Establishing and evaluating FRAX®probability thresholds in Taiwan.
OBJECTIVE
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%).


CONCLUSIONS
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.
Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Superintendent's Office, National Taiwan University Hospital Chu-Tong Branch, Hsinchu City, Taiwan.
Ding-Cheng
DC
Chan
Metabolic Bone Centre, Northern General Hospital, Sheffield, United Kingdom.
Eugene V
EV
McCloskey
Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Chu-Tong Branch, Hsinchu County, Taiwan.
Chirn-Bin
CB
Chang
Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Kun-Pei
KP
Lin
Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
Lay Chin
LC
Lim
Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Keh-Sung
KS
Tsai
Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: rsyang@ntuh.gov.tw.
Rong-Sen
RS
Yang
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use*; D000465:Algorithms; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology
D050071:Bone Density Conservation Agents; D019386:Alendronate
FRAX(®); alendronate; antiosteoporosis medicines; cost effectiveness