Impact of the Requirement of Bone Mineral Density Evidence on Utilization of Anti-osteoporosis Medications, Clinical Outcome and Medical Expenditures of Patient With Hip Fracture in Taiwan

Document Type : Original Article

Authors

1 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

2 Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

3 Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan

4 Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan

5 Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan

6 Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan

7 Health Data Research Center, National Taiwan University, Taipei, Taiwan

8 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan

Abstract

Background
Since 2011, Taiwan’s National Health Insurance Administration (NHIA) issued a regulation on the reimbursement to anti-osteoporosis medications (AOMs). This study aimed to evaluate the impact of this regulation in reimbursement on the utilization of AOMs, clinical outcomes and associated medical expenditures of patients with incident hip fractures.
 
Methods
By using the National Health Insurance Research Database (NHIRD), patients with incident hip fracture from 2006 to 2015 were identified as our study cohort. Patients younger than 50 years old or prescribed with AOMs within one year prior to incident fracture were excluded. Outcomes of interest were quarterly estimates of the proportion of patients who received bone mineral density (BMD) examination, who were prescribed AOMs, as well as who encountered subsequent osteoporotic fracture-related visits and associated medical expenditures. Particularly, age- and gender-specific estimates were reported. An interrupted time series study design with segmented regression model was used to quantitatively explore the impact of the changes of the reimbursement criteria on the level (immediate) and trend (long-term) changes of these outcomes.
 
Results
Our study enrolled 118 493 patients with incident hip fracture with those patients aged older than 80 years old accounting for the largest proportion. A significantly decreased trend of AOMs prescription rates was observed immediately post regulation except for female aged between 65 and 80, while the long-term pattern showed no significant difference. However, the percentage of patients encountered subsequent osteoporotic fracture-related visit was not statistically different between pre- and post-regulation periods. Noteworthy, the policy regulation was associated with an increasing trend of osteoporotic fracture associated medical expenditures, especially for patients older than 80 years old.
 
Conclusion
The regulation on the reimbursement for AOMs decreased the prescribing rate of AOMs immediately although the effect did not sustain thereafter. However, higher subsequent osteoporotic fracture-related medical expenditures were introduced, especially among those very old population.

Keywords


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Articles in Press, Corrected Proof
Available Online from 03 October 2020
  • Receive Date: 27 February 2020
  • Revise Date: 09 July 2020
  • Accept Date: 25 August 2020