Establishing and evaluating FRAX® probability thresholds in Taiwan
Journal
Journal of the Formosan Medical Association
Journal Volume
116
Journal Issue
3
Pages
161-168
Date Issued
2017
Author(s)
Abstract
Background/purpose The Taiwanese FRAX? calculator was launched in 2010. However, cost-effectiveness thresholds for the prescription of antiosteoporosis medications were not established. This study aims to establish and evaluate FRAX?-based probability thresholds in Taiwan. Methods Using previous data from Taiwan and literature, we determined cost-effectiveness thresholds for prevention of osteoporotic fractures by alendronate with a Markov model, as well as using two other translational approaches. Sensitivity analysis was applied using different alendronate prices. A clinical sample was used to test these Taiwan-specific thresholds by determining the percentages of high-risk patients who would be qualified for current National Health Insurance reimbursement. Results With the Markov model, the intervention threshold for hip fracture was 7% for women and 6% for men; for major osteoporotic fracture, it was 15% for women and 12.5% for men. Both translational approach models were cost effective only for certain age groups. However, if branded alendronate was reimbursed at 60% of the current price, they became cost effective in almost all age groups. This clinical screening study showed that the National Health Insurance Administration model identified the highest proportion (44%) of patients qualified for National Health Insurance reimbursements, followed by the Markov model (30%), and the United States model (22%). Conclusion Three FRAX?-based models of alendronate use were established in Taiwan to help optimize treatment strategies. The government is encouraged to incorporate FRAX?-based approaches into the reimbursement policy for antiosteoporosis medicines. ? 2016
Other Subjects
alendronic acid; alendronic acid; bone density conservation agent; adult; age; aged; Article; clinical assessment tool; cohort analysis; controlled study; cost effectiveness analysis; diagnostic test accuracy study; drug cost; EQ 5D score; female; forearm fracture; fracture risk assessment tool; fragility fracture; high risk patient; hip fracture; human; major clinical study; male; Markov chain; musculoskeletal disease assessment; national health insurance; osteoporosis; probability; proximal humerus fracture; quality adjusted life year; quality of life; quality of life assessment; reimbursement; sensitivity analysis; Short Form 36; spine fracture; systematic review (topic); Taiwan; Taiwanese; translational research; United States; very elderly; age distribution; algorithm; cost benefit analysis; economics; Hip Fractures; middle aged; osteoporosis; Osteoporotic Fractures; risk assessment; risk factor; sex ratio; Age Distribution; Aged; Aged, 80 and over; Alendronate; Algorithms; Bone Density Conservation Agents; Cost-Benefit Analysis; Female; Hip Fractures; Humans; Insurance, Health, Reimbursement; Male; Middle Aged; Osteoporosis; Osteoporotic Fractures; Risk Assessment; Risk Factors; Sex Distribution; Taiwan
Publisher
Elsevier B.V.
Type
journal article