Daisuke SATO

Abstract Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%–10%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real‐world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well‐established oral medication, experienced a substantial decrease in prescription volume. The sex‐ and age‐adjusted prescription volume per 100 000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019–2021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first‐line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost‐effective treatment strategies. This study provides valuable insights into the real‐world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.

Abstract Background and Aim Changes in the number of surgeries for gastric cancer during the coronavirus disease 2019 (COVID‐19) pandemic have been reported, but data are insufficient to understand the impact at the national level. This study aimed to determine the impact of the COVID‐19 pandemic on gastric surgery in Japan. Methods Insurance claims data registered from January 2015 to January 2021 were used. Changes in the number of endoscopic resections and gastrectomies for gastric cancer were estimated using an interrupted time‐series analysis. Results The number of endoscopic resections significantly decreased in July 2020 (−1565; 95% confidence interval [CI]: −2022, −1108) and January 2021 (−539; 95% CI: −970, −109), and the number of laparoscopic surgeries significantly decreased in July 2020 (−795; 95% CI: −1097, −492), October 2020 (−313; 95% CI: −606, −19), and January 2021 (−507; 95% CI: −935, −78). Meanwhile, the number of open gastrectomies remained unchanged, and the number of robot‐assisted gastrectomies steadily increased since their coverage by public health insurance in April 2018. Conclusions The decreased number of endoscopic resections and laparoscopic surgeries in Japan suggests a decline in early‐stage gastric cancer diagnosis, likely due to the suspension of gastric cancer screening and diagnostic testing during the pandemic. Meanwhile, the number of open and robot‐assisted gastrectomies remained unchanged and increased, respectively, indicating that these applications were not affected by the pandemic‐related medical crisis. These findings highlight that procedures for cancer diagnosis, including screening, should still be provided during pandemics.