The Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) as a measuring unit was developed along with an increased concern about drug utilization studies in Europe in the 1960s. Its use was recommended by the WHO Regional Office of Europe on 1981, then by the WHO Headquarters in Geneva in 1996. It is maintained by the WHO Collaborating Centre on Drug Statistics Methodology in Olso (http://www.whocc.no/) and widely used in Europe. However, it is rarely used in other parts of the world. This paper aims to inform the Japanese public about the ATC/ DDD system towards a more rational use of drugs in Japan. It attempts to answer the five Ws on ATC/ DDD, i.e., “What is ATC/DDD?”; “Why is ATC/DDD used?”; “When was ATC/DDD established?”; “Who decide ATC/DDD and how?”; and “Where is ATC/DDD used?”

“Appropriate/Rational allocation for limited healthcare resources”, which was the fundamental concept of the health economics, had not been widely accepted/disseminated for the general public in Japan. Although vast majority agreed with the existence of healthcare budget constraint, it had not been widely recognized that “physical” healthcare resources, such as healthcare professional and/or healthcare facilities, were also limited and restricted, until current COVID-19 ERA. The HTA （Health Technology Assessment） concept could be used for COVID-19 related resource allocation issues, such as prioritization of the vaccination. Kohli et al. conducted cost-utility analysis of various treatment strategy for the hypothetical vaccine in the US setting. They proved that vaccination for elderly and stuffs for health care/long term care facilities were cost-effective （dominant and USD 20,000/QALY, respectively）, while we need to take into account relatively low incidence rate of COVID-19 in Japan.However, current framework of the HTA with narrower perspective, could not capture entire value of the preventive intervention against COVID-19. Appleby et al. argued that broader perspective, under which external impacts, outside of healthcare area, would be incorporated, would be needed for appropriate decision making.Faced with COVID-19 pandemic, importance of re-defining （or expanding） the value of intervention would be widely recognized and further conceptual research should be warranted.

OBJECTIVE: The pharmacological effects of generic (GE) donepezil are the same as Aricept, its brand-name counterpart. However, little is known as to whether these two drugs provide the same quality of life (QOL). The study subjects were patients with Alzheimer's disease who were taking donepezil hydrochloride tablets, and were selected by visiting either the local pharmacies or the patients' homes. We chose the brand-name drug Aricept and its GE form donepezil to investigate, from a long-term caregiver's perspective, the influence of both drugs on the patients' QOL. METHODS: An EuroQol-5 Dimension (EQ-5D) was used to assess the QOL of patients with Alzheimer's disease, before and after various Aricept and/or donepezil regimens. Patients were divided into four groups: first time users of Aricept (n=43), first time users of GE donepezil (n=45), users refilling previous prescriptions of Aricept (n=51), and users switching from Aricept to GE donepezil (n=51). RESULTS: The average change in the EQ-5D utility indices rose significantly in the patients starting a new regimen of Aricept and its GE drug. The patients continuing an existing regimen of Aricept showed no significant differences, even after Aricept was switched to a GE drug. CONCLUSION: The QOL of patients starting a new regimen of Aricept and its GE drug improved. The QOL was maintained upon switching to the GE drug form.
Alzheimer Disease* ; Drugs, Generic ; Humans ; Pharmacies ; Prescriptions ; Quality of Life* ; Tablets