Constraining in reimbursement criteria and the adherence to anti-osteoporosis medications (AOMs) in Taiwan: Urbanization makes the difference

Chen-Yu Wang; Tsung-Han Yang; Shau-Huai Fu; Jawl-Shan Hwang; Ho-Min Chen; Jou-Wei Lin; Chih-Cheng Hsu; Yin-Fan Chang; Chih-Hsing Wu; Ding-Cheng Chan; Rong-Sen Yang

doi:10.1016/j.jfma.2023.05.012

Constraining in reimbursement criteria and the adherence to anti-osteoporosis medications (AOMs) in Taiwan: Urbanization makes the difference

J Formos Med Assoc. 2023:122 Suppl 1:S45-S54. doi: 10.1016/j.jfma.2023.05.012. Epub 2023 Jun 2.

Authors

Chen-Yu Wang¹, Tsung-Han Yang², Shau-Huai Fu³, Jawl-Shan Hwang⁴, Ho-Min Chen⁵, Jou-Wei Lin⁶, Chih-Cheng Hsu⁷, Yin-Fan Chang⁸, Chih-Hsing Wu⁹, Ding-Cheng Chan¹⁰, Rong-Sen Yang¹¹

Affiliations

¹ School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
² Department of Orthopedics, NTU BioMedical Park Hospital, NTUH Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung Univeristy, Taoyuan, Taiwan.
⁵ Health Data Research Center, National Taiwan University, Taipei, Taiwan.
⁶ Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin County, Taiwan.
⁷ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
⁸ Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁹ Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁰ Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: doctord6226@yahoo.com.
¹¹ Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: rsy0819@gmail.com.

PMID: 37271714
DOI: 10.1016/j.jfma.2023.05.012

Abstract

Background: The Bureau of National Health Insurance in Taiwan implemented a new reimbursement scheme incorporating bone mineral density (BMD) criteria on Jan. 1, 2011. This study aimed to investigate a real-life 11-year secular trend of adherence in new AOMs users and evaluated the change of adherence to AOMs therapy in different urbanization areas after reimbursement criteria were restrained.

Methods: We used Taiwan's National Health Insurance Research Database to identify new AOMs users as our study population. The AOMs in this study included denosumab, zoledronate, ibandronate, alendronate, raloxifene, and risedronate. The first prescription date of AOMs was defined as the cohort entry date. The adherence rates within one year after initiation were assessed.

Results: High adherence (≥75%) in the first year increased markedly after the new reimbursement scheme in 2011, changing from 31.8% in 2008, and 41.7% in 2011 to 54.2% in 2018. On the other hand, low adherence (<25%) decreased from 38.8% in 2008 to 14.6% in 2018. In addition, the switchers increased from 5.9% in 2008 to 9.3% in 2018, indicating a more flexible choice of AOMs. The proportion of high adherence to AOMs was highest in high-urbanization areas, and the proportion increased about two times from 30% in 2008 to 60% in 2018.

Conclusion: The implementation of new reimbursement criteria in 2011 was associated with increased adherence to AOMs and the increase was most apparent in high-urbanization areas.

Keywords: Adherence; Anti-osteoporosis medications; Osteoporosis; Urbanization.

MeSH terms

Alendronate / therapeutic use
Bone Density Conservation Agents* / therapeutic use
Humans
Ibandronic Acid / therapeutic use
Osteoporosis* / drug therapy
Taiwan
Urbanization

Substances

Alendronate
Ibandronic Acid
Bone Density Conservation Agents