Points of View The Value of Pharmaceuticals that the Public Values -A Report on the Results of a Survey of Public Attitudes toward Prices, Systems, and Value of Pharmaceuticals, Part 2

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Akiko Yoshida, Senior Researcher, Pharmaceutical Industry Policy Institute

1. Introduction

The author conducted a web-based questionnaire survey, "Survey on Public Awareness of Prices, Systems and Values of Pharmaceuticals" (hereinafter referred to as "this survey"), in order to grasp the actual status of awareness and interest in the prices, systems (medical care at the time of consultation, drug prices and medical insurance systems related to pharmaceuticals, etc.) and values of pharmaceuticals by various attributes.

In the "Policy Research Institute News No. 671," we reported on the results of the survey ⁽ Part 1), including the public's awareness of and interest in the price and system of pharmaceuticals, and the characteristics of the groups with high awareness of and interest in these issues.

In this report, as the second report of the results of this survey, we would like to discuss the value of pharmaceuticals that the public places importance on, based on their perception of the value of pharmaceuticals as revealed by the results of the survey.

The author has examined and extracted the elements of the value of pharmaceuticals, referring to Policy Research Institute News No. 62, 63, etc. ²⁾, the elements used in the report by Nakano et al. (reviewed and extracted by Nakano et al. based on ISPOR Task force report, etc. ³⁾, and the material of the press conference by the Chairman of the Japan Pharmaceutical Manufacturers Association (June 26, 2019) ⁴⁾. and set up. (Figure 1)

The following factors were considered and selected by the authors: "efficacy," which is the level of effectiveness; "safety," such as high safety and fewer side effects; "innovation," such as new treatments for previously untreatable diseases; "improvement in treatment methods," such as treatments without surgery; "convenience," such as fewer doses and ease of use; "cost effectiveness," such as being cheaper than conventional drugs; and "cost effectiveness," such as being able to provide the same level of medical care as conventional drugs. These six value elements are defined as "medical values" because they are values that are easily directly influenced by and directly felt by the user. On the other hand, "productivity" is defined as the ability to continue one's own role, or to improve the quality and efficiency of one's own role, such as work, housework, schoolwork, nursing care, and caretaking, and "reintegration/return to work" as the ability to go to school, do housework, work, etc., which were not possible before. These five value elements are "reintegration and return to work," "reduction of the burden of nursing care," "reduction of the burden of nursing care," "reduction of the burden of doctors, nurses and pharmacists," and "reduction of the burden of healthcare professionals," and they are values that have a ripple effect on the patient and his/her surroundings when he/she uses the drug, and the value can also affect society. These five value elements are defined as "non-medical value" that is realized as a ripple effect of treatment with pharmaceuticals.

Medical value" and "non-medical value" are defined as "value from a micro perspective.

Also, "contribution to the sustainability of the social security system," which leads to more people supporting the economy and society or more efficient consumption of medical resources; "extension of the national life expectancy," which can extend the period during which people have lives; and "extension of the national healthy life expectancy," which can extend the period during which people can live without having their daily lives restricted by health problems, The values such as "development of medicine and pharmaceutical science" that advance and expand the study of medicine and pharmaceutical science indicate the social value of pharmaceuticals as a contribution to social goals, where the use of pharmaceuticals (including those other than oneself) affects the whole society beyond oneself and one's surroundings, and is defined as "value from a macro perspective. Definition.

The results of the survey will be divided into a micro perspective that relates to oneself and one's surroundings and a macro perspective that relates to society, and since the former (micro perspective) includes "medical value" mainly based on a medical perspective and "non-medical value" realized as a ripple effect of treatment with pharmaceuticals, etc., these will be described separately. Therefore, we will discuss them separately.

It is not difficult to imagine that, in general, "medical values" such as "efficacy" and "safety" are more important than "non-medical values" such as "productivity," "rehabilitation/return to work," and "reduction of care burden. In fact, survey results show such results. However, even when the number of responses was limited to three, as in the question "Please select three items of value you expect from medicines," there were a certain number of respondents who placed importance on "non-medical value. In particular, this paper assumes that the group that emphasizes "value other than medical value" has a broad view of the value of pharmaceuticals and a high awareness of issues related to the price, system, and value of pharmaceuticals. We thought that if we could identify a group of people who are aware of these issues, it could be a key factor in considering issues related to the price, system, and value of drugs. Therefore, in this survey, we analyze and report on the characteristics of the groups that value "values other than medical values. In addition, by asking survey respondents, who tend to lean toward the healthy side, to recall that they had a disease, we analyzed whether or not they recalled the disease, whether the value of medicines they valued differed depending on the disease they recalled, and the differences between those who actually had the disease and those who had not had the disease, as well as the characteristics of each attribute.

Survey and analysis methods

Survey Method

The web-based survey was conducted in the following manner. It should be presented in advance that there are limitations in the characteristics of the survey, such as the fact that the respondents are limited to those who have access to the Internet.

Analysis Method

Crosstabulations and multiple regression analysis using a linear probability model were used.

3. respondent demographics 4. survey results (by question)

The main information related to the respondents' attributes is appended at the end of this section.

Survey and analysis results

4.1. value of medicines (micro viewpoint)

First, we asked the respondents "what you expect from medicines" in order to understand which values they value from a micro perspective related to themselves and their surroundings. In order to see whether there were differences in the tendency to place importance on these items, we obtained responses (multiple answers, top three answers) from 12 options, from which the respondents selected multiple or top three options (multiple answers, top three answers). (Table 1) The responses are listed in descending order of percentage of responses. (Figure 2)

In both cases of multiple responses and top three responses, the most important values in order of importance were "safety," "effectiveness," "economic efficiency," "improvement of treatment methods," and "innovation.

When multiple responses were given, "safety," "efficacy," "economic efficiency," "improvement of treatment methods," and "innovation" received 70.0%, 61.0%, 49.2%, 48.9%, and 40.1% of the responses, respectively. Following "innovation," 39.6% of respondents selected "convenience," 39.4% selected "appropriate administration to patients," and almost the same percentages for "return to work," 27.8% selected "return to society," 26.6% selected "reduction in burden of nursing care," 24.7% selected "reduction in burden of medical personnel," 19.6% selected "productivity," and 8.6% selected "no expectation," respectively. The top three responses were "no expectations," "productivity," and "no expectations.

The top three responses were "safety" at 50.4%, "effectiveness" at 40.0%, "economic efficiency" at 27.0%, "improvement of treatment methods" at 25.2%, and "innovation" at 24.0%. Innovation" was followed by "appropriate administration to patients" at 13.6% and "convenience" at 12.4%, with the percentages being more than 10% lower. Also, 8.6% of the respondents selected "no expectations," 7.1% selected "return to society/returning to work," 5.9% selected "reduction in the burden of nursing care," 5.1% selected "reduction in the burden of medical personnel," and 3.8% selected "productivity.

When the results are divided into "medical value," which is mainly based on a medical perspective, and "non-medical value," which is realized as a ripple effect of drug treatment, etc., the ratio of "medical value," such as "safety" and "efficacy," was higher than that of "non-medical value" in both multiple responses and the top three responses, and the ratio of "non-medical value" was lower than that of "medical value" in the top three responses. In the case of the top three responses, "non-medical values" tended to have a lower response rate than "medical values. This indicates that respondents tended to select "medical value" more often as a value that is important to them. On the other hand, it is interesting to note that "values other than medical value" was selected to a certain extent by a certain percentage of respondents, ranging from 20% to 40% (19.6% to 39.4%) for multiple responses and from 10% (3.8% to 13.6%) for the top three responses. The "non-medical value" was selected to a certain extent, which is interesting to note. Therefore, we decided to classify the groups that place importance on "values other than medical values" into two groups and analyze them in the following sections.

Characteristics of the group that values "value other than medical value": by value, by attribute category

We then analyzed the characteristics of the value of the medicines that they value by the attribute categories (Table 2), which were classified beforehand. Table 3 shows the results of the characteristics of the attributes that were statistically significant (top three responses) by multiple regression analysis using a linear probability model, with each value factor as the explained variable, taking 1 if the respondent gave a choice response and 0 otherwise, and the attribute category as the explanatory variable.

The main characteristics that showed a high probability of selection were the attributes that responded "receiving/presence of disease" as the most important, with "productivity" and "appropriately administered to the patient" being the most important. The "reintegration into society/returning to work" was selected more frequently by the "older age" and "employed" groups. The probability of selection was high for the respondents with the lowest level of education and those with a family member in need of nursing care. Differences in the values emphasized were observed for several attributes. Those who were currently visiting a medical institution selected "productivity" and "appropriate administration to the patient" more often, those who were "employed" selected "return to society/return to work" more often, and those who had "family members in need of care" selected "reduction in burden of caregiving" more often. This suggests that the values that are closely related to one's own situation may be more important.

Characteristics analysis of the group that emphasizes "value other than medical value": Main characteristics of the group

Next, we analyzed the characteristics of the attributes of the two groups of respondents who selected the "non-medical value" factor. Group 1 consisted of those who selected "value other than medical value" at least once (1,032 respondents, 48.7%, excluding those who selected all of "productivity," "reintegration/return to work," and "reduced burden of caregiving") when responding to multiple questions, and Group 2 consisted of those who selected "productivity," "reintegration/return to work," and "reduced burden of caregiving" when responding to multiple questions. Those who selected all of these (236 respondents, 11.1%) were designated as Group 2. Group 1 was assumed to be the group that tended to recognize and give little importance to "non-medical values," while Group 2 was assumed to be the group that tended to give importance to values that are likely to have a ripple effect on themselves and their surroundings, especially the use of pharmaceuticals, such as taking drugs.

The characteristics of each attribute were cross-tabulated and are shown in the graphs. (Figure 3) In addition, Table 4 shows a multiple regression analysis using a linear probability model, with the "value other than medical value" group as the explained variable, taking 1 if the group was selected and 0 otherwise, and the attribute category as the explanatory variable, respectively.

First, we present the results for the characteristics of the attributes that were statistically significant. In Group 1, the selection probability was high for the attributes "Female," "Low household income," "Received medical examinations and diseases," and "High subjective health," while in Group 2, the selection probability was high for the attributes "Female," "Employed," "High final education level," "High medical cost burden," and "Low subjective health. Although there was little difference in the coefficients among the attribute categories with statistically significant differences, the high probability of "low annual household income" and "receiving medical examinations and having diseases" in Group 1 and "female" in Group 2 suggest that the characteristics of each of these attributes had an influence.

When "age" was divided into low/high age groups, there were no statistically significant differences. However, looking at the differences by decade in the graph, Group 1 had a lower percentage of respondents in the "20s to 50s" group than the overall group, and a higher percentage of respondents in the "60s and older" group than the overall group. Group 2 was higher than the overall percentage for respondents in their "30s to 50s" and especially for those in their "40s.

Others: Differences by presence or absence of disease recall and by disease recall

It can be assumed that the values that are important to them and their priorities differ depending on their health status, such as the presence or absence of disease. Next, in order to understand whether there is a difference in the value of medicines that the respondents value from a micro perspective in relation to themselves and their surroundings depending on whether they do or do not recall the disease and the type of disease they recall, we asked the respondents whether they recall having three diseases (hypertension, rheumatoid arthritis, cancer) that are assumed to have different effects on their QOL and mental health, and if they recall the diseases, the value of the medicines that they value from a micro perspective is different. (hypertension, rheumatoid arthritis, and cancer) (Table 5) ^5). The respondents were then asked what items they expected from the medications, and two different responses (multiple responses, top three responses) were obtained. The results are shown below, in order of the percentage of responses, for the multiple responses and the top three responses.

The results of the multiple responses are shown first. (Figure 4) The highest response rate was "safety" followed by "efficacy" for "no disease recall" and "hypertension recall," whereas for "rheumatoid arthritis" and "cancer" recall, the top response rate was "efficacy" followed by "safety," showing a reversal of the results. In addition, a higher percentage of respondents with "rheumatoid arthritis" and "cancer" recall showed "reintegration/return to work," "reduced burden of caregiving," and "productivity" as non-medical values compared to those with "no disease recall," while these were lower for "hypertension" than for "no disease recall.

The results for the top three responses are shown below (Figure 5). (Figure 5) Compared to "no recall of disease," "convenience," "return to society/returning to work," and "reduction in burden of caregiving" were selected at higher percentages for all disease recall, while "safety" was selected at lower percentages for all disease recall. When recalling hypertension, "improvement of treatment methods" (18.8%) and "innovation" (17.0%) were less frequently cited, while "effectiveness" (49.2%) and "economic efficiency" (30.8%) were more frequently cited. Rheumatoid arthritis" showed low percentages for "safety" (46.6%), "efficacy" (49.2%), "economy" (23.8%), "improvement of treatment methods" (19.8%), "innovation" (22.9%), and "appropriate patient administration" (12.0%), whereas "convenience" (19.4%) and The highest percentages were for "Return to society/returning to work" (11.9%), "Reduced burden on healthcare professionals" (10.2%), and "Reduced burden on caregivers" (9.3%).

When asked about "cancer," a low percentage of respondents selected "safety" (45.9%), while a high percentage selected "innovation" (31.7%), "economy" (31.2%), "convenience" (14.2%), "less burden on caregivers" (9.3%), and "return to work/returning to society" (7.9%).

These results indicate that the percentage of respondents who answered "non-medical values" such as "return to society" and "reduction in nursing care burden" increased when they recalled "rheumatoid arthritis" or "cancer," indicating that even survey respondents who tend to lean toward healthy people place more importance on non-medical values when they recall having a disease that affects their QOL or mental health. This indicates that even those survey respondents who tend to lean toward the healthy group place a different value on medicines when they recall having a disease that affects their quality of life or mental health, in other words, there is a change in their values.

Other: Differences between those with and without major medical diagnoses

The next step was to analyze whether there is a difference in the value (micro perspective) emphasized by those who actually have a disease and are currently receiving medical examinations and those who have not received medical examinations for the disease in question. However, since the main purpose of this survey was not to conduct a patient survey, and the number of respondents with medical examinations and diseases was limited, caution must be exercised in interpreting the results.

The 1,173 respondents (55.4%) in this survey who currently "see a doctor or have a disease" were analyzed for their top 15 diseases. Respondents receiving medical care for any disease other than the top 15 diseases are shown as "other diseases.

Multiple regression analysis with a linear probability model was performed using each value factor as the explained variable, taking 1 if the value factor was a choice response, 0 otherwise, and the disease seen as the explanatory variable. The characteristics that were statistically significant are listed in the table. (Table 6)

The main characteristics of the results are as follows: "glaucoma" was the most important for "effectiveness"; "dyslipidemia," "glaucoma," and "eczema/urticaria" were the most important for "safety"; "cancer" and "other diseases" were the most important for "innovation"; "improved treatment methods" were the most important for "back pain syndrome," "cancer," and "other The respondents who selected "convenience" and "economy" were more likely to select "diabetes" and "diabetes" as the most important factors, suggesting that they tend to place more importance on these factors.

The respondents who selected "productivity" were more likely to select "depression/depression" and "other diseases," and the respondents who selected "reintegration/returning to work" were more likely to select "depression/depression" and "reintegration/returning to society," suggesting that these attributes tend to be more important.

These results suggest that there is a difference in the value (micro perspective) emphasized by those who actually have a disease and are currently receiving medical examinations and those who have not received such examinations. In addition, the content of the results suggests that disease-specific conditions, which are known only to patients with the disease, may change the values they place importance on and their priorities.

4.2. value of medicines (macro perspective)

The next section looks at trends in social value as the contribution of pharmaceuticals to social goals, where the taking of pharmaceuticals and other uses (including those other than one's own) have an impact on society as a whole beyond oneself and one's surroundings.

Specifically, the respondents were asked about the four elements of value, "contribution to the sustainability of the social security system," "extension of people's life expectancy," "extension of people's healthy life expectancy," and "development of medicine and pharmaceutical science," with explanations attached, and how important they think these elements are as things that can be realized by having medicines," and rated on a 6-point scale (very important, important, fairly The respondents were asked to choose one of six levels (very important, important, fairly important, not so important, not important, and not important at all) and "don't know. The results are shown in Figure 6.

Looking at the results in terms of the three most important responses ("very important" or "important" or "fairly important"), in descending order of percentage, 88.8% of respondents chose "development of medical and pharmaceutical sciences," 84.8% chose "contribution to the sustainability of the social security system," 84.3% chose "extension of healthy life expectancy of the nation," and over 80% chose 70.0%, or 70%, of respondents placed importance on this. (Data omitted.) However, when looking at the two most important responses ("very important" or "important"), in descending order of importance, "development of medical and pharmaceutical sciences," 52.9%, "extension of healthy life expectancy of the nation," 47.9%, "contribution to the sustainability of the social security system," 43.5%, and "extension of life expectancy of the nation" 29.4%, indicating that 30% to 50% of the respondents place importance on the results. Only about 30% to 50% of the respondents placed importance on "extension of national life expectancy" (Figure 6). (Figure 6) There were also a certain number of respondents (about 6-8%) who were "don't know.

Characteristic analysis of each attribute category by value

Next, we will analyze the characteristics of the attributes for each of the value elements of the macro perspective. Table 7 shows the characteristics of the attributes that were statistically significant by multiple regression analysis using a linear probability model with each value factor as the explained variable, taking 1 when the respondent selected "very important" or "important" and 0 otherwise, and the attribute category as the explanatory variable.

As for the value of pharmaceuticals from a macro perspective, the probability of selecting "sustainability of the social security system" as important was high for the attributes that responded "unemployed," "have family members in need of care," "have a high final education level," "have a low household income," "have a large medical burden," "have a medical examination or disease," and "have high subjective health level" as the value of pharmaceuticals. Among the attributes, "high medical burden" and "high subjective level of health" with large coefficients are assumed to be the most influential. Similarly, the probability of selecting "extending the life expectancy of the nation" was high for respondents in the "younger age group," "highest level of final education," "high medical cost burden," "receiving medical examinations and having diseases," and "high subjective level of health" groups. Among the attributes, "receiving medical examinations and having diseases" and "having a high level of subjective health" with large coefficients were the most likely to be affected by the selection probability. The probability of selecting "Extension of healthy life expectancy" was high for respondents who were female, younger, had a family member in need of nursing care, had a high level of final education, had a high medical cost burden, had a medical checkup or disease, and had a high level of subjective health. Among the attributes, the "highest level of final education," "younger age," and "high level of subjective health" with the largest coefficients were most likely to have influenced the choice. Finally, "development of medicine/pharmacology" was selected with high probability by the respondents with "low household income," "high medical expenses," "have received medical examinations and diseases," and "high subjective level of health. Among the attributes, "high level of perceived health" and "high medical expenses" with large coefficients are presumed to have influenced the selection probability. The common characteristics of all four values of pharmaceuticals from a macro perspective were "medical checkups and presence of disease" and "high subjective health level.

These results indicate that there are differences in the values emphasized by each attribute (category) for the four elements of value from the macro perspective of "contribution to the sustainability of the social security system," "extension of life expectancy of the people," "extension of healthy life expectancy of the people," and "development of medical and pharmaceutical sciences. The results also suggest that the characteristics of those who place importance on the value elements may be related to their own circumstances (especially medical examinations), such as "high medical expenses" and "medical examinations and existence of diseases," and may not necessarily depend on their own circumstances, such as "high level of final education," "low age," and "high level of subjective health. It is assumed that the "medical diagnosis" may not necessarily be based on one's own situation.

Analysis of characteristics of groups that value "values other than medical values

This section also analyzed the extent to which the group that selected and responded to the "non-medical value" factor emphasized the value of the macro perspective.

The groups are as described above, and the characteristics of each group attribute are divided into "very important" or "important" selected responses and others, cross-tabulated, and shown in the graph. (Figure 7)

Multiple regression analysis using a linear probability model was conducted with each value factor as the explained variable, taking 1 if the value factor was answered as "very important or important" and 0 otherwise, and Group 1 and Group 2 as explanatory variables, and the characteristics that were statistically significant are listed in Table 8.

Group 1 and Group 2 showed a higher probability of selection in the value of the drug from both macro perspectives (Figure 7). Both Group 1 and Group 2 were significantly more important in the value of both macro perspectives. The coefficients for both were higher for Group 2 than for Group 1, suggesting that Group 2 had an influence.

Although these results cannot rule out the possibility that Group 2 is biased toward positive responses, the group that emphasized "values other than medical values" showed that the four values from the macro perspective related to society ("contribution to the sustainability of the social security system," "extension of the life expectancy of the people," "extension of healthy life expectancy of the people," and "development of medicine and The percentage of respondents who answered "very important" or "important" was higher for all four values from a macro perspective ("contribution to the sustainability of the social security system," "extension of life expectancy of the nation," "extension of healthy life expectancy of the nation," and "development of medicine and pharmaceutical science").

5. summary

The results of this survey showed that the perception of the value of pharmaceuticals can be divided into a micro perspective related to the respondents themselves and their surroundings and a macro perspective related to society, with the micro perspective divided into "medical value" based mainly on a medical perspective and "non-medical value" realized as a spillover effect of treatment with pharmaceuticals. The results have been described.

First, as an overall trend of the values of pharmaceuticals that are important to them, the micro perspective showed that "medical value" based mainly on the medical perspective was selected and answered more often than "non-medical value" realized as a ripple effect of treatment, etc. by pharmaceuticals.

We speculate that this result is probably due to the fact that taking pharmaceuticals and other uses are more likely to be emphasized than values that have a ripple effect on oneself and one's surroundings, and whose value can also affect society, since taking pharmaceuticals and other uses are values that can easily affect oneself directly and be directly felt. Another reason for the high frequency with which "non-medical value" was selected is thought to be the fact that many citizens do not face illnesses that would cause them to realize "non-medical value.

On the other hand, the fact that a certain percentage of respondents selected "non-medical values" such as "appropriate administration to patients," "rehabilitation/return to work," "reduction in the burden of nursing care," "reduction in the burden of medical personnel," and "productivity" even when answering the top three, indicates that there are people who place importance on "non-medical values. This indicates that there are people who value "values other than medical values. Those who selected "value other than medical value" were more likely to select "productivity" and "appropriate administration to patients" for those who were currently receiving medical care, "return to society/return to work" for those who were "older" and "employed," and "less burden on caregivers" for those who had "lower final education level" and "have family members in need of care. These results suggest that there are differences in the values that are important depending on one's situation, and that "values other than medical values" may be more important as values that are closely related to one's situation. On the other hand, there may be other selection factors, such as "final education," that do not depend on one's situation.

Next, we divided the group into two groups: Group 1, which tended to recognize and place even a little importance on "non-medical values," and Group 2, which tended to place particular importance on values that are assumed to have a ripple effect on themselves and their surroundings ("productivity," "return to work/return to society," and "reduction in burden of nursing care").

The group 1 that tended to recognize and place even a little importance on "values other than medical values" was "over 60s," "low household income," and "medical checkups and illnesses," and the group 2 that tended to place more importance on "values other than medical values" was "over 60s," "low household income," and "medical checkups and illnesses," and the group 3 that tended to place more importance on "values other than medical values" was "over 60s," "low household income," and "medical checkups and illnesses. Group 2, which tends to emphasize values that are expected to have a ripple effect on themselves and their surroundings ("productivity," "return to society/return to work," and "reduction in burden of caregiving"), was found to be more common among those in their "30s to 50s," especially among those in their "40s. The age difference between Groups 1 and 2 suggests that the "30s to 50s" tend to place particular importance on "productivity," "returning to work/returning to society," and "reducing the burden of nursing care," and that they have circumstances closely related to their own situation, such as child-rearing, housework, work, and nursing care, or that they are facing challenges in these areas. The impact on quality of life, mental health, etc.

The three diseases with different effects on quality of life and mental health were listed, and the tendency of values to be emphasized differed depending on whether the respondents recalled having the disease or not, as well as on the disease they recalled. In addition, the value (from a micro viewpoint) that is important to those who have a disease and are currently receiving a medical examination differs from those who have not received such an examination, and also depending on the disease they have. From these results, it can be inferred that the value of the most important medicines itself is not constant, but can change depending on the disease, and that the disease-specific conditions known only to patients with the disease may change the value and priority of the most important medicines.

As for the overall trend in the value of medicines that are important, from a macro perspective, when looking at the results of the two most important responses ("very important" or "important") for "contribution to the sustainability of the social security system," "extension of life expectancy of the people," "extension of healthy life expectancy of the people," and "development of medicine and pharmaceutical science," in order of increasing percentage, "development of medicine and pharmaceutical science," "extension of healthy life expectancy of the people," and "development of medicine and pharmaceutical science" are the most important. The results showed that only about 30% to 50% of the respondents placed importance on "development of medical and pharmaceutical sciences," "extension of healthy life expectancy of the people," "contribution to the sustainability of the social security system," and "extension of life expectancy of the people," in descending order of importance. These four values differ from the micro perspective in that their use, such as taking medicines, involves something other than themselves and affects society as a whole beyond themselves and their surroundings. For this reason, they may be less directly felt and less emphasized. However, it is a value with a large social impact that has an effect on a wider area than oneself and one's surroundings.

Those who place importance on the value of pharmaceuticals from a macro perspective are significantly more likely to respond "high medical burden" and "high subjective health" for "sustainability of social security system" and "development of medicine and pharmaceuticals," "receiving medical examinations and having diseases" and "high subjective health" for "extending the life expectancy of the nation," and "high final education level," "low age," and "high subjective health" for "extending the healthy life expectancy of the nation. The results of the survey showed that "final education level high," "lower age," and "high level of subjective health" were significantly more frequent and characterized as "high" in the "increase in national health expectancy. From these results, it can be inferred that, even from a macro perspective, the characteristics of those who place importance on values may be related to their own situation (especially medical examinations), such as "high medical expenses" and "have medical examinations and diseases," as well as not necessarily related to their own situation, such as "high level of final education," "younger age," and "high subjective health level. It is assumed that the value of the macro perspective may be based on the number of people who receive medical examinations and the number of people who receive medical examinations. While the value of the macro perspective is an aspect that is learned or discovered through the experience of medical examinations and morbidity, it may have been easier to answer from an objective, long-term perspective, independent of one's own situation.

In the two groups that emphasized "values other than medical values," in common with the two groups, the percentage of respondents who answered "very important or important" was high for all four macro-perspective values, and the degree of importance was higher in Group 2 than in Group 1. The group that emphasized "values other than medical values" also tended to recognize and emphasize the four values of the macro perspective more. The two groups that emphasize "value other than medical value," especially Group 2, may also emphasize "value from a macro perspective," which indicates the social value of medicines as a contribution to social goals, not just the use of medicines such as taking medicines, and thus may have higher health ^literacy6). It is necessary to continue analyzing the relationship between the group that emphasizes "values other than medical values" and the group that has "high awareness and interest" in the price and system of pharmaceuticals, as described in the previous issue.

6. conclusion

It was found that some of the public recognized and emphasized not only the "medical value" of pharmaceuticals based on a medical perspective, but also the "non-medical value" that is realized as a ripple effect of treatment, etc. with pharmaceuticals. They also recognized the value of pharmaceuticals from a social macro perspective. The value of pharmaceuticals from a social macro perspective ("contribution to the sustainability of the social security system," "extension of life expectancy," "extension of healthy life expectancy," and "development of medicine and pharmaceutical science") is an extremely important factor in considering the value of pharmaceuticals, their prices, and the system for determining prices in the age of 100 years of life. The "extension of the public's health span" and "development of medicine and pharmaceuticals" are very important factors to be considered in the 100-year life period. However, the public is not yet fully aware of the value of pharmaceuticals. Therefore, we believe that the "non-medical value" realized as a ripple effect of treatment with pharmaceuticals is also a value that should not be overlooked, and that it would be beneficial for our country if the public knew about "non-medical value," not only the value presented in this survey.

The value of pharmaceuticals is diverse, and the elements of value and innovation interact and change together in both directions. We must not forget that the value that the public and patients, who are the recipients of value, place on value varies depending on their own and surrounding circumstances (presence or absence of disease, type of disease, medical visits, housework, work, nursing care, understanding, etc.), and that there is a weight and sense of value unique to the disease that is only noticed when one becomes a patient. As the importance of Patient and Public Involvement (PPI) increases, the voices of the public and patients will bring awareness to various elements of value, such as "values other than medical values," and their evaluation will lead to new innovations and a virtuous cycle in which the value of better medicines will continue to be shared by the public. I sincerely hope that this will become a virtuous circle in which the value of pharmaceuticals will continue to be recognized by the public.

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