OBJECTIVES: In the previous study, we found that the implementation of Center of Healthy Aging Program (CHAP) since 2008 to increase the awareness of healthy lifestyle reduced cardiovascular disease risks in a Japanese rural area, Hirosaki city. The aim of this study is to confirm overall medical costs covered by the Japanese public health insurance system for participants of CHAP and non-participants.

METHODS: We compared total medical costs in the follow-up period from 1st July 2015 to 31st March 2020 using the claims data of residents in Hirosaki city between 3 groups, which were identified by the participation of checkups during 1 year before the follow-up period (baseline period): CHAP participants (CHAP group), residents who received an annual standard health checkup (checkup group), and everyone else (no-checkup group). We used a zero-inflated model to compare medical costs used in the follow-up period, adjusted by age, sex, coronary heart disease (CHD) risk score, and Charlson Comorbidity index (CCI) in the baseline period. As we used result of checkups to estimate the CHD risk score, we applied a multiple imputation method for missing values in the no-checkup group.

RESULTS: The checkup groups showed highest age in 3 groups. After background factors were adjusted, medical costs in the CHAP and checkup groups were estimated as 0.869 and 0.967 times as much as the no checkup group, respectively. The CHAP and checkup groups showed lower probability of having no costs (odds ratios of 0.371 and 0.107, respectively). Medical costs per person for 5 years were estimated as −163,993JPY and −41,311JPY in the CHAP and standard checkup groups, respectively.

CONCLUSIONS: The health programs including the CHAP and the standard health checkup associated with the higher probability of the occurrence of health service but without higher expenses. They can lead overall medical cost reduction.