Neurological Surgery 脳神経外科47巻7号

2019年07月発行

総説

医療経済からみた脳神経外科疾患

著者： 亀田雅博¹ 伊達勲¹

所属機関： ¹岡山大学大学院医歯薬学総合研究科脳神経外科

ページ範囲：P.707 - P.717

Ⅰ．はじめに
　わが国においては少子高齢化が進行する一方で，国民医療費は年々上昇を続ける状況がこれからも続くことが予想されている．また，わが国ではほとんどの医療や介護は，国民皆保険制度や介護保険制度といった社会制度の中で行われている．限りある予算をいかに効率的に使うかという議論は，これら制度を持続可能なものとするために重要である．よって，おのおのの治療法は，治療効果の評価のみならず，「かけた治療費に対して見合った治療効果とQOLの改善が得られているか」という医療経済の観点からも評価が行われる必要がある．特に日本では，脳神経外科は専門医制度において基本診療科の1つとなっている．そのような背景から，日本の脳神経外科医には，手術そのものの治療効果のみならず，手術と非手術の治療効果の比較に加え，医療経済効果の観点からも評価できる素養をもつことが求められる．
　最近，われわれは，SINPHONI study¹²⁾とSINPHONI-2 study¹⁸⁾の結果に基づき，特発性正常圧水頭症（idiopathic normal pressure hydrocephalus：iNPH）に対するシャント手術は，保存的に経過観察を続けるより，医療経済的に有益であることを報告した¹⁷⁾．本稿では，①医療経済効果に関する評価を行う上で基本となる事項の解説，②数学的なモデルを用いた，iNPHに対するシャント手術の医療経済効果の再検討，③脳神経外科疾患に対する医療経済効果に関する文献数や内訳の変遷，④医療経済からみた脳神経外科疾患に関する報告にはどのようなものがあるか，という点をまとめる．

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