What do running a business and flying an airplane have in common?

“Starting a business is like takeoff and cruising,” says Yasunori Kakemizu, a Corporate Affiliates Visiting Fellow at Stanford’s Shorenstein Asia-Pacific Research Center (Shorenstein APARC). “But exiting from it is very difficult—like landing—because you need to try to make a profit.” 

Kakemizu should know. He has spent over a decade promoting business development at Japan’s Sumitomo Corporation and its affiliate company Jupiter Telecommunications (J:COM). He is also currently training in his free time for his pilot’s license.

Assistant to the general manager of the Cable TV Department in Sumitomo’s Media Division, Kakemizu has spent the past year at Stanford studying the strategies of major American cable companies in adapting to industry changes like the rise of online streaming media. He has examined, for example, the launch of Comcast’s Xfinity streaming service, and how the company has successfully grown it into a profitable part of its business.

“I’m looking for lessons J:COM and other affiliates can use in the next steps of their own streaming services, which is still relatively new in Japan,” Kakemizu says.

Kakemizu is also taking advantage of Stanford’s close ties to Silicon Valley by attending entrepreneurship seminars and enrolling in classes like cloud computing and investment finance. He is fascinated by the opportunities Stanford students have to work on projects with Silicon Valley companies, and the important role Stanford plays in the regional and global business world.

“This university gathers people from around the world and educates them on how to create new companies,” he says. “They then transmit this knowledge globally.”

During the academic year, Kakemizu has enjoyed taking part in the Corporate Affiliates Program site visits to cutting-edge local tech companies, such as Facebook. He found the visit to Cypress Envirosystems, a company that merges digital technology with older HVAC analog technology, especially intriguing.

“Most businesses are ‘forward thinking,’ but they’re focusing on older technologies,” Kakemizu says. “As a result, they don’t have any market competitors. From a business point of view, their strategy is very clever.”

As the academic year winds down, Kakemizu will wrap up his research project and present the results at a seminar. He and the other Visiting Fellows will have a chance to receive feedback and respond to questions from Shorenstein APARC faculty.

Kakemizu will also finish up his pilot’s license training before he returns to Japan. If you hear an airplane flying over campus one day this spring, it might just be him.

“The view of Stanford from the air is very beautiful,” he says.

A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent – by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP.

They created an economic model focused on gay men, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

For instance, using the pill in the general population of gay men would cost $495 billion over 20 years, compared to $85 billion when targeted to those at particularly high risk, the researchers found. The study will be published in the April 17 issue of the Annals of Internal Medicine.

Senior author Eran Bendavid, an affiliate of Stanford Health Policy at the Freeman Spogli Institute, said the results are a departure from a previous study. Earlier research found PrEP was not cost-effective when compared with other commonly accepted prevention programs.

The new Stanford study differs in a few important respects, taking into consideration the decline in transmission rates over time as more individuals take the pill. The Stanford team also assumed individuals would stop taking PrEP after 20 years, not stay on the drug for life, as the previous study had assumed.

The pill combination, marketed under the brand name Truvada, is widely used for treating HIV infection. But it wasn’t until a landmark trial, published in the New England Journal of Medicine in November 2010, that individuals and their doctors began to seriously consider using the drug as a preventive therapy. The drug’s maker, Foster City, Calif.-based Gilead Sciences Inc., has filed a supplemental new drug application to market it for prevention purposes.

The CDC issued interim guidelines on the drug’s use in January 2011, suggesting that if practitioners prescribe it as a preventive measure, they regularly monitor patients for side effects and counsel them about adherence, condom use and other methods to reduce their risk of infection.

In developing their model, the Stanford researchers took into account the cost of the drug – about $26 a day, or almost $10,000 a year – as well as the expenses for physician visits, periodic monitoring of kidney function affected by the drug, and regular testing for HIV and sexually transmitted diseases.

“We’re talking about giving uninfected people a drug that has some toxicities, so it’s crucial to have them monitored regularly,” said Bendavid, who is an assistant professor of medicine in Stanford’s School of Medicine.

Without PrEP, the researchers calculated there would be more than 490,000 new infections among gay men in the United States in the next 20 years. If just 20 percent of these men took the pill daily, there would be nearly 63,000 fewer infections.

However, the costs are substantial. Use of the drug by 20 percent of gay men would cost $98 billion over 20 years; if every man in this group took PrEP for 20 years, the costs would be a staggering $495 billion.

Given these figures, the researchers looked at the option of giving PrEP only to men who are at high risk – those who have five or more sexual partners in a year. If just 20 percent of these high-risk individuals took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.

At less than $50,000 per quality-adjusted life year gained (a measure of how long people live and their quality of life), that strategy represents relatively good value, according to Juusola.

“However, even though it provides good value, it is still very expensive,” she said. “In the current health care climate, PrEP’s costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”

She said the costs could be significantly reduced if the pill is found to be effective when used intermittently, rather than on a daily basis. Current trials are examining the effectiveness of the drug when used less often.

Other co-authors are Margaret L. Brandeau, the Coleman F. Fung Professor of Engineering, and Douglas K. Owens, the Henry J. Kaiser, Jr. Professor at Stanford and senior investigator at the Veterans Affairs Palo Alto Health Care System. Owens also is director of Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research.

The study was funded by the National Institutes of Health and the Department of Veterans Affairs and supported by Stanford’s departments of Medicine and Management Science and Engineering.