Cost and effectiveness analyses of the anti-osteoporosis medication in patients with hip fracture in Taiwan: A population-based national claims database analysis

Chen-Yu Wang; Chih-Hsing Wu; Ho-Min Chen; Jou-Wei Lin; Chih-Cheng Hsu; Yin-Fan Chang; Ta-Wei Tai; Shau-Huai Fu; Jawl-Shan Hwang

doi:10.1016/j.jfma.2023.07.018

Cost and effectiveness analyses of the anti-osteoporosis medication in patients with hip fracture in Taiwan: A population-based national claims database analysis

J Formos Med Assoc. 2023:122 Suppl 1:S92-S100. doi: 10.1016/j.jfma.2023.07.018. Epub 2023 Aug 11.

Authors

Chen-Yu Wang¹, Chih-Hsing Wu², Ho-Min Chen³, Jou-Wei Lin⁴, Chih-Cheng Hsu⁵, Yin-Fan Chang⁶, Ta-Wei Tai⁷, Shau-Huai Fu⁸, Jawl-Shan Hwang⁹

Affiliations

¹ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
² Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
³ Health Data Research Center, National Taiwan University, Taipei, Taiwan.
⁴ 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.
⁵ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
⁶ Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁷ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
⁸ Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: b90401045@gmail.com.
⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan. Electronic address: hwang2570@gmail.com.

PMID: 37574339
DOI: 10.1016/j.jfma.2023.07.018

Abstract

Background: Real-world cost and effectiveness analyses of the anti-osteoporosis medications (AOM) using a nationwide database in Asia were limited. The aim of this study was to evaluate the cost and effectiveness of AOMs therapy under the reimbursement of National Health Insurance in Taiwan.

Methods: Using Taiwan's National Health Insurance Research Database, patients who had hospitalization due to incident hip fractures with related operation between 2008 and 2017 were identified as our study population. Patients who initiated AOMs within 1 year post incident hip fracture were matched with those did not according to the propensity score. The direct medical cost and subsequent fracture within three years were estimated. Statistically significant differences of risk for subsequent fracture between the AOM and non-AOM groups were estimated using the COX proportional hazards model. All costs were presented as New Taiwan Dollars (NTD).

Results: There were 27,357 new hip fracture patients who initiated AOMs, and 76% of them were women with a mean age of 77.7 years. Among patients ages ≥70 who encountered hip fractures, those who initiated AOMs experienced fewer non-vertebral fractures (HR = 1.07 (1.02-1.13), p = 0.0114 for those ages 70-79 years old; HR = 1.11 (1.06-1.17), p < 0.0001 for those ages ≥80 years) and mortality (HR = 1.18 (1.14-1.22), p < 0.0001 for those ages 70-79; HR = 1.20 (1.16-1.23), p < 0.0001) within 3 years post incident fracture; meanwhile, consuming fewer medical resources in the national insurance healthcare system. (Increment cost = -16011.2 NTD, p = 0.0248 for those ages 70-79; Increment cost = -17257.9 NTD, p = 0.0032 for those ages ≥80 years) CONCLUSION: Overall, under Taiwan's national health insurance, the use of AOMs is cost-saving, especially in the population aged ≥70 years. The finding of this research was valuable for policymakers in considering healthcare policy promotion and resource allocation in the future.

Keywords: Anti-osteoporosis medication; Cost and effectiveness analyses; Disease burden; Fracture; Osteoporosis.