[Can We Incorporate Financial Toxicity in Clinical Guidelines Made in Japan?]

There is ambivalence over whether we should prioritize clinical guidelines and health technology assessment(HTA)is ambivalence. Clinical guidelines are to help patients and physicians to solve the problems encountered at clinical practice. HTA, especially the cost-effective analysis(CEA)can be analyzed from both individual and population perspective. Individual perspective largely depends on private expenses, and is difficult to make a general statement. Population perspective will negate the small improvement, which is still an important step in cancer medicine. Systematic reviews adopted to make evidence-based recommendations in guideline is also becoming a mere facade. In oncology one phase Ⅲ trial may change the practice, generally accompanying with new approval of the treatment. Negative results of trials only lead to non-approval of the new treatment. In those restricted environment, CEA can be used where clinical usefulness is comparable. Since the treatment has an authorized price, guideline can recommend the treatment by CEA factors. Price competition is an original situation, and moreover recommendation using authorized cost determined under the clerical rule, is academically non-scientific.