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Budget impact analysis of osteoporosis medications for primary prevention of fractures in Taiwan

  • Kun-Ling Wu
  • Chih-Hsing Wu
  • Yin-Fan Chang
  • Yun-Ting Lin
  • Jason C. HsuEmail author
Original Article

Abstract

Introduction

Taiwan's national health insurance currently only covers the use of osteoporosis drugs for the secondary prevention of fractures and does not provide coverage for primary prevention. The purpose of this study is to develop a model for analyzing the budgetary impact of the use of osteoporosis medications of primary prevention.

Methods

The budget impact model in this study is the “actual medication cost” minus the “medical expenses for all types of fractures that can be avoided by taking osteoporosis medications.” We developed six possible insurance payment plans for primary prevention based on the age of the patients and T-scores and performed eleven steps to estimate the budget impact of each payment plan.

Results

The results of this study indicated that there may be 71,220 (T-score ≤ − 3.0, 75 + y/o) to 157,515 (T-score ≤ − 2.5, 65 + y/o) people using the drugs, and the budget impact may be US$26.28–58.98 million in 2019. However, the payment plans may avoid 492–766 fracture events and save medical expenditures for fracture treatment by US$1.30–2.02 million. The average costs for primary prevention within a year will be US$53,386–77,006.

Conclusion

The budget impact of using osteoporosis medications to primary prevention of fractures is significant, but it can be compensated due to savings in fracture treatment costs.

Keywords

Budget impact analysis Osteoporosis medication Primary prevention Taiwan 

Abbreviations

BIA

Budget impact analysis

ISPOR

International Society for Pharmacoeconomics and Outcomes Research Health Sciences Policy Council

FRAX

Fracture Risk Assessment Tool

IOF

International Osteoporosis Foundation

WHO

World Health Organization

NHI

National Health Insurance

ICD-9

International Classification of Diseases, 9th edition

NHIRD

National Health Insurance Research Database

DXA

Dual-energy X-ray absorptiometry

Notes

Author contributions

KLW, CHW, YFC, and JCH conceptualized and designed the study. KLW, CHW, and YTL collected data and conducted the analyses. JCH and YTL drafted the manuscript. All authors reviewed all data, revised the manuscript critically for intellectual content, and approved the final version for submission.

Funding

This work was supported by National Cheng Kung University Hospital-the Show Chwan Health Care System R&D Project grant (Grant number: NCKUSCMH10710), National Cheng Kung University Hospital (Grant numbers: NCKUH-106-9007, NCKUH-10709012), and Taiwan Ministry of Science and Technology (Grant number: 106-2314-B-006-064-MY2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no competing interests.

Ethics approval and consent to participate

Use of the publicly published data and NHIRD for research purpose is exempt from IRB review in Taiwan.

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Copyright information

© The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Family MedicineTainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation)TainanTaiwan
  2. 2.Outpatient Clinic DepartmentTainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation)TainanTaiwan
  3. 3.Department of Family Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  4. 4.Institute of Geriatrics, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  5. 5.Department of Pharmacy, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  6. 6.Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of MedicineNational Cheng Kung UniversityTainanTaiwan

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