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Open Access Research article

Regional differences in performance of bone marrow transplantation, care-resource use and outcome for adult T-cell leukaemia in Japan

Toshiki Maeda1*, Akira Babazono1, Takumi Nishi1, Shinya Matsuda2, Kiyohide Fushimi3 and Kenji Fujimori4

Author Affiliations

1 Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

2 Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555, Japan

3 Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan

4 Department of Health Administration and Policy, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan

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BMC Health Services Research 2014, 14:337  doi:10.1186/1472-6963-14-337

Published: 8 August 2014

Abstract

Background

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.

Methods

This 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.

Results

We 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.

Conclusions

There 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.

Keywords:
Adult T-cell leukaemia; Regional differences; Bone marrow transplantation; Care-resource; Outcome; Hospital administrative database