Estimation of the cost of influenza antiviral medication guidance or support provided by healthcare professionals: a questionnaire survey in Japan

Figures & data

Table 1. Question types and sentences to ask the monetary value for fear during guidance and/or support by type.

Type		Question sentences
A	WTP type / Direct method	What is the maximum amount you would be willing to pay if the fear of infection disappears per guidance and/or support?
B	Value evaluation type / Direct method	How much is the value of disappearance of fear of infection per guidance and/or support?
C	WTP type / Two-step method	1) What is the maximum amount you would be willing to pay if working to guide and/or support drug administration with fear is replaced by another person per one time?
		2) What is the maximum amount you would be willing to pay if the fear of infection disappears per one time?
D	Value evaluation type / Two-step method	1) How much is the total value of guidance and/or support for drug administration while having fear of infection one time?
		2) Of the value you have provided, what is the amount of the value attributable to your fear?

WTP: willingness to pay.

Table 2. Characteristics of respondents (overall): physicians.

% of men	90.1%
	(88.8%–91.4%)
Age (years)
Mean	49.7
	(49.1–50.3)
Median	50
Standard deviation	14.6
By type of facilities / employment (%) N = 2,149^a
Workers of hospitals (except for affiliated   hospitals of medical educational institutions)	55.9%
	(53.8%–58.0%)
Hospital founders or corporate representatives   of hospitals (except for affiliated hospitals   of medical educational institutions)	2.7%
	(2.0%–3.4%)
Workers (clinical instructors or teachers)   of affiliated hospitals of   medical educational institutions	8.0%
	(6.9%–9.1%)
Workers (clinical physicians)   of affiliated hospitals of   medical educational institutions	7.1%
	(6.0%–8.2%)
Workers (clinical graduate students)   of affiliated hospitals of   medical educational institutions	1.5%
	(1.0%–2.0%)
Founders or corporate representatives of clinics	11.6%
	(10.2%–13.0%)
Workers of clinics	8.1%
	(6.9%–9.3%)
Other than above	5.0%
	(4.1%–5.9%)

^aNumber of respondents except for those aged <20 or ≥65 years. Numbers in brackets represent 95% confidence intervals. Note: A clinic is a facility with maximum 19 beds as per Japanese law; it is mainly owned and managed by a physician, and focuses on the care of outpatients.

Table 3. Characteristics of respondents (overall): pharmacists.

% of men	63.2%
	(60.7%–65.7%)
Age (years)
Mean	45.7
	(44.9–46.5)
Median	45
Standard deviation	14.4
By type of facilities / employment (%) N = 1,385^a
Workers in pharmacies	50.6%
	(48.0%–53.2%)
Pharmacy founders   or corporate representative	6.0%
	(4.7%–7.3%)
Employees engaged in dispensing   and ward operation in hospitals	36.2%
	(33.7%–38.7%)
Employees engaged in the other works   (clinical trials,   clinical examination etc.) in hospitals	2.2%
	(1.4%–3.0%)
Employees engaged in dispensing   and ward operation in clinics	1.5%
	(0.9%–2.1%)
Other than above	3.5%
	(2.5%–4.4%)

^aNumber of respondents except for those aged <20 or ≥65 years. Numbers in brackets represent 95% confidence intervals. Note: A clinic is a facility with maximum 19 beds as per Japanese law; it is mainly owned and managed by a physician, and focuses on the care of outpatients.

Table 4. Characteristics of respondents (overall): certified care workers.

% of men	33.4%
	(32.2%–34.6%)
Age (years)
Mean	46.2
	(46.0–46.4)
Median	46
Standard deviation	9.1
By type of services (%) N = 6,257^a
Long-term care facilities
Welfare facilities for the elderly    requiring long-term care	23.0%
	(22.0%–24.0%)
Health care facilities for the elderly    requiring long-term care	9.2%
	(8.5%–9.9%)
Sanatorium type medical care facilities    for the elderly requiring care	2.6%
	(2.2%–3.0%)
Nursing care clinics	1.6%
	(1.3%–1.9%)
Outpatient type care services
Outpatient care	19.8%
	(18.8%–20.8%)
Community-based outpatient care	7.0%
	(6.4%–7.6%)
Outpatient rehabilitation    (health care facilities for the elderly    requiring long-term care)	5.7%
	(5.1%–6.3%)
Outpatient rehabilitation (medical care facilities)	2.8%
	(2.4%–3.2%)
Outpatient rehabilitation (nursing care clinics)	1.0%
	(0.8%–1.2%)
Home-visit type care-services
Home-visit care	18.0%
	(17.0%–19.0%)
Home-visit bathing service	2.6%
	(2.2%–3.0%)
Others
Short-term admission daily life care	10.5%
	(9.7%–11.3%)
Daily life care in communal    living for elderly with dementia	8.5%
	(7.8%–9.2%)
Daily life care for elderly in specific facility	6.8%
	(6.2%–7.4%)
Other than above	15.5%
	(14.6%–16.4%)

^aNumber of respondents except for those aged <20 or ≧65 years. Type of services provided by the workplaces, multiple choices allowed. Numbers in brackets represent 95% confidence intervals.

Figure 1. Percentage of respondents by required time for guidance and/or support for drug administration among physicians (A), pharmacists (B), and certified care workers (C).

Table 5. Required time for guidance and/or support for drug administration.

Type of occupation	N^a	Oral (minutes)		Inhalant (minutes)
		Each occupation^b	Entire facility	Each occupation^b	Entire facility
Required time for guidance and/or support (min/patient)^c
Physicians	909	3.5	7.1	4.2	8.3
		(3.3–3.7)	(6.2–7.9)	(3.9–4.4)	(7.5–9.2)
Pharmacists	962	3.5	7.5	7.0	12.4
		(3.3–3.6)	(6.3–8.7)	(6.8–7.2)	(11.0–13.8)
Certified care workers	423	4.9	16.0	5.1	16.1
		(4.3–5.5)	(13.1–18.9)	(4.5–5.8)	(13.0–19.2)
Estimated cost for guidance and/or support (JPY)^d
Physicians		121	244	144	289
Pharmacists		120	260	243	428
Certified care workers		170	555	177	557

^aNumber of respondents except for those who answered as “0%” or “not sure” to the question about the percentage of guidance or assistance by themselves, ^bOccupation of respondents, ^cMean (95% confidence interval), ^dMean required time for guidance and/or support (min/patient)^c × average wage (JPY/month)¹⁰/average working time (hour/month)¹¹/60.

JPY: Japanese yen.

Table 6. Required time for guidance and/or support for drug administration by type of facilities and type of employment (physicians).

Type of facilities/employment^a	N	Oral (minutes)^b		Inhalant (minutes)^b
		Physicians	Entire facility	Physicians	Entire facility
Workers of hospitals (except for affiliated hospitals of medical educational institutions)	541	3.2	6.7	3.8	7.9
		(3.0–3.5)	(5.7–7.7)	(3.5–4.1)	(6.9–8.9)
Hospital founders or corporate representatives of hospitals (except for affiliated hospitals of medical educational institutions)	24	6.0	15.2	6.0	16.2
		(3.5–8.4)	(4.3–26.1)	(3.8–8.3)	(6.2–26.2)
Workers (clinical instructors or teachers) of affiliated hospitals of medical educational institutions	72	4.3	9.8	5.3	11.0
		(3.3–5.2)	(5.8–13.9)	(4.1–6.4)	(7.1–15.0)
Workers (clinical physicians) of affiliated hospitals of medical educational institutions	54	4.4	7.8	4.9	8.4
		(3.2–5.6)	(4.1–11.6)	(3.7–6.0)	(5.0–11.9)
Workers (clinical graduate students) of affiliated hospitals of medical educational institutions	17	3.9	7.2	6.3	10.2
		(2.0–5.8)	(1.1–13.4)	(3.5–9.0)	(2.7–17.6)
Founders or corporate representatives of clinics.	104	3.2	4.7	4.0	6.7
		(2.6–3.8)	(3.1–6.3)	(3.3–4.7)	(4.7–8.7)
Workers of clinics	68	2.8	5.0	3.7	6.4
		(2.1–3.5)	(2.9–7.2)	(2.9–4.5)	(4.1–8.8)

^aShown in descending order of number of respondents by category of facility (hospitals, affiliated hospitals of medical educational institutions, and clinics), ^bMean (95% confidence interval).

Table 7. Required time for guidance and/or support for drug administration by type of facilities and type of employment (pharmacists).

Type of facilities/ employment^a	N	Oral (minutes) ^b		Inhalant (minutes) ^b
		Pharmacists	Entire facility	Pharmacists	Entire facility
Workers in pharmacies	518	3.4	5.8	6.8	10.0
		(3.2–3.6)	(4.5–7.1)	(6.5–7.1)	(8.5–11.5)
Pharmacy founders or corporate representative	59	3.4	4.7	6.3	7.8
		(2.8–3.9)	(1.6–7.7)	(5.4–7.2)	(4.2–11.4)
Employees engaged in dispensing and ward operation in hospitals	347	3.6	9.9	7.5	16.2
		(3.4–3.8)	(7.2–12.6)	(7.1–7.9)	(13.1–19.2)
Employees engaged in the other works (clinical trials, clinical examination etc.) in hospitals	18	3.8	8.2	8.1	13.8
		(2.7–4.9)	(0–18.0)	(6.1–10.1)	(2.4–25.2)
Employees engaged in dispensing and ward operation in clinics	13	3.2	24.7	7.0	26.7
		(2.1–4.2)	(0–59.1)	(4.9–9.1)	(0.7–52.7)

^aShown in descending order of number of respondents by type of facility (pharmacies, hospitals, and clinics), ^bMean (95% confidence interval).

Table 8. Required time for guidance and/or support for drug administration by type of services (certified care workers).

Type of services^a	N	Oral (minutes)^b		Inhalant (minutes)^b
		Certified care workers	Entire facility	Certified care workers	Entire facility
Long-term care facilities
Welfare facilities for the elderly requiring long-term care	152	5.3	19.3	5.7	16.2
		(4.1–6.4)	(13.5–25.2)	(4.5–6.9)	(11.0–21.3)
Health care facilities for the elderly requiring long-term care	67	4.0	11.3	4.4	11.3
		(2.7–5.3)	(6.1–16.4)	(3.0–5.7)	(5.9–16.8)
Sanatorium type medical care facilities for the elderly   requiring care	17	5.0	12.1	6.4	12.2
		(1.7–8.3)	(1.1–23.0)	(2.4–10.3)	(0.6–23.9)
Nursing care clinics	10	4.8	8.7	4.8	8.7
		(0.7–8.9)	(0–19.0)	(0.9–8.7)	(0–19.5)
Outpatient type care services
Outpatient care	92	4.8	14.3	4.8	13.4
		(3.4–6.1)	(8.7–19.8)	(3.5–6.0)	(7.9–18.8)
Community-based outpatient care	41	4.8	13.4	5.0	12.9
		(2.8–6.8)	(5.6–21.2)	(3.0–6.9)	(5.0–20.8)
Outpatient rehabilitation (health care facilities for the elderly   requiring long-term care)	38	8.0	19.6	7.1	16.9
		(4.5–11.5)	(7.7–31.4)	(4.1–10.1)	(6.1–27.6)
Outpatient rehabilitation (medical care facilities)	18	8.1	16.0	9.0	17.4
		(2.9–13.2)	(1.9–30.1)	(3.5–14.5)	(1.3–33.6)
Outpatient rehabilitation (nursing care clinics)	6	15.0	30.7	17.3	33.2
		(0–31.5)	(0–77.4)	(0–35.6)	(0–86.2)
Home-visit type care-services
Home-visit care	99	5.2	15.1	5.6	15.6
		(3.8–6.6)	(9.4–20.8)	(4.2–7.1)	(9.5–21.8)
Home-visit bathing service	16	4.6	17.9	4.6	17.0
		(1.5–7.6)	(1.2–34.6)	(1.6–7.5)	(0.3–33.7)
Others
Short-term admission daily life care	79	5.2	14.4	4.5	13.2
		(3.6–6.7)	(8.3–20.4)	(3.2–5.8)	(7.4–19.0)
Daily life care in communal living for elderly with dementia	60	5.0	13.7	4.5	12.9
		(3.2–6.7)	(7.1–20.3)	(3.0–6.0)	(6.4–19.4)
Daily life care in specific facility	50	5.6	14.7	4.9	24.5
		(3.5–7.8)	(6.9–22.4)	(3.1–6.7)	(10.9–38.1)

^aShown in descending order of number of respondents, ^bMean (95% confidence interval).

Table 9. Monetary value for fear of infection.

Question types	Type A		Type B		Type C				Type D
	Willing to pay for disappearance of fear		Value of disappearance of fear		1) Willing to pay for replacement of working to guide and/or support with fear with other person		2) Willing to pay for disappearance of fear		1) Value of guidance and/or support having fear		2) Value attributable to fear of the guidance and/or support
	Oral	Inhalant	Oral	Inhalant	Oral	Inhalant	Oral	Inhalant	Oral	Inhalant	Oral	Inhalant
Physicians
	N = 222	N = 250	N = 213	N = 249	N = 219	N = 250	N = 219	N = 250	N = 223	N = 248	N = 223	N = 248
Mean	1,687	1,844	4,492	5,208	597	677	482	548	1,733	2,059	1,100	1,365
95%CI
Lower	1,328	1,478	2,867	3,538	468	553	363	435	1,440	1,732	909	1,140
Upper	2,047	2,210	6,117	6,877	726	802	600	660	2,027	2,387	1,291	1,591
25%ile	100	163	500	900	100	100	50	50	500	500	225	300
50%ile	500	1,000	1,000	1,500	500	500	300	300	1,000	1,000	500	700
75%ile	1,000	2,000	5,000	5,000	1,000	1,000	500	500	2,000	3,000	1,000	1,900
Pharmacists
	N = 173	N = 248	N = 183	N = 250	N = 173	N = 250	N = 173	N = 250	N = 176	N = 250	N = 176	N = 250
Mean	1,157	1,584	2,147	3,627	591	888	426	632	1,523	3,383	1,072	2,716
95%CI
Lower	838	1,241	1,711	3,014	432	692	300	489	1,179	2,372	832	1,851
Upper	1,476	1,927	2,583	4,241	749	1,085	551	775	1,866	4,393	1,312	3,581
25%ile	100	100	300	500	0	0	0	0	450	500	200	400
50%ile	500	500	1,000	1,500	200	500	100	200	1,000	1,000	500	900
75%ile	1,000	1,275	2,750	5,000	500	1,000	500	800	1,625	3,950	999	2,974
Certified care workers
	N = 128	N = 130	N = 138	N = 139	N = 118	N = 118	N = 118	N = 118	N = 150	N = 151	N = 150	N = 151
Mean	4,227	5,048	11,367	12,217	2,266	2,654	1,232	1,233	3,912	4,444	2,903	3,381
95%CI
Lower	2,329	2,705	5,709	6,505	586	798	386	387	2,372	2,556	1,472	1,624
Upper	6,125	7,391	17,024	17,930	3,946	4,510	2,077	2,078	5,452	6,331	4,334	5,137
25%ile	744	869	1,000	1,000	105	105	50	20	500	900	400	400
50%ile	1,500	1,750	5,000	5,000	1,000	1,000	500	500	1,000	1,000	900	999
75%ile	5,000	5,000	10,000	10,000	1,375	1,500	987	1,000	5,000	5,000	2,875	3,000

All costs are in Japanese yen (JPY). CI: confidence interval.

Table 10. Estimated treatment cost of available antivirals in Japan.

	Baloxavir marboxil	Oseltamivir	Oseltamivir (generic)	Laninamivir	Zanamivir
Administration route	Oral	Oral	Oral	Inhalant	Inhalant
Duration and frequency of administration	1	10	10	1	10
	(once a day × 1 day)	(twice a day × 5 days)	(twice a day × 5 days)	(once a day × 1 day)	(twice a day × 5 days)
Costs (JPY)
1 Drug cost^a	4,878	2,672	1,281	4,359	2,882
2 Value of convenience^b	−3,387	−741	−741	−2,646	0
3 Productivity loss^c	46,816	52,812	52,812	50,227	52,572
4 Estimated cost for guidance and/or support ^d	504	504	504	717	717
5 Estimated cost for fear of infection^e	1,720	1,720	1,720	4,072	4,072
Total (1 + 2 + 3 + 4 + 5)	50,531	56,967	55,576	56,729	60,243

^aCalculated based on the National Health Insurance Drug Price List in August 2020^12,13, ^bEstimated based on a conjoint analysis in Japanese adults who had experiences of receiving antiviral treatments⁴, ^cEstimated with average number of days to return to usual life from a survey of Japanese adults who had experience of taking antiviral treatments⁴, ^dTotal amount of estimated cost of guidance and/or support for each administration route in the entire facility for physicians and pharmacists (Table 5), ^eTotal amount of estimated cost of fear of infection for each administration route in physicians and pharmacists. The estimated cost of fear of infection was calculated as the mean monetary value of fear of infection (Type D in Table 9) × percentage of respondents who felt fear.

Note: ^cConfounding factors were not adjusted in the estimation of productivity loss because no confounding factors were assumed to be available for treatment choice among respondents⁴.

All costs are in Japanese yen (JPY).

Table 11. Corresponding monetary value for fear of infection based on purchasing power parities.

Country	Japan	US	Canada	UK	Germany	Austria	Mexico	Australia	Singapore
Currency unit	JPY	USD	CAD	GBP	EUR	EUR	MXN	AUD	SGD
PPP^a	102.835	1.000	1.206	0.700	0.746	0.764	9.522	1.472	0.881
Exchange rate to USD^b	113.930	1.000	1.240	0.862	0.860	0.860	20.180	1.330	1.350
Physicians
Oral	1,100	10.69	12.90	7.49	7.98	8.17	101.83	15.74	9.42
Inhalant	1,365	13.28	16.01	9.29	9.91	10.14	126.43	19.55	11.70
Pharmacists
Oral	1,072	10.43	12.57	7.30	7.78	7.97	99.28	15.35	9.19
Inhalant	2,716	26.41	31.85	18.49	19.70	20.18	251.49	38.88	23.27
Certified care workers
Oral	2,903	28.23	34.05	19.76	21.06	21.57	268.83	41.56	24.87
Inhalant	3,381	32.87	39.65	23.01	24.52	25.12	313.02	48.39	28.96

^aPurchasing power parities (PPP) measured in terms of national currency per US dollar (USD) in 2018 in Singapore or in 2020 in other countries¹⁵. ^bAs of October 2021.

[Japanese Basic Survey on Wage Structure on 2018. [Internet]. Tokyo (Japan): Ministry of Health, Labour and Welfare; 2019. [cited 2021 July 5]; Available from: https://www.mhlw.go.jp/toukei/itiran/roudou/chingin/kouzou/z2018/dl/01.pdf

 Google Scholar

[Handbook of Labour Statistics] [Internet]. Tokyo (Japan): Ministry of Health, Labour and Welfare; 2018. [cited 2021 July 5]; Available from: https://www.mhlw.go.jp/toukei/youran/index-roudou.html

 Google Scholar

[National health insurance drug price list 2020 August (oral)] [Internet]. Tokyo (Japan): Ministry of Health, Labour and Welfare; 2020. [cited 2020 Nov 26]; Available from: https://www.mhlw.go.jp/topics/2020/04/dl/tp20200826-01_01.pdf

 Google Scholar

[National health insurance drug price list 2020 August (topical agent)] [Internet]. Tokyo (Japan): Ministry of Health, Labour and Welfare; 2020. [cited 2020 Nov 26]; Available from: https://www.mhlw.go.jp/topics/2020/04/dl/tp20200826-01_03.pdf

 Google Scholar

Hosogaya N, Takazono T, Yokomasu A, et al. Estimation of the value of convenience in taking influenza antivirals in Japanese adult patients between baloxavir marboxil and neuraminidase inhibitors using a conjoint analysis. J Med Econ. 2021;24(1):244–254.

 PubMed Web of Science ®Google Scholar

[Statistics of physicians, dentists, and pharmacists 2018] [Internet]. Tokyo (Japan): Ministry of Health, Labour and Welfare; 2019. [cited 2020 Nov 26]; Available from: https://www.mhlw.go.jp/toukei/saikin/hw/ishi/18/index.html

 Google Scholar