Impact of a national reimbursement policy on anti-osteoporosis medication prescription at discharge after hip-fracture surgery in Japan: an interrupted time-series analysis
Authors' conclusion
Embedding a modest, stage-specific financial incentive within the national fee schedule produced a sustained large increase in anti-osteoporosis medication prescription at discharge after hip fracture, predominantly for oral agents.
Study context
- Population
- Adults aged ≥ 65 years undergoing hip-fracture surgery, Q1 2015 to Q4 2023, 172 acute-care hospitals in Aichi Prefecture, Japan (DPC/PDPS data)
- Participants
- 78,224 adults
- Exposure
- Post-intervention vs pre-intervention
- Post-interventionn = 18,677
- Pre-interventionn = 59,547reference
- Outcome
- Quarterly initiation rate of any anti-osteoporosis medication prescription at discharge
Methodological detailssegmented interrupted time-series regression, 172 acute-care hospitals in Aichi Prefecture
- Segmented interrupted time-series regression
- 172 acute-care hospitals in Aichi Prefecture
Main finding
As reported in the abstract
Pre-policy slope, pp/year (95% CI 1.0-1.8; p < 0.001)
+ 1.4
Immediate level change after Secondary Fracture Prevention Continuous Management Fee (SFP-CMF) introduction, pp (95% CI 14.9-26.7; p < 0.001)
+ 20.8
Post-intervention slope over the subsequent 7 quarters (1.75 years), pp/year (95% CI 13.6-22.1; p < 0.001)
+ 17.8
Observational data: associations, not effects.
Further findings
Route-specific prescription (oral vs injectable)
- Most gains attributable to oral agents (vitamin D analogs, bisphosphonates); injectables rose briefly but subsequently declined
Original publication
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