Presentation (CTI)

OBJECTIVES: Since 2008, Japan’s National Health Insurance system has provided Standardized Health Training (SHT) in conjunction with Standardized Health Check-ups (SHC) to prevent lifestyle-related diseases among individuals at risk for metabolic syndrome. Depending on risk level, participants receive either motivational support (MS) or proactive support (PS), the latter including continuous follow-up by public health nurses. PS is delivered through three modalities—individual, group, and web-based support—yet their relative effectiveness remains unclear. Using the “Wellness-Star” database provided by Nippon Life Insurance Co., which contains SHT, SHC, and medical expenditure data, we compared the effectiveness of these PS modalities.
METHODS: We included insured individuals with one year before and six months after the SHC date as the baseline period and up to four years of follow-up. The intervention group comprised individuals who received PS at the index date, categorized by modality. The comparison group consisted of PS-eligible individuals who did not receive PS. Matching was performed using age, sex, BMI, HbA1c, triglycerides, blood pressure, and baseline medical expenditures. The primary outcome was the return (benefit), defined as the difference in lifestyle-related disease medical expenditures between the intervention and comparison groups over four years. As a negative control, we also evaluated non-lifestyle-related medical expenditures.
RESULTS: The “Wellness-Star” database included 5.69 million insured individuals. The intervention and comparison groups comprised 26,861 and 49,281 individuals, respectively. Over the four-year period, the average monthly medical expenditures were 79.1%, 73.9%, and 85.1% of those in the comparison group for the individual, group, and web-based support modalities, respectively. Group support showed the greatest reduction in lifestyle-related disease expenditures.
CONCLUSIONS: Among the modalities of proactive support, group-based support appeared to provide the greatest effectiveness in reducing lifestyle-related disease medical expenditures.