Abstract
BackgroundJapan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region. Regional differences in prevalence might cause regional differences in physicians’ experiences and the efficiency of care-resource use. This study investigated regional differences in the performance of bone marrow transplantation (BMT), outcome and care-resource use in patients with ATL in Japan.MethodsThis was a cross-sectional study using a Japanese hospital administrative database in 2010, with a diagnostic-procedure combination/per diem payment system. We examined the association between BMT performance, resource use, outcomes and region.ResultsWe analysed data for 712 subjects of whom 60.5% were Kyushu/Okinawa residents. Significantly more patients with ATL underwent BMT in Kanto (p = 0.018) and Kansai (p < 0.001) regions compared with the Kyushu/Okinawa regions. The lengths of hospital stay were longer in Kanto (p = 0.002) and Kansai (p = 0.006) regions than in the Kyushu/Okinawa region. Total health-care costs were higher in Kanto (p = 0.001) and Kansai (p = 0.005) regions than the Kyushu/Okinawa region. The risks of in hospital mortality were not significantly different between regions.ConclusionsThere were significant regional differences in BMT performance and resource use within Japan. ATL prevalence was not related to the performance of BMTs, resource use or outcomes. Factors related to regional socioeconomics might affect the performance of BMTs and care resource use within Japan.
Highlights
Japan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region
This study aimed to clarify the regional differences in the performance of bone marrow transplantation (BMT) for ATL, and the differences in prognosis and care-resource use associated with different treatment patterns
The proportions of patients treated with BMT tended to be higher in the Kanto and Kansai regions compared with the Kyushu/Okinawa region
Summary
Japan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region. Regional differences in prevalence might cause regional differences in physicians’ experiences and the efficiency of care-resource use. This study investigated regional differences in the performance of bone marrow transplantation (BMT), outcome and care-resource use in patients with ATL in Japan. Adult T-cell leukaemia (ATL) was initially described by Takatsuki et al in 1977 [1]. ATL is characterized by an increase in mature T cells following the insertion of human T-lymphotropic virus 1 (HTLV-1) into chromosomal DNA, and only occurs in HTLV-1 carriers. ATL occurs in less than 5% of people with HTLV-I infection, with a mean latency period of more than 30 years [3]. The median survival time ranges from 3.7 to 6.0 months for the acute and lymphomatous
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