Japanese Tariff Research Articles

Cost-Effectiveness of Lenvatinib in the Treatment of Patients With Unresectable Hepatocellular Carcinomas in Japan: An Analysis Using Data From Japanese Patients in the REFLECT Trial

BackgroundHepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Japan. Prognosis is poor, and until recently sorafenib was the only treatment option available for patients with unresectable disease. Lenvatinib is the first therapy to demonstrate noninferiority to sorafenib. An analysis was conducted using clinical data from Japanese patients in the phase III REFLECT trial to assess the cost-effectiveness of lenvatinib versus sorafenib for first-line treatment of unresectable HCC in Japan. MethodsA partitioned survival model was implemented adopting the perspective of the Japanese healthcare system, with costs and outcomes modeled over a lifetime horizon and using a discount rate of 2%, as per Japanese guidelines. Population data from the Japanese subpopulation of REFLECT were used to extrapolate outcomes, and costs and resource use were based on Japanese sources. The Japanese tariff was applied to EQ-5D data collected during the REFLECT clinical trial to obtain utility values reflecting the preferences of the Japanese population. ResultsCompared with sorafenib, lenvatinib is dominant because it is associated with a reduction in incremental costs of ¥156 799 and incremental quality-adjusted life-years of 0.31. These results were robust to changes in key assumptions, and probabilistic outcomes aligned with deterministic outcomes. ConclusionGiven the use of Japan-specific data in the cost-effectiveness model, it is expected that the use of lenvatinib as a first-line treatment in Japan will be associated with cost savings and improved clinical outcomes versus sorafenib for patients with unresectable HCC.

Economic evaluation of nivolumab combined with ipilimumab in the first-line treatment of advanced melanoma in Japan

Aims The objective of this study was to evaluate the cost-effectiveness of nivolumab in combination with ipilimumab (nivo + ipi) compared to current therapeutic alternatives in first-line treatment of patients with advanced melanoma from the Japanese national healthcare payer perspective using 48-month survival data from the CheckMate 067 Phase III trial. Materials and methods A three-state partitioned survival model was developed from projections of overall survival (OS) and progression-free survival (PFS) to estimate accrued quality-adjusted survival and costs over a 30-year time horizon. The analysis included nivo + ipi, nivolumab, and ipilimumab monotherapies (the three treatments included in CheckMate 067). Drug acquisition, administration, disease management, subsequent therapy, and adverse event (AE) costs were obtained via published sources and expert input (solicited via Delphi panel). AE frequencies were collected from the Checkmate 067 trial. Utility weights were estimated from the Checkmate 067 trial, based on Japanese tariffs. Results were presented as incremental cost-utility ratios (ICURs, cost per quality-adjusted life-year (QALY)). Results Nivo + ipi had the greatest estimated survival among the three competing treatments, followed by nivolumab monotherapy accruing the second greatest survival. The incremental cost-effectiveness of nivo + ipi was ¥778,000 per QALY vs. nivolumab and ¥1,584,000 per QALY vs. ipilimumab. The results indicate that nivo + ipi is cost-effective in Japan when compared to a threshold of ¥7,500,000 per QALY. This finding was found to be generally robust to sensitivity and scenario analyses. Limitations Limitations include uncertainty in long-term survival extrapolations and lack of Japan-specific clinical data. Conclusions This analysis indicates that adding ipilimumab to nivolumab therapy represents a cost-effective new treatment option for patients with unresectable malignant melanoma in Japan.

An evaluation of EQ-5D-3L health utility scores using five country-specific tariffs in a rural population aged 45\u201369\u2009years in Hua county, Henan province, China

BackgroundThis study aims to compare the performance of the recently developed Chinese (city) tariff of the EQ-5D-3L against the UK, US, Japanese and Korean tariffs in a general rural population in China.MethodsFrom November 2015 to September 2016, 12,085 permanent residents aged 45–69 from 257 villages randomly selected from Hua County, Henan Province, China, were interviewed using EQ-5D-3L, and a one-on-one questionnaire investigation was used to collect data on factors associated with HRQOL. The health utility scores were calculated using the UK, US, Japanese, Korean and Chinese (city) tariffs. The agreement, known-groups validity and sensitivity of these five tariffs were evaluated. Transition scores for pairs of observed EQ-5D-3L health states were calculated and compared.ResultsThe Korean tariff yielded the highest mean health utility score (0.963), followed by the Chinese (city) (0.948), US (0.943), UK (0.930) and Japanese (0.921) tariffs, but the differences in the scores of any two tariffs did not exceed the MCID. The Chinese (city) tariff showed higher ICC values (ICCs> 0.89, 95% CI:0.755–0.964) and narrower limits of agreement (0.099–0.167) than the Korean tariff [(ICCs> 0.71, 95% CI:0.451–0.955); (0.146–0.253)]. The Chinese (city) tariff had a higher relative efficiency and effect size statistics in 10 out of 11 variables as compared to the UK, US and Japanese tariffs. The Chinese (city) tariff (0.215) was associated with moderate mean absolute transition scores compared with the UK (0.342), US (0.230), Japanese (0.149) and Korean (0.189) tariffs for 1485 observed pairs of the EQ-5D-3L health states.ConclusionsHealth utility scores derived from the five tariffs differed. The Chinese (city) tariff was the most suitable of these tariffs and was without obvious weakness. We recommend adopting the Chinese (city) tariff when applying EQ-5D-3L to assess quality of life among the elderly in China’s agricultural region with socio-economic status similar to Hua County. Results of this study had provided a crucial basis for health surveys, health promotion projects, health intervention trials, and health economic evaluation taking HRQOL as a target in rural areas of China.

PRM160 - The Impact of Country-Specific Utility Tariffs on the Outcome of Cost-Utility Analyses; A Case Study

Countries generally use their own utility tariff to convert EQ-5D-3L health states to utility scores. However, it is unclear what the impact of these country-specific tariffs on the outcome of a cost-utility analysis is. Therefore, the aim of the current study was to evaluate this issue. Because the EQ-5D-3L mainly focusses on physical aspects of HRQOL, we evaluated this using data from two studies; a randomized controlled trial in patients with a physical disorder (low back pain) and a randomized controlled trial in patients with a mental disorder (depression). A literature search was done to identify EQ-5D-3L utility tariffs derived using the Time Trade Off method. Missing data was imputed using Multiple Imputation by Chained Equations (MICE). Incremental Cost-Utility Ratios (ICURs), cost-effectiveness planes and cost-effectiveness acceptability curves (CEA curves) were estimated. Thirteen utility tariffs were identified. In the low back pain study, the ICUR using the Dutch tariff was 11,600 €/QALY, and ranged from 8,278 €/QALY for the Taiwanese tariff to 18,355 €/QALY for the Polish tariff. The probability of cost-effectiveness at a ceiling ratio of 30,000 €/QALY was 0.77, and ranged from 0.61 for the Polish tariff to 0.83 for the UK tariff. In the depression study, the ICUR using the Dutch tariff was 50,574 €/QALY, and ranged from 36,124 €/QALY for the US tariff to 96,551 €/QALY for the Japanese tariff. The probability of cost-effectiveness at a ceiling ratio of 30,000 €/QALY was 0.39, and ranged from 0.30 for the Japanese tariff to 0.45 for the US tariff. The results show that depending on the utility tariff that is chosen, the intervention may be considered cost-effective in comparison with usual care in one country and not cost-effective in another country. This suggests that results from cost-utility analyses cannot be unthinkingly transferred from one country to another.

A Tale of Pork Prices: Evasion and Attenuation of a Japanese Tariff

This paper empirically examines the effectiveness of a safeguard tariff in the Japanese market for imported pork parts. The goals are, first, to consider a refinement to the traditional market-based method for evasion detection, and, second, to apply the method in a setting where evasion is suspected to be widespread. Utilising a within-pig variation in tariff burdens and the timing of safeguard invocations, I examine a panel of monthly wholesale prices on narrowly-defined pork productions from 2001 through 2008. The results are consistent with a hypothesis that a widespread evasion nullified the safeguard tariff on pork, and are robust to a range of alternative explanations including the adjustment of profit margins by traders. Safeguard tariffs appear to be a simple mechanism, but behavioural responses can undo the policy intent.

A Tale of Pork Prices: Evasion and Attenuation of a Japanese Tariff

This paper empirically examines the effectiveness of a safeguard tariff in the Japanese market for imported pork parts. The goals are, first, to consider a refinement to the traditional market-based method for evasion detection, and, second, to apply the method in a setting where evasion is suspected to be widespread. Utilizing a within-pig variation in tariff burdens and the timing of safeguard invocations, I examine a panel of monthly wholesale prices on narrowly-defined pork products from 2001 through 2008. The results are consistent with a hypothesis that a widespread evasion nullified the safeguard tariff on pork, and are robust to a range of alternative explanations including the adjustment of profit margins by traders. A safeguard tariff appears to be a simple mechanism but behavioral responses can undo its policy intent.

Japanese Tariff Protection of Rapeseed and Soybean Processing

This paper estimates the level of protection afforded rapeseed and soybean oil processing in Japan. It introduces the concept of the relative rate of protection. A major finding is that Japan's tariff structure results in a favoring of rapeseed processing over soybean processing in that country. Canadian crushers are subject to low, unprofitable margins because of the Japanese tariffs.Nous procédons, dans le présent article, à une estimation du niveau de protection accordé á la production de I'huile de colza et de soja au Japon. Nous introduisons la notion de taux relatif de protection. Nous constatons en particulier que la structure tarifaire en usage au Japon favorise la transformation du colza, comparativement a la transformation du soja. Le secteur canadien de la trituration doit subirdes marges insuffisantes et non rentables á cause des tarifs pratiqués par les Japonais.

The Impact on the Canadian Rapeseed Industry from Changes in Transport and Tariff Rates: Comment

In a recent Journal article, Furtan, Nagy, and Storey (FNS) used a spatial equilibrium model of the world rapeseed market to measure the impact of changes in transport and tariff rates on the Canadian rapeseed industry. Although their emphasis was on the Crows Nest rail freight rate, they also analyzed effects of abolishing the Japanese rapeoil tariff. For removal of the Japanese rapeoil tariff only, FNS reported substantial changes in Canadian, Japanese, and EC prices, consumption and trade volumes of rapeseed, rapeoil, and rapemeal. They concluded that the Japanese tariff is effective in preventing Canadian rapeseed oil from entering Ja