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Original research
Impact of policy alterations on elective percutaneous coronary interventions in Japan
  1. Tetsuji Morishita1,2,
  2. Daisuke Takada1,
  3. Jung-ho Shin1,
  4. Susumu Kunisawa1,
  5. Kiyohide Fushimi3,
  6. Yuichi Imanaka1
  1. 1 Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  2. 2 Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
  3. 3 Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Bunkyo, Tokyo, Japan
  1. Correspondence to Dr Yuichi Imanaka, Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan; imanaka-y{at}


Objective Establishing appropriate percutaneous coronary intervention (PCI) in stable angina pectoris (SAP) has become a distinctive performance measure worldwide. Clinical guidelines call for documenting ischaemia in patients with SAP prior to elective PCI. The Japanese Ministry of Health, Labour and Welfare introduced a new reimbursement policy in April 2018 to promote the appropriate and judicious implementation of PCI. The 2018 reimbursement changes clarified the required proof of ischaemia. Tests to evaluate functional ischaemia and coronary stenosis have been added as a requirement for reimbursement. We examined whether this reimbursement revision had an impact on PCI procedures for SAP in Japan.

Methods We used administrative claims data in Japan’s Diagnosis Procedure Combination database from April 2014 through March 2020. We used interrupted time series analyses with a control to ascertain the impacts on elective PCI procedures before and after the Japanese reimbursement revision. The primary outcome was the change in elective PCI procedures per month. Emergent PCI procedures served as a control group.

Results A total of 773 240 PCI procedures were identified between April 2014 and March 2020: 388 817 and 180 462 elective PCIs before and after the reimbursement revision, respectively. After the 2018 reimbursement revision, significant trend changes were found in elective PCI procedures per month (−106.3, 95% CI −155.8 to −56.8, p<0.01), while the number of emergent PCIs remained stable throughout the study period.

Conclusions After revising the reimbursement tariff for elective PCIs in 2018, there was a significant reduction in elective PCI procedures per month.

  • angina pectoris
  • percutaneous coronary intervention

Data availability statement

No data are available. Data cannot be shared for ethical/privacy reasons.

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Data availability statement

No data are available. Data cannot be shared for ethical/privacy reasons.

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  • Contributors Study concept and design—TM, DT, J-hS, SK, KF and YI. Statistical analysis—TM, DT and J-hS. Data analysis and interpretation—TM, DT, J-hS, SK and YI. Drafting of the manuscript—TM. Critical revision of the manuscript and intellectual —TM, DT, J-hS, SK, KF and YI. YI serves as the

    guarantor for this work.

  • Funding This study was supported by JSPS KAKENHI (Grant Number JP19H01075) from the Japan Society for the Promotion of Science, by the GAP Fund Program of Kyoto University type B and by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare, Japan (21IA1005) to Yuichi Imanaka. This study was also supported by a Health, Labour and Welfare Policy Research Grant for Research on Policy Planning and Evaluation (Grant number: 20AA2005, 22AA2003) (recipient: Yuichi Imanaka).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.