台湾髋部骨折患者抗骨质疏松药物的成本效益分析：基于人群的全国索赔数据库分析。

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

作者信息

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

机构信息

National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.

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.

出版信息

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

DOI:10.1016/j.jfma.2023.07.018

PMID:37574339

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.

摘要

背景

在亚洲，利用全国性数据库对抗骨质疏松药物（AOM）进行真实世界成本效益分析的研究有限。本研究旨在评估台湾地区国民健康保险报销范围内AOM治疗的成本和效益。

方法

利用台湾地区国民健康保险研究数据库，将2008年至2017年间因首次发生髋部骨折并接受相关手术而住院的患者确定为研究对象。首次髋部骨折后1年内开始使用AOM的患者与未使用AOM的患者根据倾向得分进行匹配。估算直接医疗成本和三年内后续骨折情况。使用COX比例风险模型估算AOM组和非AOM组后续骨折风险的统计学显著差异。所有成本均以新台币（NTD）表示。

结果

有27357名首次髋部骨折后开始使用AOM的患者，其中76%为女性，平均年龄77.7岁。在≥70岁发生髋部骨折的患者中，开始使用AOM的患者在骨折后3年内发生非椎体骨折的情况较少（70 - 79岁患者的风险比[HR] = 1.07（1.02 - 1.13），p = 0.0114；≥80岁患者的HR = 1.11（1.06 - 1.17），p < 0.0001），死亡率也较低（70 - 79岁患者的HR = 1.18（1.14 - 1.22），p < 0.0001；≥80岁患者的HR = 1.20（1.16 - 1.23），p < 0.0001）；同时，在国民健康保险医疗系统中消耗的医疗资源较少。（70 - 79岁患者的增量成本 = -16011.2新台币，p = 0.0248；≥80岁患者的增量成本 = -17257.9新台币，p = 0.0032）结论：总体而言，在台湾地区国民健康保险制度下，使用AOM具有成本节约效果，尤其是在≥70岁人群中。本研究结果对政策制定者未来考虑医疗政策推广和资源分配具有重要价值。