Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
Outpatient Clinic Department, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
J Bone Miner Metab. 2020 May;38(3):316-327. doi: 10.1007/s00774-019-01061-5. Epub 2019 Nov 11.
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.
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.
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.
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.
台湾的全民健保目前仅涵盖骨质疏松症药物用于骨折的二级预防，而不提供一级预防的覆盖范围。本研究的目的是开发一种用于分析骨质疏松症药物一级预防使用的预算影响的模型。
本研究中的预算影响模型是“实际用药成本”减去“通过服用骨质疏松症药物可避免的所有类型骨折的医疗费用”。我们根据患者的年龄和 T 分数制定了六种可能的一级预防保险支付计划，并进行了十一步来估计每种支付计划的预算影响。
本研究的结果表明，可能有 71220 人（T 分数≤-3.0，75 岁以上）到 157515 人（T 分数≤-2.5，65 岁以上）使用该药物，预算影响可能在 2019 年达到 2628 万至 5898 万美元。然而，这些支付计划可能会避免 492 至 766 例骨折事件，并节省 130 万至 202 万美元的骨折治疗费用。一年内用于一级预防的平均费用将为 53386 美元至 77006 美元。
使用骨质疏松症药物进行骨折的一级预防的预算影响是显著的，但由于骨折治疗成本的节省可以得到补偿。
