{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:05:39Z","timestamp":1792757139222,"version":"4.5.0"},"reference-count":58,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T00:00:00Z","timestamp":1727136000000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020964","name":"Fusion Oriented REsearch for disruptive Science and Technology","doi-asserted-by":"publisher","award":["JPMJFR2154"],"award-info":[{"award-number":["JPMJFR2154"]}],"id":[{"id":"10.13039\/501100020964","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP17H06151"],"award-info":[{"award-number":["JP17H06151"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007330","name":"Ministry of Land, Infrastructure, Transport and Tourism","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100007330","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2024,9,3]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Cardiovascular diseases (CVDs) are more prevalent in colder homes, partly due to cold-induced high blood pressure (BP). While thermal insulation and heating are rational strategies to mitigate cold exposure, the high initial and running costs pose significant barriers. Therefore, this study aims to evaluate the cost-effectiveness of living in well-insulated warm houses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>An economic model was developed based on the indoor temperature\u2013BP and BP\u2013CVDs relationships. Five scenarios were outlined: a base scenario (Scenario 0: the most prevalent thermal insulation level (Grade 2) and indoor temperature (15\u00b0C) in Japan), two scenarios of upgrading insulation and living in warm houses after age 40 years (Scenario 1\u20131: Grade 4 &amp; 18\u00b0C and Scenario 1\u20132: Grade 6 &amp; 21\u00b0C), and two scenarios of retrofitting insulation of entire houses and living in warm houses after age 60 years (Scenario 2\u20131: Grade 4 &amp; 18\u00b0C and Scenario 2\u20132: Grade 6 &amp; 21\u00b0C). Monte Carlo simulations for 100\u2009000 virtual husband\u2013wife pairs were conducted to investigate quality-adjusted life-years (QALYs) and life-cycle costs for thermal insulation work, heating and medical treatments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Regarding the upgrading insulation scenarios, compared with Scenario 0, Scenarios 1\u20131 and 1\u20132 increased the life-cycle cost by Japanese yen (JPY) 0.26 and JPY0.84 million, respectively, while extending the combined healthy life expectancy of a husband and wife by 0.31 and 0.48 QALYs. The incremental cost-effectiveness ratios were below the threshold value of JPY5 million\/QALY gained. Regarding the retrofitting insulation scenarios, probabilistic sensitivity analyses showed that Scenario 2\u20132 emerged as the most cost-effective option when the willingness to pay reached JPY6.5 million or more, which is above the threshold.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Upgrading insulation and residing in warmer homes could be cost-effective strategies. When conducting insulation retrofitting, lower-cost methods such as partial insulation retrofitting should be considered. These findings support decision-making for residents and policymakers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001143","type":"journal-article","created":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T13:45:24Z","timestamp":1727185524000},"page":"e001143","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Effect of living in well-insulated warm houses on hypertension and cardiovascular diseases based on a nationwide epidemiological survey in Japan: a modelling and cost-effectiveness analysis"],"prefix":"10.1136","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2167-3429","authenticated-orcid":false,"given":"Wataru","family":"Umishio","sequence":"first","affiliation":[{"name":"Department of Architecture and Building Engineering, School of Environment and Society, Tokyo Institute of Technology, Meguro-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3451-5614","authenticated-orcid":false,"given":"Toshiharu","family":"Ikaga","sequence":"additional","affiliation":[{"name":"Institute for Built Environment and Carbon Neutral for SDGs, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8251-4480","authenticated-orcid":false,"given":"Kazuomi","family":"Kario","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9126-206X","authenticated-orcid":false,"given":"Yoshihisa","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1466-8410","authenticated-orcid":false,"given":"Naoki","family":"Kagi","sequence":"additional","affiliation":[{"name":"Department of Architecture and Building Engineering, School of Environment and Society, Tokyo Institute of Technology, Meguro-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0964-5289","authenticated-orcid":false,"given":"Masaru","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6254-9451","authenticated-orcid":false,"given":"Shintaro","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Architecture, Faculty of Environmental Engineering, The University of Kitakyushu, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6465-8205","authenticated-orcid":false,"given":"Keigo","family":"Saeki","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Nara Medical University School of Medicine, Kashihara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuzo","family":"Murakami","sequence":"additional","affiliation":[{"name":"Institute for Built Environment and Carbon Neutral for SDGs, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,24]]},"reference":[{"key":"2025083110011795000_2.2.e001143.1","doi-asserted-by":"crossref","first-page":"5355","DOI":"10.3390\/su14095355","article-title":"Home Use and Experience during COVID-19 in London: Problems of Housing Quality and Design","volume":"14","author":"Jacoby","year":"2022","journal-title":"Sustainability"},{"key":"2025083110011795000_2.2.e001143.2","unstructured":"U.S. Bureau of Labor Statistics . 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