Do reductions in out-of-pocket expenses for dual energy X-ray absorptiometry scans translate to reduced fracture incidence amongst older Australians? A population-based study

Impact of the guidance on fracture Liaison Services and the introduction of a new fee for secondary fracture prevention in Japan: Implementation of secondary fracture prevention during hospitalization for fragility fractures

In Japan, the publication of the Fracture Liaison Service Clinical Standard (FLS-CS) had no apparent effect on the implementation of secondary fracture prevention, but the introduction of a new management fee for secondary fracture prevention significantly promoted the implementation of secondary fracture prevention for the target disease.

BACKGROUND

Secondary fracture prevention is important for managing fragility fractures. In Japan, the FLS-CS was published in 2019, alongside the introduction of a new management fee for secondary fracture prevention, launched in 2022 for patients who underwent surgery for hip fracture. FLS programs were hospital-based. This study evaluated the impact of these interventions on the implementation of secondary fracture prevention during hospitalization for fragility fractures.

METHODS

Using claims data from the Quality Indicator/Improvement Project database, patients aged 50 years or older with hip fracture who underwent surgery or with vertebral fractures were included. The publication of FLS-CS was the first intervention, followed by the introduction of the management fee as the second intervention. To evaluate the impact of these interventions, we performed an interrupted time series analysis separately for hip and vertebral fractures.

RESULTS

For hip fractures, there was no immediate change after the first intervention, and the monthly rate of change decreased (incidence rate ratio [IRR]: 0.985, 95% confidence interval [CI]: 0.979-0.991). After the second intervention, there was an immediate increase (IRR: 1.890, 1.761-2.029), and the monthly rate of change also increased (IRR: 1.050, 1.044-1.056). For vertebral fractures, the proportion of change increased only immediately after the second intervention (IRR: 1.148, 1.038-1.270).

CONCLUSION

The publication of FLS-CS had no apparent effect on the implementation of secondary fracture prevention in patients with either hip or vertebral fractures. Conversely, the introduction of the management fee had the effect of increasing that for the target disease.

Effects of the Revised Reimbursement Guideline for Anti-Osteoporosis Medication in South Korea

BACKGROUND

The Korean National Health Insurance (NHI) reimbursement guideline was revised in May 2015 with the aim of preventing secondary osteoporotic fractures. Here we compared the: (1) rate of bone mineral density (BMD) measurements; (2) prescription rate of anti-osteoporosis medication within 3 months after hip fracture surgery (HFS); (3) incidence of a second hip fracture; and (4) first-year mortality rate after HFS.

METHODS

This before-after study used the revised reimbursement system as a reference period. We retrospectively reviewed the medical records of 515 patients who underwent HFS at a tertiary referral hospital between January 2014 and December 2016. The period 1 group underwent HFS in 2014, while the period 2 group underwent HFS in 2016.

RESULTS

Despite the fact that there was no significant intergroup difference in BMD measurement rate, the period 2 group had a higher prescription rate for anti-osteoporosis drugs within 3 months of HFS. However, the incidence of a second hip fracture did not differ between groups. The first-year mortality rate was higher in the period 1 versus period 2 group.

CONCLUSIONS

Revision of the NHI guideline in May 2015 was associated with an increased prescription rate of anti-osteoporosis medication in osteoporotic hip fracture patients.

Assessing the effects of National Health Insurance reimbursement policy revisions for anti-osteoporotic drugs in Korean women aged 50 or older

Introduction

The Korean National Health Insurance revised its reimbursement criteria to expand coverage for anti-osteoporotic drug treatments in 2011 (expanding diagnostic criteria and the coverage period for anti-osteoporotic therapy) and 2015 (including osteoporotic fracture patients regardless of bone mineral density). We examined whether the two revisions contributed to an increase in the prescription rates of anti-osteoporotic drugs in Korea.

Methods

We used the Health Insurance Review and Assessment Service-National Patient Sample data from 2010 through 2016. A segmented regression analysis of interrupted time series was performed to assess changes in the monthly prescription rates of anti-osteoporotic drugs among women aged 50 or older, defined as the proportion of elderly women prescribed with anti-osteoporotic drugs.

Results

Both the levels (i.e., abrupt jump or drop) and the trends (i.e., slope) of the prescription rates of anti-osteoporotic drugs in the general population, osteoporotic patients, and osteoporotic fracture patients showed no significant changes after the first revision. However, there was a significant increase in the trends in the general population (β = 0.0166, p = 0.0173) and in osteoporotic patients (β = 0.1128, p = 0.0157) after the second revision. Women aged 65 to 79 years were the most significantly increased group in terms of the treatment proportion after the second revision because the trend was significant after the second revision in all three study populations (β = 0.0300, 0.1212, 0.1392, respectively; p < 0.05).

Conclusions

Although the two revisions expanded reimbursement coverage, only the second revision on reimbursing based on osteoporotic fracture regardless of bone mineral density was associated with increasing the proportion of post-menopausal women being treated with anti-osteoporotic drugs.