---
title: "Dyslipidemia care in Japan before and after the 2024 fee revision: nationwide claims analysis"
id: "plos-one-19-real-world-patterns-of-dyslipidemia-care-before-and-after-a-national-fee"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-19-real-world-patterns-of-dyslipidemia-care-before-and-after-a-national-fee"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358270"
published_at: "2026-09-15T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Dyslipidemia care in Japan before and after the 2024 fee revision: nationwide claims analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-19-real-world-patterns-of-dyslipidemia-care-before-and-after-a-national-fee
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358270)
- **Published At:** 2026-09-15T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This nationwide retrospective cohort study used the Medical Data Vision (MDV) hospital claims and laboratory database covering approximately **30 million** patients to examine real-world dyslipidemia care in Japan before and after a national reimbursement fee revision implemented on 1 June 2024. - Inclusion required adults (≥18 years) with an ICD-10 dyslipidemia code (E78.x) and at least one lipid measurement between 1 January 2021 and 31 December 2024; patients with <6 months follow-up or missing key data were excluded. - The analytic sample included about **590,000 patients** contributing a total of **23,600,010 outpatient visits**; visits were the unit for visit-level analyses and events/patient-years were analyzed at the patient level. - The study compared the previous disease-specific “specific disease management fee” period (M1: 1 Jan 2021–31 May 2024) with the new “lifestyle disease management fee” period (M2: 1 Jun 2024–31 Dec 2024). Each patient was classified by their predominant fee category during follow-up; sensitivity analyses separated incident M2-treated patients from those transitioning from M1. - Primary outcome: attainment of guideline-recommended **LDL-C** goals at outpatient visits. Secondary outcomes included changes in lipid parameters, major adverse cardiovascular events (MACE), and all-cause mortality. - LDL-C goal attainment occurred at 58.3% of visits during the M1 period and 58.5% during M2. Lipid levels and cardiovascular event rates were broadly similar across fee periods. - High rates of pharmacotherapy were observed, with frequent use of **statins** and combination therapy including ezetimibe or fibrates; nonetheless goal attainment was lower in secondary prevention than in primary prevention. - Post-revision follow-up was short: post-revision patient-years were limited to roughly six months and were much smaller than pre-revision patient-years (reported as ~58,500 vs. 1,542,800 patient-years), constraining inference about the fee change’s impact on outcomes. - The MDV database covers large acute care hospitals and excludes most small clinics and non-DPC facilities; data are de-identified claims and lab results and were accessed on 15 October 2025. Raw data are not publicly shareable by the authors due to contractual restrictions. - Authors conclude the descriptive snapshot does not establish causal effects of the fee revision; longer follow-up and complementary study designs are needed to evaluate whether the new **lifestyle disease management fee** affects LDL-C control or cardiovascular outcomes.
## Clinical Analysis & Structured Key Points
Real world patterns of dyslipidemia care before and after a national fee revision in Japan: A nationwide study using a 30 million patient claims database | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Dyslipidemia is a key risk factor for cardiovascular disease, and its prevalence continues to rise with population aging in Japan. A 2024 change to the fee categories in Japan’s insurance system aimed to encourage a more holistic approach and better patient involvement in developing treatment plans; however, the real-world impact of these changes on patient outcomes remains unclear. Using a nationwide claims database, we sought to: (1) describe the achievement of low-density lipoprotein cholesterol goals and major adverse cardiovascular events among patients with dyslipidemia; (2) compare lipid control and outcomes under the previous disease-specific management fee with those under the new lifestyle disease management fee, and (3) identify patient groups that may benefit from additional lifestyle-based interventions. We conducted a retrospective cohort study among adults aged ≥ 18 years with dyslipidemia (International Classification of Diseases, Tenth Revision code E78) and at least one lipid measurement. In total, 590,000 patients contributed 23,600,010 outpatient visits. Ourpatient visits were the unit of observation for lipid and fee-category analyses; cardiovascular outcomes and patient-years were analyzed at the patient level. The primary outcome was low-density lipoprotein cholesterol goal attainment; secondary outcomes were changes in lipid parameters, major adverse cardiovascular events, and all-cause mortality. Low-density lipoprotein cholesterol goals were attained at 58.3% of outpatient visits under the previous fee and 58.5% under the new fee, and less often in secondary than in primary prevention, despite high statin use and frequent combination therapy with ezetimibe or fibrate. Lipid levels were broadly similar across fee periods. Cardiovascular event rates were also similar, but post-revision patient-years were limited to approximately 6 months (58,500 vs. 1,542,800 patient-years); therefore, this comparison is exploratory and cannot exclude an effect of the new fee structure. Longer follow-up and complementary designs are needed to evaluate the causal impact of the new fee on outcomes. Citation: Yamasaki S, Tokunou T, Horiuchi T (2026) Real world patterns of dyslipidemia care before and after a national fee revision in Japan: A nationwide study using a 30 million patient claims database. PLoS One 21(9): e0358270. https://doi.org/10.1371/journal.pone.0358270 Editor: Yee Gary Ang, National Healthcare Group, SINGAPORE Received: April 23, 2026; Accepted: August 29, 2026; Published: September 15, 2026 Copyright: © 2026 Yamasaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The data underlying this study are third party claims data from Japan’s MDV database, a nationwide hospital based claims and electronic health record database maintained by Medical Data Vision Co., Ltd. (Tokyo, Japan). The specific dataset used was extracted from the MDV database covering approximately 30 million patients and includes de identified administrative claims and laboratory data from participating acute care hospitals in Japan. The authors are not permitted to publicly share the raw data because of contractual and legal restrictions related to patient privacy and data use agreements. Researchers who meet the criteria for access to confidential data can apply directly to Medical Data Vision Co., Ltd. ( https://www.mdv.co.jp/) for data access under a data use agreement, with approval from their institutional ethics committee. The authors did not have any special access privileges to the MDV database that others would not have. Because the data were purchased from MDV under a license agreement, the authors do not have the authority to redistribute or share the data with third parties. Funding: This work was supported by the Health, Labour, and Welfare Scientific Research Fund (grant no. 24FA1004). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors funded the article processing. Competing interests: The authors declare no conflict of interest. Introduction Dyslipidemia is a major modifiable risk factor for cardiovascular disease, and its prevalence continues to increase in Japan, together with rapid population aging [ 1 ]. Despite the widespread use of lipid-lowering agents such as statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, real-world data from large administrative databases have consistently shown that a substantial proportion of high-risk patients fail to achieve guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets [ 2 ]. Recent real-world observational data from cardiology outpatient clinics in Turkey similarly showed that many patients remain above target despite intensified statin-based therapy, and that adding ezetimibe improved but did not normalize goal attainment [ 3 ]. This residual risk highlights the limitations of pharmacotherapy alone and underscores the need for sustainable, lifestyle-based strategies that can be implemented as part of routine care. Complementary and non-pharmacological approaches, such as structured counseling on diet, physical activity, weight management, and smoking cessation, have attracted growing interest as adjuncts to conventional dyslipidemia management. These lifestyle-based strategies are increasingly embedded in chronic care programs and reimbursement schemes, including Japan’s new lifestyle disease management fee. The Japanese government has recognized the importance of addressing the social determinants of health in reducing and managing the risk of non-communicable diseases, such as cardiovascular disease, and has made changes to the medical reimbursement system to reflect this [ 4 ]. In Japan, most residents are covered by public insurance schemes, and patients generally pay a fixed copayment at the point of care. The remainder is reimbursed directly from insurers to medical facilities based on the national fee schedule. In 2024, the long-standing “specific disease management fee” for conditions such as hypertension, diabetes, and dyslipidemia was replaced by a new “lifestyle disease management fee,” which took effect on 1 June 2024 [ 5 ]. These “management fees” are paid to providers as add-on fees for ongoing, structured chronic disease management, rather than as direct payments to patients. The design of the management fee categories may therefore influence provider behavior, adoption, and adherence to chronic care programs. Eligibility for the lifestyle-related disease management fee, which is applicable to outpatient visits only and billed on a per-visit basis, requires physicians to work with patients to create and periodically review a structured Treatment Plan Sheet [ 5 ]. This covers both biomedical targets (e.g., LDL-C levels) and broader lifestyle and social determinants (e.g., sleep, physical activity, work conditions, body weight). This reform therefore comprised both a technical change in coding and a broader shift in the institutional framework for chronic disease care. The new management fee emphasizes comprehensive lifestyle management with integrated goals and includes lifestyle counseling, rather than the previous approach in which comorbidities were effectively treated in parallel with standard pharmacotherapy and brief, disease-focused counseling during routine outpatient visits. Pharmacotherapy remains guideline-based and disease-appropriate under the new system. The intended added value lies in the more holistic, goal-oriented, and lifestyle-focused management framework, rather than in changes to drug regimens [ 6 ]. Overall, the fee revision was designed to encourage a more comprehensive, collaborative approach, with patients and physicians working together to create and review treatment plans. In theory, this approach should enhance adherence and outcomes. However, as far as can be ascertained, no study to date has examined the effect of these changes on patient outcomes related to dyslipidemia. Therefore, questions remain, such as how often LDL-C goals are achieved in routine care, and whether there have been reductions in major adverse cardiac events. To address this gap, we conducted a nationwide retrospective cohort study using the Medical Data Vision (MDV) Diagnosis Procedure Combination (DPC) database, which includes approximately 30 million patients across acute care hospitals in Japan. We explored patterns of dyslipidemia care and outcomes before and after the 2024 fee revision to identify gaps in current care and potential target populations for future lifestyle-related interventions. Given the short post-revision observation window and observational design of the present study, our objective was not to estimate the causal effect of the fee revision but to provide an early descriptive snapshot of care patterns and outcomes surrounding implementation of the new lifestyle disease management fee. Methods Real-world data source We conducted a retrospective, observational study using the MDV (Medical Data Vision Co., Ltd., Tokyo, Japan) administrative claims and laboratory database, one of the largest hospital-based datasets in Japan. This database covers approximately 30 million patients from more than 450 acute care hospitals participating in the DPC system, including tertiary referral centers and large community hospitals. The MDV database excludes most small clinics and non-DPC facilities. It contains detailed information on demographics, diagnoses (International Classification of Diseases, Tenth Revision codes), procedures, prescriptions, hospitalizations, and laboratory test results. This broad coverage makes the MDV database well-suited for evaluating real-world treatment patterns and outcomes in patients with dyslipidemia. This database was accessed for research purposes on 15 October 2025. The authors had no access to any information that could directly identify individual participants at any time during or after data collection. Study design and population We identified adults (aged ≥ 18 years) with at least one International Classification of Diseases, Tenth Revision code for dyslipidemia (E78.x) and at least one recorded measurement of lipid parameters, total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), between 1 January 2021 and 31 December 2024. The index date (baseline) was defined as the earliest date on which both a dyslipidemia diagnosis and a lipid measurement were recorded during the study period. Inclusion criteria were: (1) age ≥ 18 years on the index date; (2) continuous observation in the database for at least 6 months after the index date; and (3) available baseline lipid data. We excluded patients with missing key demographic variables (age or sex) or incomplete baseline lipid data, as well as those with a follow-up duration of < 6 months. To reflect changes in the fee policy, we divided the observation period into two fee categories: (1) the specific disease management fee period (M1), from 1 January 2021–31 May 2024; and (2) the lifestyle disease management fee period (M2), from 1 June 2024–31 December 2024, during which time the new lifestyle disease management fee for hypertension, diabetes, and dyslipidemia was in place. Each patient was classified according to the predominant disease management fee category recorded during follow-up. In sensitivity analyses, we distinguished between patients who were treated for the first time under M2 and those who transitioned from M1 to M2. The primary unit of analysis for baseline characteristics was the patient; for the analyses of fee categories and visit-level outcomes, we used outpatient visits as the unit of observation. Individual patients could contribute multiple visits and could contribute visits to both fee categories, depending on the timing of their follow-up relative to the 2024 fee revision. Cohort subgroups Prespecified subgroups were defined according to: (1) age (< 65, 65–74, and ≥ 75 years); (2) cardiovascular risk category (primary prevention vs. secondary prevention after atherosclerotic cardiovascular disease, and the presence of diabetes mellitus or chronic kidney disease); and (3) baseline lipid levels. These strata were chosen to align with Japanese Atherosclerosis Society (JAS) guidelines [ 7 ] and to capture populations most likely to be considered for lifestyle-oriented or complementary interventions in future studies [ 8 ] Exposures and comparators The primary exposure was the disease management fee category (M1 vs. M2), reflecting the policy shift from disease-specific to lifestyle disease management for chronic cardiometabolic conditions. Pharmacological treatment patterns for dyslipidemia were also evaluated, including use of statins, ezetimibe, fibrates, PCSK9 inhibitors, and other lipid-lowering agents, alone or in combination. We compared lipid control and cardiovascular outcomes between the M1 and M2 periods overall and within age and risk subgroups, accounting for differences in drug regimens and comorbidities. Outcomes The primary outcome was the attainment of LDL-C goals, defined as achievement of JAS guideline targets based on cardiovascular risk: < 120 mg/dL in primary prevention and < 100 mg/dL (or < 70 mg/dL for very high-risk patients) in secondary prevention. Secondary lipid outcomes included absolute changes in TC, HDL-C, and TG from baseline to follow-up assessments. Clinical secondary outcomes included major adverse cardiovascular events (myocardial infarction, ischemic stroke, hospitalization for heart failure, and cardiovascular death), all-cause mortality, and hospitalization for any cardiovascular cause. We also assessed treatment persistence and adherence to lipid-lowering therapy, as reflected by prescription continuity in the claims data. For each disease management fee category, on-treatment lipid parameters (TC, LDL-C, HDL-C, and TG) were defined as the most recent lipid measurement obtained during the observation window while the patient was receiving lipid-lowering therapy. LDL-C goal attainment was assessed at this most recent on-treatment measurement under the predominant fee category (M1 or M2). For patients with health care visits during both fee periods, goal attainment was evaluated separately for each period using the relevant on-treatment measurements. Statistical analysis We used descriptive statistics to summarize patients’ baseline characteristics, disease management fee categories, and treatment patterns. We reported the mean with standard deviation or median with interquartile range for continuous variables and the frequency with percentage for categorical variables. For between-group comparisons (e.g., M1 vs. M2, age, and risk strata), we used chi-square tests for categorical variables and the Student t -test or analysis of variance for continuous variables. Additionally, we calculated standardized mean differences (SMDs) for baseline characteristics to assess the magnitude of between-group differences independent of the large sample size. An SMD with an absolute value < 0.1 was interpreted as indicating a negligible imbalance, consistent with common practice in observational studies. Cardiovascular outcomes and all-cause mortality were analyzed at the patient level rather than at the visit level. For each fee period, every patient who contributed at least one outpatient visit during that period was followed from the first qualifying visit until the event of interest, loss of database observation, or end of that fee period, whichever occurred first; crude incidence rates were then calculated per 1000 patient-years with exact (Poisson) 95% confidence intervals (CIs). Because a patient could contribute visits to both fee periods, and multiple visits within the same period, the M1 and M2 groups are not independent samples and visit-level proportions are clustered within patients. To avoid overstating precision, 95% CIs for visit-level proportions were calculated using the number of unique patients contributing visits in each stratum as the effective sample size, which is a deliberately conservative approach. Visit-level counts are reported as the number of outpatient visits and are never interpreted as the number of patients. All analyses were descriptive and exploratory; this study was not designed or powered to estimate causal effects of the fee revision. For all statistical analyses, we used EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan) [ 9 ], a graphical user interface for R that extends the functionality of R Commander, as well as R version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). Ethical considerations The MDV database contains fully anonymized patient-level data collected for administrative and research purposes. In accordance with Japanese ethical guidelines for medical and health research involving human subjects, the use of anonymized secondary data in this study did not require individual informed consent. The study was approved by the Institutional Review Board of St. Mary’s Hospital, Kurume, Japan (approval number 25–0912). Results Study population and baseline characteristics From approximately 30 million patients in the MDV DPC database, we identified 590,000 adults with dyslipidemia who had at least one lipid measurement and at least 6 months of follow-up between 2021 and 2024 ( Table 1 ). Most visits occurred in large acute care hospitals participating in the DPC system, including university hospitals and tertiary centers, with the remainder seen at non-university acute care hospitals. Among the 590,000 patients with dyslipidemia and at least 6 months of follow-up, approximately 472,000 (roughly 80%) had visits only under the specific disease management fee (M1), approximately 38,000 (roughly 6%) had visits only under the lifestyle disease management fee (M2), and approximately 79,000 (roughly 14%) had visits during both periods; this indicated that the M1 and M2 visit counts partially reflected the same patients over time. Download: PNG larger image TIFF original image Table 1. Baseline characteristics of the outpatient cohort with dyslipidemia, by management fee category (unit of observation: outpatient visits). https://doi.org/10.1371/journal.pone.0358270.t001 The outpatient cohort comprised 23,600,010 visit-level records, of which 21,000,013 visits were reimbursed under the specific disease management fee (M1) and 2,599,997 under the lifestyle disease management fee (M2). Accordingly, 551,000 unique patients (472,000 with M1 visits only plus 79,000 with visits in both periods) contributed the 21,000,013 M1 visits, and 117,000 unique patients (38,000 with M2 visits only plus 79,000 with visits in both periods) contributed the 2,599,997 M2 visits; the M1 and M2 visit counts therefore describe outpatient encounters, not distinct individuals. The mean patient age was similar across categories (67.4 years in M1 and 66.9 years in M2), with roughly one-third of visits involving patients aged 65–74 years and approximately 9%–10% involving those aged ≥ 75 years. Men accounted for just over half of visits in both groups (52.4% in M1 and 53.8% in M2). Although fewer patients contributed to M2 and its post-fee-revis
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