෇ (65.7୓෇)
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