Value in health regional issues · 2026
Hospital Budget Impact and Provider-Side Economic Evaluation of Lecanemab and Donanemab Under Japan's National Fee Schedule: A Head-to-Head Linear Model.
СтатьяНазвание и аннотация: Перевод в очереди
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Makita Kotaro, Nishihara Takuto, Arakaki Yuta, Ohida Tomoya, Goto Kosei, Kutsuna Nobuo
Аннотация
OBJECTIVES: The study aimed to assess the provider-side financial viability of antiamyloid disease-modifying therapies for early Alzheimer's disease in Japan, we developed a linear hospital-provider model that separates a short inpatient diagnostic phase from an outpatient infusion phase.
METHODS: Using public National Health Insurance tariffs, official 2025 drug prices, and workflow-based labor costing with time-driven activity-based costing, we estimated per-case outpatient margins and program-level break-even case volumes. Scenarios examined fee-for-service versus diagnosis procedure combination/per-diem payment system hospitals, magnetic resonance imaging surveillance intensity, purchase discounts, wage growth, routine-workflow staff time, and the scheduled 15% lecanemab price reduction effective November 1, 2025.
RESULTS: At 1.5 T with no assumed wage growth, donanemab yielded positive outpatient margins from + 37,670JPY at no purchase discount to + ¥110 777 at a 2.6% discount. Lecanemab at 50 kg yielded -¥9048 at no discount and broke even at a discount of 0.304% before the scheduled price reduction and 0.358% after it. At 55 to 60 kg, the equal-discount threshold at which lecanemab overtook donanemab shifted from about 6.2% before the price reduction to 20.9% after it. Sensitivity analyses showed purchase discounts were the dominant driver, whereas labor and workflow inputs affected lecanemab more because it requires more infusions per year.
CONCLUSIONS: Under Japan's fee schedule, both therapies were financially viable across typical purchase-discount ranges in scenario analyses, but findings should be interpreted as provider-margin estimates rather than comparative clinical judgments.
METHODS: Using public National Health Insurance tariffs, official 2025 drug prices, and workflow-based labor costing with time-driven activity-based costing, we estimated per-case outpatient margins and program-level break-even case volumes. Scenarios examined fee-for-service versus diagnosis procedure combination/per-diem payment system hospitals, magnetic resonance imaging surveillance intensity, purchase discounts, wage growth, routine-workflow staff time, and the scheduled 15% lecanemab price reduction effective November 1, 2025.
RESULTS: At 1.5 T with no assumed wage growth, donanemab yielded positive outpatient margins from + 37,670JPY at no purchase discount to + ¥110 777 at a 2.6% discount. Lecanemab at 50 kg yielded -¥9048 at no discount and broke even at a discount of 0.304% before the scheduled price reduction and 0.358% after it. At 55 to 60 kg, the equal-discount threshold at which lecanemab overtook donanemab shifted from about 6.2% before the price reduction to 20.9% after it. Sensitivity analyses showed purchase discounts were the dominant driver, whereas labor and workflow inputs affected lecanemab more because it requires more infusions per year.
CONCLUSIONS: Under Japan's fee schedule, both therapies were financially viable across typical purchase-discount ranges in scenario analyses, but findings should be interpreted as provider-margin estimates rather than comparative clinical judgments.