་⒪ᢏ⾡ホ౯
Health Technology Assessment (HTA)
Technology assessment in health care is a multidisciplinary field of policy
analysis. It studies the medical, social, ethical, and economic implications ofdevelopment, diffusion, and use of health technology.

㻴㼀㻭䛸䛿㻌

Healthcare technology is defined as prevention and rehabilitation, vaccines,
pharmaceuticals and devices, medical and surgical procedures, and the systems
within which health is protected and maintained.

➨䠕ᅇ㻯㻿㻼㻙㻴㻻㻾ᖺ఍㻌䛂䝦䝹䝇䝔䜽䝜䝻䝆䞊䜰䝉䝇䝯䞁䝖䠄㻴㼀㻭䠅䛻䛚䛡䜛㻌㻾㼑㼍㼘㻌㼃㼛㼞㼘㼐㻌㻰㼍㼠㼍䛾ᛂ⏝䛾ྍ⬟ᛶ䛃㻌㻞㻜㻝㻡㻚㻢㻚㻞㻣㻌㻌㻌ᅜ❧ಖ೺་⒪⛉Ꮫ㝔㻌་⒪ᢏ⾡ホ౯䛸䛿䚸㞟Ꮫⓗ䛺ᨻ⟇ศᯒ䛾㡿ᇦ䛷䛒䜛䚹་⒪ᢏ⾡䛾㛤Ⓨ䚸ᬑཬ䚸౑⏝䛻క䛖䚸་Ꮫⓗ䚸♫఍ⓗ䚸⁼䑗䛕˚⤒῭ⓗ䛺ᙳ㡪䛻䛴䛔䛶◊✲䛩䜛䚹㻌㻌་⒪ᢏ⾡䛸䛿䚸ண㜵䜔䝸䝝䝡䝸䝔䞊䝅䝵䞁䚸䝽䜽䝏䞁䚸་⸆ရ䜔་⒪ᶵჾ䚸ෆ⛉ⓗ䛚䜘䜃እ⛉ⓗฎ⨨䚸䛥䜙䛻೺ᗣ䜢⥔ᣢ䛩䜛䝅䝇䝔䝮䜢ᣦ䛩䚹㻌㻌㻌་⒪䞉⚟♴䝃䞊䝡䝇◊✲㒊㻌㻌 ⚟㻌 ⏣㻌 㻌 ᩗ㻌㼠㻙㼒㼡㼗㼡㼐㼍㻬㼚㼕㼜㼔㻚㼓㼛㻚㼖㼜㻌

INAHTA(International Network of Health Technology Assessment)䝩䞊䝮䝨䞊䝆䜘䜚㻌
National Institute of Public Health, Japan

2

National Institute of Public Health, Japan་⒪⤒῭ホ౯䛾ᨻ⟇䜈䛾ᛂ⏝EBM, CER, HTA
DOES IT WORK?

IS IT WORTH IT?

Comparative EffectivenessResearchHealth Technology
Assessment

Evidence Based Medicine
Clinical Guidelines

Coverage Decision
MakingPatient LevelDecision Making

煾Drummond et al. Int J Technol Assess Health Care 2008; 24(3): 244-258.煿
3

National Institute of Public Health, Japan᪥ᮏ䛻䛚䛡䜛་⒪⤒῭ホ౯䛾฼⏝䛻㛵䛩䜛ὶ䜜䕿་⒪ᢏ⾡䛾㐍Ṍ䛻䜘䜚䚸⏕Ꮡᖺᩘ䛾ᘏ㛗䜔㻽㻻㻸䛾ྥୖ䛺䛹ከ䛟䛾䝯䝸䝑䝖䛜䜒䛯䜙䛥䜜䛶䛔䜛䚹㻌㻌䕿୍᪉䛷䚸་⒪ᢏ⾡䛾㐍Ṍ䛿་⒪㈝䛾ቑຍ䛻ᐤ୚䛧䛶䛔䜛䚹㻌㻌䕿බⓗ་⒪ಖ㞀ไᗘ䜢᭷䛩䜛ᅜ䛻䛚䛔䛶䛿䚸་⒪ᢏ⾡䛾⤒῭ホ౯䠄㈝⏝ᑐຠᯝ䛾ホ౯䠅䜢⾜䛔䚸䜹䝞䞊䛩䜛ᢏ⾡䜔ൾ㑏౯᱁タᐃ➼䛻཯ᫎ䛧䛶䛔䜛ᅜ䛜䛒䜛䚹㻌㻌 㻌 㻌 ౛䠅䜲䜼䝸䝇㻙㻺㻵㻯㻱䚸䜸䞊䝇䝖䝷䝸䜰㻙㻼㻮㻭㻯㻌㻌㻌
National Institute of Public Health, Japan䛣䜜䜎䛷䛾་⒪ᢏ⾡ホ౯䛻䛚䛡䜛㈝⏝ᑐຠᯝホ౯
䛾㈨ᩱ䛾ᥦฟ≧ἣ་⸆ရ(ᡂศᩘ)㻝㻥㻤㻡ᖺ㻌 ཌ⏕┬ಖ㝤ᒁ་⒪ㄢ㛗㻌㻌 㻌 㻌 㻌 㻌 㻌 䛂᪂་⒪ᢏ⾡䛾ᑟධ䛻䚸䝁䝇䝖䝧䝛䝣䜱䝑䝖䛸䛔䛖⪃䛘᪉䜒䛔䜜䛶䛔䛟䜉䛝䛃㻌㻌㻝㻥㻥㻞ᖺ㻌 ᪂⸆䛾⸆౯஺΅㈨ᩱ䛻⤒῭ⓗホ౯㈨ᩱ䛾ῧ௜䛜ㄆ䜑䜙䜜䜛䛣䛸䛻䛺䛳䛯䚹㻌㻌㻞㻜㻜㻜ᖺ㻌 ୰་༠⸆౯ᑓ㛛㒊఍䛻䛚䛔䛶䚸⸆౯⟬ᐃ䛻䛚䛡䜛㈝⏝ᑐຠᯝ䛾཯ᫎ᪉ἲ䛾◊✲䛻╔ᡭ䛩䜛䛣䛸䛜ᥦゝ䛥䜜䛯䚹㻌㻌㻞㻜㻜㻝ᖺ㻌 䛂⸆౯⟬ᐃ⤌⧊䛃䛜タ⨨䛥䜜䚸⤒῭Ꮫᑓ㛛ᐙ䛜ཧຍ䚹㻌H18-H23

་⒪ᮦᩱ(ရ┠ᩘ) ་⒪⪅➼䛾ᢏ⾡(ᢏᢏ⾡ᩘ)
H23
H23㈝⏝ຠᯝศᯒ䛾䛖䛱QALY䜢⏝䛔䛶䛔䜛䜒䛾䠏䠍䠉㈝⏝ຠᯝศᯒ䛾䛖䛱QALY䜢⏝䛔䛶䛔䛺䛔䜒䛾䠐䠍䠉䠉䠍䠉䛭䛾௚䠄㈝⏝ศᯒ䚸㈝⏝᭱ᑠ໬ศᯒ➼䠅䠍䠎䠌䠍䠎䠑ྜィ䠔䠎䠏䠍䠎䠑㈝⏝౽┈ศᯒ䜢⏝䛔䛶䛔䜛䜒䛾煾Ṿ⎌⎥ 崌䕹ⱏ⌊㟭媦ῲⱓ旑愹Ὣ煾2012.7.18煿崘㗪͢͠ᾭ㉡煿
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National Institute of Public Health, Japan⸆๣⤒῭Ꮫⓗホ౯䜢ῧ௜䛧䛺䛛䛳䛯⌮⏤National Institute of Public Health, Japan୰་༠㻌 ᖹᡂ24ᖺᗘデ⒪ሗ㓘ᨵᐃ䛻ಀ䜛⟅⏦᭩㝃ᖏពぢ2012.2.10
煾⎌嗽┒˚⎌䚓㞡㗪䮚͆悺㮴͂媦ῲ煿㹌Ἧ̷̯̣̻䑗䖂⋃⑙*崘㗪㐡≋͆ηπΙΞ̤̜͂̀偔̷̷̠͙70%≗㟡ͪ墝̷̞͙͆ΝϒΕ̤Ṟ帄̷̷̯̜͙̾

43%䦏⇖̓㌖⾤偖̷̷̤̜̣̻͙͂

11%

̵͆ἧ9%

熇 熋 旈㝰␟彚┒͆嗽ῲ͆̚͢㘊̼̜̓̾㥭婟ͪ墝̜˚⿝䛋⎌嗽┒̭͆͂ͣ͡㚿␛̓③̷̩㏻便ͪ⽦̥䷫̥孬̰̫ͣ̀˛熇 熌 ㊜墤͜∷便˚⇖䨢䛕͂媋㗾͜㥭㡌ͪ⑼̷͙⎌䚓㋑墤̼̜̓̾˚⎌䚓ṛ͆㝚䕹へ͜⌊䏘へ͂́ͪ幠͖̠ヴ偖̓㐡Ῥ̭ͤͣ⎌䚓͆崻͆娄䄊̣͡˚䊺̀㋑墤͆媦ῲ͆̚͢㘊ͪ⑼͙˚媋䚓⢂憽ṛ͆䝉ⱏ䛕͂媦ῲ͚⑀兎̞̀͂ͣ͂͠㘊䮧̼̜̓̾㥭婟ͪ墝̞̫̀˛熇 熍 枺㘁䛕͂㘁姠⎌䚓㞡㗪̵͆͜㞡㗪ͪ䕹̜ͣ㘁姠㋑墤˚枺㘁䛕͂⎌嗽┒䮚͆‫‮‬曋悺䕹͆媦ῲ̓曬̯˚䯨⯫ρϒρ͜ⰺ寁͆̚͢㘊͚⑼͙˚崌䕹ⱏ⌊㟭͆娄䄊ͪ⑀兎͂䰕❃̿ⱟ↶̱̫̼̜ͣ̀̓̾㥭婟ͪ墝̞̫̀˛*:㹌Ἧ̷̯̣̻70┒䜿̓ⱏ̱ͣ⋃⑙㲱䖁,Ⱡ戟⢫煾2003煿
National Institute of Public Health, Japan

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National Institute of Public Health, Japan8⌧⾜䛾་⒪ಖ㝤ไᗘ䛻䛚䛡䜛་⒪ᢏ⾡䛾ホ౯䛻䛴䛔䛶୰་༠㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍㨜㉡㻌 熇⑈煾㖀㊦⃅煿⨥┲㻌熌⑞㻌 熈⑈煾媋䚓⃅煿⨥┲㻌熌⑞㻌 ↽䜛⨥┲㻌熊⑞㻌 ⱓ旑⨥┲㻌熊⑞㻌 ␓偔Ἃ㻌熉⑞㻌㻌⇖Ⰺ㻌 崌䕹ⱏ⌊㟭͆媦ῲⱏ岲˚媦ῲ㊜㴦˚媦ῲ䶡㟭͆㶌䕹㘊㴦䮚̼̜̓̾寁嬧̱ͣ˛㻌㻌Ὣ⑙煾㻞㻜㻝㻡⻅㻢㝙㻝㘶䑏❹煿㻌 㻞㻜㻝㻞⻅㻡㝙㻞㻟㘶煾䭽熇✯煿燔㻞㻜㻝㻡⻅㻡㝙㻞㻣㘶煾䭽㻞㻡✯煿㻌㻌䕿⌧⾜䛾་⒪ᢏ⾡䛾ホ౯䛻䛚䛔䛶䛿䚸Ᏻ඲ᛶ䞉᭷ຠᛶ䜢୰ᚰ䛸䛧䛶⥲ྜⓗ䛺ホ౯䜢⾜䛳䛶䛔䜛䚹㈝⏝ᑐຠᯝ䛻䛴䛔䛶䛿䚸ಖ㝤㐺⏝䜢ᕼᮃ䛩䜛㝿䛻㈝⏝ᑐຠᯝ䛻㛵䛩䜛㈨ᩱ䛾ᥦฟ➼䜢ồ䜑䜛➼䛾ᑐᛂ䜢⾜䛳䛶䛔䜛䛜䚸་⸆ရ䚸་⒪ᮦᩱ䚸ᡭ⾡➼䛾ᡭᢏ䛾䠏ศ㔝䛷ྲྀ䜚ᢅ䛔䛜␗䛺䛳䛶䛔䜛䚹㻌㻌䕿㈝⏝ᑐຠᯝ䛾ホ౯⤖ᯝ䜢᫂♧ⓗ䛺ຍ⟬䛾せ௳䛸䛩䜛➼䛾ලయⓗ䛺ุ᩿ᇶ‽䛜タᐃ䛥䜜䛶䛚䜙䛪䚸㈝⏝ᑐຠᯝ䛾ホ౯䛜་⒪ಖ㝤ୖ䛾ホ౯䛻ᚲ䛪䛧䜒཯ᫎ䛥䜜䛶䛔䛺䛔䛸䛔䛖ᣦ᦬䛜䛒䜛䚹㻌㻌䕿䛥䜙䛻䚸㈝⏝ᑐຠᯝホ౯䛻㛵䛩䜛㈨ᩱ䛾ᥦฟ➼䜢⾜䛳䛯ሙྜ䛷䛒䛳䛶䜒䚸ಖ㝤ᑟධᚋ䛻ᥦฟ㈨ᩱ䛾᳨ド䜢⾜䛖➼䛾ᑐᛂ䛿⾜䜟䜜䛶䛔䛺䛔䚹㻌㻌㻌䠄➨䠎ᅇ㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍㈨ᩱ䜘䜚䠅㻌
9National Institute of Public Health, Japan་⒪ᢏ⾡䛾㈝⏝ᑐຠᯝホ౯䛻㛵䛩䜛⪃䛘᪉䕿㧗ᗘ䛺་⒪ᢏ⾡䛜ቑຍ䛧䚸㧗䛔἞⒪ຠᯝ䜔Ᏻ඲ᛶ䛜ᮇᚅ䛷䛝䜛୍᪉䛷䚸䛣䜜䜙䛾䛖䛱㈝⏝䛾኱䛝䛺་⒪ᢏ⾡䛜ቑຍ䛩䜛䛣䛸䛻䜘䜛་⒪ಖ㝤㈈ᨻ䜈䛾ᙳ㡪䛜ᠱᛕ䛥䜜䜛䛸䛔䛖ᣦ᦬䛜䛒䜛䚹㻌㻌䕿ᡃ䛜ᅜ䛾་⒪ಖ㝤ไᗘ䛻䛚䛔䛶䛿䚸ᚑ᮶䛛䜙䚸་⒪ᢏ⾡䛾Ᏻ඲ᛶ䞉᭷ຠᛶ䜢୰ᚰ䛻ホ౯䜢⾜䛳䛶䛝䛯䛜䚸㈝⏝ᑐຠᯝ䛻䛴䛔䛶䛿䚸ホ౯⤖ᯝ䜢⏝䛔䛯ຍ⟬せ௳➼䚸ලయⓗ䛺ุ᩿ᇶ‽䜢タ䛡䛪䛻䚸ಖ㝤཰㍕䜔ಖ㝤ൾ㑏౯᱁䜢Ỵᐃ䛧䛶䛝䛯䚹㻌㻌㻌㻌㻌 ௨ୖ䜢㋃䜎䛘䚸་⒪ಖ㝤ୖ䛾ホ౯䜢⾜䛖䛻䛒䛯䜚䚸ⴭ䛧䛟ᚑ᮶ᢏ⾡䜘䜚䜒㧗㢠䛺㈝⏝䜢せ䛩䜛ᢏ⾡➼୍ᐃ䛾せ௳䜢‶䛯䛩་⒪ᢏ⾡䜢ᑐ㇟䛸䛧䛶䚸ຠᯝ䠄Ᏻ඲ᛶ䞉᭷ຠᛶ➼䠅䛾䜏䛺䜙䛪䚸㈝⏝䜒⪃៖䛧䛯ホ౯䜢⾜䛖䛯䜑䚸་⒪ᢏ⾡䛾㈝⏝ᑐຠᯝホ౯䛻䛴䛔䛶ᑟධ䜢᳨ウ䛩䜛䚹㻌㻌䠄➨䠎ᅇ㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍㈨ᩱ䜘䜚䠅㻌㻌11National Institute of Public Health, Japan• ୍⯡ⓗ䛺་⒪ᢏ⾡ホ౯䛾ពᛮỴᐃ䛾䝥䝻䝉䝇• ㈝⏝ᑐຠᯝ䜢ྵ䜑䛯ᵝ䚻䛺せ⣲䜢⪃៖䛧䛶ホ౯䜢⾜䛖䚹

Appraisal(媦ῲ)燛 㝚⌊へϑ⯚↹へ䮚͆媦ῲ͆ ⯰墝ϑ崌䕹ⱏ⌊㟭媦ῲ͆⯰墝燛 ≗㟡䶡㟭͆娴戙燛 ̵͆ἧ(刹⻛䛕˚⁼䑗䛕˚䦏Ὣ䛕…)⿂桐͆偔ㆿ10ไᗘ䛾ᇶᮏⓗ䛺⪃䛘᪉煾熇煿ⱏ岲㋑墤̼̜̓̾ ⱏ岲㋑墤̼̜͇̓̾˚Ṝ婩͆⏰⊘̓⡋̧̫̤̽̀䤋嫞̷̭ͤ˛ Ȋ⹝Ɫ͂䘏ヴͪⱏ岲̯̜̜̫̀̾͂̀˛ ȋⱏ岲̀͂ͣ䘏䘖̼̜̓̾ἴ㝐へ͆ͣ̚ἧ͆⎌䚓㋑墤̤⮩❹̱̫ͣ̀˛ Ȍἴ㝐̱ͣ⎌䚓㋑墤̀㰥彔̯̾˚㝚䕹へ͆娄䄊̣͡˚峲㖐⿂桐̤⥸̥̜⑀兎へ̤̫ͣ̀̚˛ ȍ⯚↹へϑ㝚⌊へ䮚̤ṑ⯫䩜⻷䤋䬜̯̜̫̾ͣ̀˛̷̸̯˚ṛ婩ἶ⥧͚̼̜͚͆͆̓̾˚Ἓ⿝͆㥭婟̓͢͠〖姒̤ͣ̚⢅⑙͇˚ⱏ岲̱̫͚͇̜̣̜̞̀ͣ̀ͣ͆̿͂̀̚㍘㒩̷͚̻̚˛煾熈煿䶡㟭㶌䕹̼̜̓̾ 䶡㟭㶌䕹̼̜͇̓̾˚Ṝ婩͆⏰⊘̓⡋̧̫̤̽̀䤋嫞̷̭ͤ˛ Ȋ⎌䚓㋑墤͆媦ῲ̼̜͇̓̾˚⯚↹へϑ㝚⌊へ͆媦ῲ͇̰͙ͪ˚㨩˞͂娄䄊̣͆͡媦ῲͪ丠⑙䛕̓〈㢙̱̜̞ͣ̀偔̠㘊ͪ⡋㝽䛕̓䷾㍒̯̼̼˚崌䕹ⱏ⌊㟭媦ῲ͆䶡㟭ͪ㶌䕹̯˚͢͠⧶⾤͂⎌䚓㋑墤͆媦ῲͪ䜿㍘̱͚̱͆̀ͣ˛ ȋ崌䕹ⱏ⌊㟭媦ῲ͇⎌䚓㋑墤͆媦ῲ͆ṑ愹≗̿̚͢˚崌䕹ⱏ⌊㟭媦ῲ͆䶡㟭͚̻͆͗ͪ̾‫‮‬曋␟彚͆⑀⑷͜ⅰ惕ῲ㢍ͪ≵⯫ϑ媦ῲ̱͚͇̜ͣ͆̿͂˛̷͖˚崌䕹ⱏ⌊㟭媦ῲ͆䶡㟭͆≵⯫͆䜿⯚䮚̼̜͚̓̾˚ṑ⯫͆㠥弰へͪ㍒̷̻͚̯͆̀˚䢽䝅䛕͂悜䕹ͪ惐̩͚̱ͣ͆̀ͣ˛ Ȍ崌䕹␛͋⌊㟭͆␝㘊͆娄䄊̣͆͡媦ῲͪ墝̞͚͆̿̚͢˚崌䕹͆娄䄊͆͗͆媦ῲͪ墝̞͚͇̜͆̿͂˛
National Institute of Public Health, Japan୰་༠㻌 ᖹᡂ26ᖺᗘデ⒪ሗ㓘ᨵᐃ䛻ಀ䜛⟅⏦᭩㝃ᖏពぢ2014.2.5་⒪ᢏ⾡ホ౯䛾䝥䝻䝉䝇Assessment(≗㟡)

National Institute of Public Health, Japan12熄⿝䛋⎌嗽┒͆ῐ䕹—悃䮧˚̜ͧͣ͞旑⊞嗽ⲑ͆媦ῲ͆姜䝅̯˚⧶䶡䏘̤ᾟ̜‫‮‬曋嗽ⲑ䮚͆悺㮴⍧䮚͆⿂桐ͪ嬐㡌ϑ㥭媍̯˚嬐⊵⢂憽䮚͆❹͢㘊̼̜̓̾⽦̥䷫̥㥭婟̱̫ͣ̀˛Decision(㝑䶓㳋⯫)13熄㯜嗽䤋嫞͆《⻦̀⥧㞶⎌䚓͆㪰兎≗⍧燛恴㒋͆㏹悃䮚̷͙͆˚∷㘊⎌̣̣̼̩͜͢⎌̀͆恴㒋ͪ⑼̷͙≗⋃嬐⊵̼̜̓̾⽦̥䷫̥㥭婟̱̫ͣ̀˛燛 㝑䶓䛕͂ㅠの㳋⯫

14熄⎌嗽┒͜⎌䚓㪰⚹䮚͆‫‮‬曋悺䕹͆媦ῲ̓曬̯̾崌䕹ⱏ⌊㟭͆娄䄊ͪⱟ↶̱̫̼̜ͣ̀̓̾˚ͺΤίϒ΍νω͆媦ῲ̀͆㗅⑙へ͚幠͖̠̼̼˚ΝϒΕϑ≗㟡䶡㟭͆␟朗˚媦ῲⱏ岲͆䰕❃˚媦ῲ͆⯰㘎ᾤ⊇䮚ͪ⑼͙˚⻄㉡28 ⻅⻷媋䚓⢂憽㖊⯫̢̩̓ͣ媷墝䛕ⱟ↶͚姧戟̓↶̤ͤ͂͡˚⽦̥䷫̥㥭婟̱̫ͣ̀˛15熄熟熙熪ͪ㶌䕹̷̯⎌䚓ㄖ⢂͆⇂㝚͆媦ῲ͆❹͢㘊ͪ㥭婟̱̫ͣ̀˛

National Institute of Public Health, Japan䛂᪥ᮏ෌⯆ᡓ␎䛃ᨵゞ䠎䠌䠍䠐
2014.6.24㻌 㛶㆟Ỵᐃ‫‮‬曋䶷Ἡⱏ岲䰕❃͆㗅䑗ϑ㥭婟㻌㻌 Ȋ㝑↙䭀͆⎌䚓㋑墤ϑ⎌嗽┒䮚͐͆怖恰͂͸΅ΑΏ䤋‫‮‬煾‫‮‬曋⥧ῆ䕹䚓楛崌⊇⻷͆⥸⺖㌲⥸煿㻌㻌 ϑ枺㘁䛕͂⎌䚓㋑墤䮚͆‫‮‬曋悺䕹͆媦ῲ㚓͆崌䕹ⱏ⌊㟭≗㟡͆ⱟ↶䮚㻌㻌㻌    ⎌䚓≗戟͆ͺΤίϒ΍νω͆ズテͪ␨̷̩̜̜̞̀ヴ偖Ρϒΐ̀⎌䚓‫‮‬曋͆㍒䷫⑀兎へ̜̞̀␝㘊͆姒嬜̠̞〭̓ͣ͠˚枺㘁䛕͂⎌䚓㋑墤䮚͆‫‮‬曋悺䕹͆媦ῲ̓曬̯˚崌䕹ⱏ⌊㟭͆娄䄊ͪ㻞㻜㻝㻢⻅⻷ͪ䜿恥̓媷墝䛕̓ⱟ↶̱ͣ˛̷͖˚崌䕹ⱏ⌊㟭̤ᾟ̷̜̭̀ͤ⎌䚓㋑墤̼̜̓̾䷪䷫䛕̓‫‮‬曋⥧ῆ䕹䚓楛崌⊇⻷̤≺䕹⑀兎̀͂ͣἦ䶕͗䮚ͪ㥭婟̱ͣ˛̳ͧ̾̚˚媦ῲ䚓楛̢̜̓̾㝚⌊へ䮚͇嫞̷͙͚ͤ͆͆͡旜䛋ΉΏΞ͆✯␟̤朴̧̯㴌橤̤悃͖̜͂䮚̓͢͠‫‮‬曋悺䕹̤姜怍͙̜͂⎌䚓㋑墤͆␧㋂̜̼̜͚̓̾˚‫‮‬曋⥧ῆ䕹䚓楛崌⊇⻷ṛ͆❹͢㘊ͪ㥭婟̱ͣ˛㻌㻌National Institute of Public Health, Japan13National Institute of Public Health, Japan㈝⏝ᑐຠᯝホ౯䛾௒ᚋ䛾᳨ウ䛻䛴䛔䛶熈熄⇈ᾤ䛕⇖Ⰺ煾熇煿ΝϒΕϑ≗㟡͆㐡≋̓⡋̧̽⇈ᾤ῜ͪ䕹̷̜㥭婟̼̜̓̾  Ȋ⇈ᾤ䛕͂⎌嗽┒˚⎌䚓㪰⚹䮚ͪ῜̷̯̀㥭婟ͪ墝̞曬͇̓˚ὒ㦾̤␟朗̷̯ΝϒΕ̵̢͋͆͠ΝϒἘ⡋̧̽≗㟡煾ἶṜ˚˥ΝϒΕϑ≗㟡˦̜̞̀˛煿ͪ㐡≋̯˚㐡≋̷̭ͤΝϒΕϑ≗㟡ͪ↔̓㥭婟ͪ墝̞̫̀̓͢͠˚䞑⯰̓㥭婟ͪ悃͙̫̤̥͇̜̣̜̞ͣ̀̿ͣ͆̿͂̀㍘㒩䮚̷̤̻̫̀ͪ̚幠͖̠˚⎌嗽┒˚⎌䚓㪰⚹̼̜̓̾˚ὒ㦾̓崌䕹ⱏ⌊㟭̤媦ῲ⑀兎̞̀͂ͣ͂͠ΝϒΕϑ≗㟡͆㐡≋ͪ姒嬜̱̫̯ͣ̀̀˚̵ͤ̓⡋̜̽̾˚⇈ᾤ䛕͂㥭婟ͪ墝̻͇̞̣̾́˛  ȋ̷̸̯˚㐡≋̷̭ͤΝϒΕϑ≗㟡͆媦ῲ䶡㟭ͪ㶌䕹̯̾˚‫‮‬曋␟彚͆⑀⑷͆㳋⯫͜‫‮‬曋ⅰ惕ῲ㢍͐͆␞㙱͇墝̲ͧ˚⾤枳͇˚㥭婟㞡㗪̯̀̾ῐ䕹̱͙̫̯͇̞̣ͣ̓̀́ͣ̀̀̾́˛  ȌΝϒΕϑ≗㟡͆㐡≋ͪ㲓͙ͣⱏ岲   煾͸煿␟彚̣͡ṑ⯫㝰旤̤䶝悟̯̜̾ͣ⎌嗽┒˚⎌䚓㪰⚹̻̿̾̚˚崌䕹͜⹓⢅͆⥸̥̭˚㷈⥧͆↽䛕䶕亥̢̩̓ͣ崌䕹ⱏ⌊㟭媦ῲ͆⯰亏䮚ͪ幠͖̠̾㝽愹Ὣ̢̜̓̾惉⯫̷̯͚̼̜͆̓̾˚㐡≋ͪ姒嬜̧̯̜̫̯͇̞̣̾̀̀̾́˛   煾ͺ煿㘁姠␟彚̭ͤͣ⎌嗽┒˚⎌䚓㪰⚹̻̿̾̚˚⏰ῲ婙䯨㘊⽠˚䖌㝰へ⋱䯨˚㝚䕹へ⋱䯨̻̓̾͠䯨⯫̷̭ͤ┒䜿̞̹͆〖姒͚̼̜͇͂͆̓̾˚㷈⥧͆↽䛕䶕亥̢̩̓ͣ崌䕹ⱏ⌊㟭媦ῲ͆⯰亏䮚ͪ幠͖̠̾ΝϒΕ͆␟朗ϑ≗㟡͆⯰㘎⑀兎へ䮚ͪ〈㢙̷̯ṛ̿˚㐡≋ͪ姒嬜̧̯̜̫̯͇̞̣̾̀̀̾́˛  ȍ㐡≋̷̭ͤΝϒΕϑ≗㟡̼̜̓̾˚⾤枳͇˚㐡≋̷̭ͤΝϒΕͪ䕹̷̜⇞≗㟡䮚ͪ␓偔Ἃ䮚̤⯰㘎̱ͣ䮚͆㥭媍ͪ墝̜˚㝽愹Ὣ̿崌䕹ⱏ⌊㟭͆娄䄊ͪⱟ↶̱̫ͣ̀䮚̼̜̓̾͆㥭婟㞡㗪̱̤̀ͣ˚⽦̥䷫̥˚㐡≋̷̭ͤΝϒΕϑ≗㟡͆㥭媍͆ἦ䶕͗ͪ㥭婟̧̯̜̫̯͇̞̣̾̀̀̾́˛
National Institute of Public Health, Japan㈝⏝ᑐຠᯝホ౯ලయ౛䜢⏝䛔䛯᳨ウ ᐇ᪋せ㡯 䠄ᢤ⢋䠅୰་༠ ㈝㸫㸰㸰㸵㸬㸳㸬㸰㸵ຠᯝ䝕䞊䝍䛾ྲྀ䜚ᢅ䛔㻌㻌ᖜᗈ䛻㛵㐃䛩䜛ຠᯝ䝕䞊䝍䛾᳨⣴䜢⾜䛖➼䚸⥙⨶ᛶ䜢ᢸಖ䛩䜛䛣䛸䛸䛩䜛䚹䜎䛯䚸ᑐ㇟㻌㞟ᅋ䜔デ⒪ᐇែ䛾㐪䛔䠄౛䛘䜀ᾏእ䝕䞊䝍䛾ሙྜ䚸་⸆ရ䞉་⒪ᶵჾ䛾౑⏝ᐇែ䛾䜟䛜ᅜ㻌䛸䛾㐪䛔➼䠅➼䛻␃ព䛧䛴䛴䚸ཎ๎䛸䛧䛶䜶䝡䝕䞁䝇䝺䝧䝹䛜㧗䛔䝕䞊䝍䜢ඃඛ䛩䜛䚹䛺㻌䛚䚸䜶䝡䝕䞁䝇䛿䚸ᙜヱ་⸆ရ䞉་⒪ᶵჾ䛜ಖ㝤㐺⏝䛥䜜䛯᫬Ⅼ䛒䜛䛔䛿㐺ᛂᣑ኱䛥䜜䛯㻌᫬Ⅼ䛾䜒䛾䛻㝈䜙䛪䚸⌧᫬Ⅼ䛷᭱᪂䛾䜒䛾䜢⏝䛔䛶䜘䛔䚹㻌㻌㻌㈝⏝䝕䞊䝍䛾ྲྀ䜚ᢅ䛔㻌ཎ๎䛸䛧䛶䚸䛂༢౯䛃䛿䚸⌧᫬Ⅼ䛻䛚䛡䜛デ⒪ሗ㓘Ⅼᩘ⾲䚸⸆౯ᇶ‽䚸≉ᐃಖ㝤་⒪ᮦᩱ㻌౯᱁ᇶ‽➼䜢⏝䛔䜛䛣䛸䛸䛧䚸䛂ᅇᩘ䛃䛿䚸䜟䛜ᅜ䛾デ⒪ᐇែ䜢㐺ษ䛻཯ᫎ䛧䛶䛔䜛䛸⪃䛘㻌䜙䜜䜛䝕䞊䝍䠄౛䠖䛂䜺䜲䝗䝷䜲䞁➼䛻♧䛥䜜䛯ᶆ‽ⓗ䛺デ⒪㐣⛬䛃䚸䡞ᐇ㝿䛾デ⒪䜢ศᯒ䛧㻌䛯䝕䞊䝍䛃䠅䜢⏝䛔䜛䚹㻌㻌㈝⏝䛿ᙜヱ་⸆ရ䞉་⒪ᶵჾ䛾㈝⏝䛾䜏䛷䛺䛟䚸᭷ᐖ஦㇟䜔ᑗ᮶ⓗ䛻㛵㐃䛩䜛ྜే⑕➼㻌䛾㈝⏝䜒ྵ䜑䜛䚹⏕⏘ᛶᦆኻ䜢ྵ䜑䛯ศᯒ䜢⾜䛖ሙྜ䛿䚸㈤㔠䜢⏝䛔䛶᥎ィ䛩䜛䛣䛸䜢ཎ๎䛸䛩䜛䚹㻌㻌㻌ලయ౛䛾᳨ウ䛻㛵䛩䜛◊✲⌜䛛䜙䛾ពぢ䛄୰ኸ♫఍ಖ㝤་⒪༠㆟఍䛻䛚䛡䜛་⸆ရ䞉་⒪ᶵჾ䛾㈝⏝ᑐຠᯝホ౯෌ศᯒ䛻㛵䛩䜛◊✲䛅⌜ (◊✲௦⾲⪅: ⚟⏣ ᩗ)
2015ᖺ5᭶27᪥(Ỉ)୰ኸ♫఍ಖ㝤་⒪༠㆟఍㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍1817National Institute of Public Health, Japan

2. ㈝⏝ຠᯝศᯒ䛾᪉ἲ䛻䛴䛔䛶

2. ㈝⏝ຠᯝศᯒ䛾᪉ἲ䛻䛴䛔䛶௻ᴗ䛾ᥦฟ䛧䛯ศᯒ䛻䛴䛔䛶䚸௨ୗ䛾㡯┠䛻ἢ䛳䛶䚸◊✲⌜䛾どⅬ䛛䜙䝺䝡䝳䞊䜢⾜䛳䛯䚹1)ຠᯝ

1)ຠᯝ

2)㈝⏝

1.1)ຠᯝ䝕䞊䝍1.2)ຠᯝ䝕䞊䝍䛾ྲྀ䜚ᢅ䛔1.1)ຠᯝ䝕䞊䝍2.1)㈝⏝䛾⠊ᅖ2.2)㈝⏝䝕䞊䝍䛾ྲྀ䜚ᢅ䛔¾ ་⒪ᶵჾ䛻䛴䛔䛶䛿䚸ᵝ䚻䛺ຠᯝᣦᶆ䜢⏝䛔䛶䛔䛯䚹¾ ་⸆ရ䛻䛴䛔䛶䛿䚸඲ရ┠䛷QALY䜢⏝䛔䛯ศᯒ䛜ᐇ᪋䛥䜜䛶䛔䛯䚹QALY௨እ䛷䛿⏕Ꮡᖺ䜢⏝䛔䛯ศᯒ䜒䛒䛳䛯䚹3)ศᯒ䛾ᯟ⤌䜏➼3.1)ẚ㍑ᑐ↷3.2)ศᯒᑐ㇟䛸䛩䜛ᝈ⪅3.3)ศᯒᡭἲ
3.4)ศᯒᮇ㛫3.5)๭ᘬ
3.6)ゎ㔘䠄୰་༠ ㈝-1(26.5.28)䛂ලయ౛䜢⏝䛔䛯᳨ウ䛻䛴䛔䛶䛃䠅1.2)ຠᯝ䝕䞊䝍䛾ྲྀ䜚ᢅ䛔
¾ ௻ᴗഃ䛜䝅䝇䝔䝬䝔䜱䝑䜽䝺䝡䝳䞊䜢᫂☜䛻ᐇ᪋䛧䛶䛔䛯ሙྜ䛸䚸ᐇ᪋䛧䛶䛔䛺䛔ሙྜ䛜䛒䛳䛯䚹Ѝ◊✲⌜䛷䛾⊂❧䛧䛯䝅䝇䝔䝬䝔䜱䝑䜽䝺䝡䝳䞊䛾㔜せᛶ䛜෌☜ㄆ䛥䜜䜛䛸䛸䜒䛻䚸౑⏝䛩䜛⮫ᗋヨ㦂䜢ኚ᭦䛩䜛䛣䛸䛜ྍ⬟䛸⪃䛘䜙䜜䜛ሙྜ䛻䛿䚸䜰䜹䝕䝭䜰䛾༠ຊ䛜㔜せ䛸ᛮ䜟䜜䛯䚹

19

2. ㈝⏝ຠᯝศᯒ䛾᪉ἲ䛻䛴䛔䛶20

2. ㈝⏝ຠᯝศᯒ䛾᪉ἲ䛻䛴䛔䛶3)ศᯒ䛾ᯟ⤌䜏➼2)㈝⏝

3.1)ẚ㍑ᑐ↷¾ 䛔䛪䜜䜒ᙜヱ་⸆ရ䞉་⒪ᶵჾ䛾ಖ㝤㐺⏝᫬Ⅼ䛻䛚䛔䛶᭱䜒⨨䛝᥮䜟䛳䛯䛸⪃䛘䜙䜜䜛䜒䛾䜢⏝䛔䛶䛔䛯䚹Ѝ䛯䛰䛧䚸ᕷ㈍ᚋ䛻⾜䜟䜜䛯᭱᪂䛾⮫ᗋヨ㦂䛾⤖ᯝ䜢⏝䛔䛶ศᯒ䛩䜛ᚲせ䛜䛒䜛ሙྜ䛺䛹䛻䛿䚸ẚ㍑ᑐ↷䜢ኚ᭦䛧䛶ᨵ䜑䛶ศᯒ䜢ᐇ᪋䛩䜛䛣䛸䜒⪃䛘䜙䜜䛯䚹

2.1)㈝⏝䛾⠊ᅖ
¾ 䛔䛪䜜䜒බⓗ་⒪㈝䜢㈝⏝䛾⠊ᅖ䛸䛧䛯ศᯒ䛜ᐇ᪋䛥䜜䛶䛚䜚䚸බⓗ௓ㆤ㈝䜔⏕⏘ᛶᦆኻ䜢ྵ䜣䛰ศᯒ䛿ᐇ᪋䛥䜜䛶䛔䛺䛛䛳䛯䚹2.2)㈝⏝䝕䞊䝍䛾ྲྀ䜚ᢅ䛔
¾ ༢౯䛿඲䛶᪥ᮏ䛾デ⒪ሗ㓘Ⅼᩘ䚸⸆౯ཬ䜃≉ᐃಖ㝤་⒪ᮦᩱ౯᱁䜢⏝䛔䛶䛔䛯䚹䜎䛯䚸䝺䝉䝥䝖䝕䞊䝍䝧䞊䝇䜢⏝䛔䛶᪂䛯䛻ゎᯒ䛧䛯⤖ᯝ䜢⏝䛔䛯ሙྜ䜒䛒䛳䛯䚹3.2)ศᯒᑐ㇟䛸䛩䜛ᝈ⪅Ѝ㐺ᛂ⑕䜔⏝ἲ䛻䜘䛳䛶ホ౯⤖ᯝ䛜኱䛝䛟␗䛺䜛ሙྜ䛻䛿䚸౛䛘䜀㐺ᛂ⑕䜢⣽ศ㢮䛧䛶ᨵ䜑䛶ศᯒ䛩䜛䛺䛹䚸せ⣲䛤䛸䛻䜘䜚ヲ⣽䛺ศᯒ䜢⾜䛖䛣䛸䛷䚸ከ㠃ⓗ䛺ホ౯䛜ྍ⬟䛸䛺䜛䛾䛷䛿䛺䛔䛛䚹3.3)ศᯒᡭἲ
¾ 䛔䛪䜜䜒㈝⏝ຠᯝศᯒ䛜ᐇ᪋䛥䜜䛶䛚䜚䚸䝗䝭䝘䞁䝖䠄ຠᯝ䛿኱䛝䛟㈝⏝䛿Ᏻ䛔䛸䛔䛖⤖ᯝ䠅䛷䛺䛔ሙྜ䛻䛿ICER(ቑศ㈝⏝ຠᯝẚ)䜢⟬ฟ䛧䛶䛔䛯䚹21

2. ㈝⏝ຠᯝศᯒ䛾᪉ἲ䛻䛴䛔䛶

22

2. ㈝⏝ຠᯝศᯒ䛾᪉ἲ䛻䛴䛔䛶3)ศᯒ䛾ᯟ⤌䜏➼ (⥆䛝)3.6)ゎ㔘 (⥆䛝)• ௒ᅇ䛾ලయ౛䛾᳨ウ䛻䛚䛔䛶䛿䚸䛹䛾ᝈ⪅㞟ᅋ䛷䜒㈝⏝ᑐຠᯝ䛜䛚䛚䜐䛽୍ᐃ䛾ሙྜ䛸䚸୍㒊䛾ᝈ⪅㞟ᅋ䜔⏝ἲ䛻䛚䛔䛶␗䛺䜛ศᯒ⤖ᯝ䛸䛺䜛ሙྜ䛜䛒䛳䛯䚹Ѝ୍㒊䛾ᝈ⪅㞟ᅋ䜔⏝ἲ䛻䛚䛔䛶␗䛺䜛ศᯒ⤖ᯝ䛸䛺䜛ሙྜ䚸ㅖእᅜ䛷䛿⤖ᯝ䛾ά⏝᪉ἲ䜢ศ䛡䛶䛔䜛ᅜ䜒䛒䜚䚸䛹䛾䜘䛖䛻⤖ᯝ䜢ゎ㔘䛩䜛䛛ㄢ㢟䛷䛒䜛䚹3.4)ศᯒᮇ㛫¾ 䛔䛪䜜䜒ホ౯䛩䜛䛾䛻༑ศ䛸⪃䛘䜙䜜䜛ศᯒᮇ㛫䜢⏝䛔䛶䛔䛯䚹Ѝ䛯䛰䛧䚸㛗ᮇ䛾᥎ィ䛷䛿୙☜ᐇᛶ䛜㧗䛟䛺䜛ሙྜ䛻䛿䚸䛒䜟䛫䛶▷ᮇ䛾᥎ィ䜢⾜䛖䛣䛸䛜ᚲせ䛺ሙྜ䜒䛒䜛䛸⪃䛘䜙䜜䛯䚹3.5)๭ᘬ

• ಖ㝤㐺⏝䛥䜜䛯ᚋ䛻䚸᪂䛯䛻⾜䜟䜜䛯⮫ᗋ◊✲➼䛻䜘䜚䚸䜘䜚᭷ຠ䛷㈝⏝ᑐຠᯝ䛾䜘䛔ᝈ⪅㞟ᅋ䛜ྠᐃ䛥䜜䜛ሙྜ䛜䛒䜛䚹Ѝᕷ㈍ᚋ䛾⮫ᗋヨ㦂䜔ᐇ⮫ᗋ䛻䜘䜚㞟✚䛥䜜䜛᭷⏝䛺䝕䞊䝍䜢䛹䛾䜘䛖䛻ά⏝䛩䜛䛛䛿ㄢ㢟䛷䛒䜛䚹¾ 㛗ᮇ䛻䜟䛯䜛ィ⟬䜢⾜䛳䛶䛔䜛ሙྜ䛻䛿๭ᘬ䜢⾜䛳䛶䛚䜚䚸๭ᘬ⋡䛿◊✲⌜䜺䜲䝗䝷䜲䞁䛷᥎ዡ䛧䛶䛔䜛2%䜢⏝䛔䛶䛔䜛䛣䛸䛜ከ䛛䛳䛯䚹3.6)ゎ㔘¾ ㈝⏝๐ῶ䛸䛺䜛䜒䛾௨እ䛷ゎ㔘䜢ᥦ♧䛧䛶䛔䜛ሙྜ䛿䚸୍ᐃ䛾ᇶ‽್䛸ẚ
㍑䛧䛶㈝⏝ᑐຠᯝ䜢㆟ㄽ䛧䛶䛔䜛䜒䛾䛜ከ䛛䛳䛯䚹
2324

㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍䛻䛚䛡䜛䛣䜜䜎䛷䛾㆟ㄽ

3. 䝕䞊䝍䜔䜺䜲䝗䝷䜲䞁䛾ᩚഛ• QOL್䛺䛹୍㒊䛾䝕䞊䝍䛻䛴䛔䛶䛿䚸᪥ᮏ䛷䛾⵳✚䛜༑ศ䛷䛺䛔䜒䛾䜒䛒䜛䚹Ѝᙜ㠃䛾䛸䛣䜝䚸እᅜ䛾䝕䞊䝍䛺䛹䜢⏝䛔䛶ศᯒ䛧䛯ୖ䛷䚸ឤᗘศᯒ➼䛻䜘䜚䛭䛾ศᯒ䛾㡹೺ᛶ䜢᳨ウ䛩䜛䛣䛸䛷ᑐᛂ䛷䛝䜛䛾䛷䛿䛺䛔䛛䚹Ѝㅖእᅜ䛾≧ἣ䜢ཧ↷䛩䜛䛸䚸ไᗘ䛜㛤ጞ䛥䜜䜛䛣䛸䛻䜘䜚䚸◊✲䜔἞㦂䛷䛾ホ౯㡯┠䛻QOL್䛜⤌䜏㎸䜎䜜䜛౛䛜ቑ䛘䚸䝕䞊䝍䛾ᩚഛ䛜㐍䜐䛾䛷䛿䛺䛔䛛䚹Ѝ᪤Ꮡ䛾䝕䞊䝍䝧䞊䝇(䝘䝅䝵䝘䝹䝕䞊䝍䝧䞊䝇䜔DPC䝕䞊䝍䚸Ⓩ㘓◊✲➼)䜒ά⏝䛷䛝䜛䛾䛷䛿䛺䛔䛛䚹Ѝ᪤Ꮡ䛾ཌ⏕ປാ⛉Ꮫ◊✲䛾⤖ᯝ䜢ά⏝䛷䛝䛯䛣䛸䛛䜙䚸QOL್䛻㛵䛩䜛䝕䞊䝍䜢䛥䜙䛻ᩚഛ䛩䜛䛯䜑䛻䜒䚸௒ᚋ䛾ཌ⏕ປാ⛉Ꮫ◊✲䜔㛵ಀᏛ఍➼䛾ྲྀ⤌䛻䛚䛔䛶䝕䞊䝍཰㞟䛜㐍䜐௙⤌䜏䜢ᩚ䛘䜛䛣䛸䠄౛䛘䜀デ⒪ሗ
㓘ᨵᐃ䛾せᮃ᫬䛻ᙜヱ䝕䞊䝍䜢ồ䜑䜛䛺䛹䠅䛜⪃䛘䜙䜜䜛䛾䛷䛿䛺䛔䛛䚹崌䕹ⱏ⌊㟭媦ῲ̼̜͇̓̾˚⻄㉡25⻅11㝙16㘶̓㝽愹Ὣ̢̜̓̾˥Ṿ旤䛕͂㗅䑗˦̼̜̓̾寁嬧̷̯曬̓˚⇈ᾤ䛕͂⎌嗽┒ϑ⎌䚓㪰⚹̓旳̱ͣΝϒΕ䮚ͪ䕹̜̾㥭婟̱̫̤ͣ̀〖姒̷̭̫̀ͤ̀ͪ␨̩˚⻄㉡26⻅⻷͆␧͢䶕̯͗̀̾˚⇈ᾤ῜͆㥭婟ͪ⯰㘎̯˚⊇⻷婾婙̓③̷̩嬃條͆㌎≋ͪ悃͙̜̫̾ͣ̀ͥ˛• ඛ⾜䛧䛶䛔䜛ㅖእᅜ䛷䛿䚸ศᯒ᪉ἲ䛻㛵䛩䜛䜺䜲䝗䝷䜲䞁䛜సᡂ䛥䜜䛶䛔䜛䚹¾ 䜰䜹䝕䝭䝑䜽䛺㈝⏝ຠᯝศᯒ䛾䜺䜲䝗䝷䜲䞁䛿᪥ᮏ䛷䜒᪤䛻సᡂ䛥䜜䛶䛚䜚䠄ᖹᡂ25ᖺ12᭶25᪥䛾㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍䛷⤂௓䠅䚸ไᗘ䛾䛒䜚᪉䛜Ỵ䜎䜜䜀䚸ᑐᛂ䛩䜛䜒䛾䛿సᡂྍ⬟䛷䛒䜛䚹䠄➨㻞㻡ᅇ㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍㈨ᩱ䜘䜚䠅㻌25

National Institute of Public Health, Japan௒ᚋ䛾㆟ㄽ䛻䛴䛔䛶˥Ṿ旤䛕͂㗅䑗˦͜˚˥⇈ᾤ῜͆㥭婟˦̓͢͠㌎≋̷̥̿嬃條䮚ͪ幠͖̠˚Ἓ⿝˚ἶṜ͆Ẍ͂嬧䄊̬̭̀̓̓͡寁嬧ͪ㹂͙ͣ˛嬧䄊煾熇煿ΝϒΕ㐡≋͆̚͢㘊䮚̼̜̓̾ ϑ媦ῲⱏ岲͆惉⯫⡋㻧͆偔̠㘊 ϑΝϒΕ㐡≋͆̚͢㘊 䮚嬧䄊煾熈煿≗㟡͆㘊㴦̼̜̓̾ ϑ≗㟡΂ͺΟοͺω ϑ⌊㟭㍘㩪͆偔̠㘊 䮚嬧䄊煾熉煿媦ῲ͆ṑ恴͆㶒ͤ͆̚͢㘊̼̜̓̾ ϑ⇞≗㟡͆̚͢㘊 ϑ͸έςͺΌρ͆̚͢㘊 䮚᪥ᮏ䛷་⒪⤒῭ホ౯䜢ᨻ⟇䛻ᛂ⏝䛧䛶䛔䛟䛯䜑䛻䛿ʫ⎌䚓䶝㹙媦ῲͪ≺䕹̱ͣ䜿䛕 ⎌䚓崌͆㋢⊇̤䜿䛕͇̜̿͂˛⎌䚓͐͆⑙䑗䛕͂㋦崘̷̱͙ͪͣ͆偔̠㘊˛㘶㝽͆㘳⮩⊇⻷ͪ㖊勀̱͚ͣ͆̿ͣ̚〖姒̤ͣ̚˛ʫ͸ΑΏηωΞ̀͸έςͺΌρ͆㘊㴦 嬁̤͸ΑΏηωΞ̢͋͠͸έςͺΌρͪ墝̞̣͆˛ ͸ΑΏηωΞ͆Ṿ䬜へ˚恠㙟へ˛ ͸έςͺΌρ͆曬̓偔ㆿ̱̥͑姒䵱˛ʫ㊜㴦͆䷂ṑ̀ΝϒΕ㗅⃪ 䶡㟭ͪ㰥彔⑀兎̷̱͙͇̀ͣ̓˚媦ῲ㊜㴦͆㩪㻧⍧̤〖姒˛̷͖⑝㚓̓˚⇂恫̿ῐ̠ͣΝϒΕΓϒΏ͜Κϒρ͆㗅⃪̤㝬͖ͤͣ˛ʫἋ㞡͆↖⯰ 媦ῲ䶕亥̸̧̩̿͂˚ΝϒΕͪ㻧⃪̱ͣ⃅͚̓⎌䚓䶝㹙媦ῲͪ⯰㘎̥̿ͣἋ㞡̤〖姒˛䠄➨㻞㻡ᅇ㈝⏝ᑐຠᯝホ౯ᑓ㛛㒊఍㈨ᩱ䜘䜚䠅㻌嬧䄊煾熊煿媦ῲ䶡㟭͆㶌䕹㘊㴦̼̜̓̾
National Institute of Public Health, Japan

National Institute of Public Health, Japan28