| Abstract: | Objective: To assess the cost and the effectiveness relationship of different adherence to anti-osteoporosis medication (AOM) therapy under the real-world National Health Insurance reimbursement scenario in Taiwan. Methods: The study used Taiwan’s National Health Insurance Research Database to identify patients who initiated AOMs (alendronate and denosumab) between 2008–2017. The study population was categorized into 4 groups according to the different levels of adherence to their AOMs therapy: Medication possession ratio (MPR) C 75%, 50 * ~75%, 25 * ~ 50%, and ~25%. The direct medical cost and the occurrence of subsequent fractures within three years were estimated, and the failure probability of composite osteoporotic fracture was estimated by the Kaplan–Meier method. The concept of the incremental cost-effectiveness ratio was adopted to evaluate the relationship between the cost and effectiveness of AOM treatment at different adherence levels. Results: 166,187 new hip fracture patients who started alendronate between 2008–2017. Among those with higher adherence to AOM had a lower event rate of composite osteoporotic fracture within 3 years. The risk was 9.12%, 10.36%, 11.60%, and 12.29% for patients with MPR C 75%, 50 * ~75%, 25 * ~50%, and ~25%, respectively. Simultaneously, those with higher adherence to AOM utilized fewer medical resources in the national insurance healthcare system. The total medical cost for 3 years was 8120, 9151, 8932,9217 USD for patients with MPR C 75%, 50 * ~ 75%, 25 * ~50%, and ~ 25%, respectively. Conclusion: Overall, under Taiwan’s national health insurance, higher adherence to AOMs was cost-saving. The finding of this research was valuable for policymakers in considering healthcare policy and resource allocation. |
