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POS1 |
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A PREVALENCE BASED COST
EVALUATION OF FRAGILITY FRACTURES IN THE
PHILIPPINES
Bonifacio LR1, Dela Rosa M2, Cañete A,
1Philippine Orhopaedic Association, Quezon, Metro
Manila, Philippines, 2Philippine Orthopaedic
Association, Quezon City, Manila, Philippines
OBJECTIVE:
Describes fragility fractures in the
country taking into account the prevalence of the
disease and appraisal of health care costs.
METHODS:
Epidemiological and costs data were
obtained from secondary sources. Female patients
°Y50 years with fractures of the hip, spine and
distal radius was considered as the surrogate
variable for fragility fractures. The Philippine
Health Insurance Corporation database, where a
total of 4670 records of patients with reported
spine fractures (11.7%, 545), distal radius
(48.8%, 2280) and hip (39.5%, 1845) were
considered in the estimation of the prevalence of
osteoporosis in 2004. Costs inputs were obtained
from randomly selected patients accounting records
from health facilities nationwide. Direct costs
include in-patient services and material costs.
The National Pension Fund (NPF) database provided
data on indirect costs covering present and future
production losses resulting from premature death,
morbidity or disability caused by the disease
provided figures on sickness reimbursements,
disability claims and death benefits. RESULTS:
Prevalence estimates relative to the total female
population according to age and fragility fracture
involving the spine, lower end of radius and hip,
showed 41%, with lower limit of 39.6 and upper
limit of 42.5 (SE=0.7). The prevalence proportion
for all age group is 67.9 for hip, 43.5 for spine
and 18.7 for distal radius. Cost valuation was
done for hip fractures, as it is most severe and
best documented. The NPF paid a minimum of 120
days and maximum of 240 days for sickness
reimbursements, an average of 35 months for
disability claims and lifetime pension for primary
beneficiary for premature deaths. CONLUSIONS:
Osteoporosis-related fractures are significant
public health problems that require a more
elaborate cost valuation assessment. Costs are
significantly affected by government subsidy,
monopoly of services and cross subsidization. A
sensitivity analysis is needed for extrapolating
costs estimates to the entire population.
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POS2 |
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PRICE AND UTILIZATION OF
OSTEOPOROSIS MEDICATIONS IN U.S. MEDICAID PROGRAMS
Knight D, Guo JJ, Shiyanbade H, Kelton CM,
University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE:
Approximately eight million women and
two million men in the U.S. suffer from
osteoporosis, a disease that causes over 1.5
million fractures each year. The cost to Medicaid
for anti-osteoporosis medications topped $85
million in the first quarter of 2004. The
objective of this study is to analyze price, cost,
utilization, and market shares of oral
anti-osteoporosis medications in U.S. Medicaid
programs, with the specific purpose of assessing
interbrand competition in a tightly oligopolistic
market. METHODS:
There are five oral medications
for osteoporosis, including Didrone (etidronate),
Skelid (tiludronate), Actonel (risedronate),
Fosamax (alendronate), and Evista (raloxifene).
Data from the First DataBank were used to
calculate the monthly Average Wholesale Price (AWP)
per daily dose for each drug over the period
1990-2004. Data from the National Medicaid
Pharmacy claims were used to calculate quarterly
drug prescriptions, market shares, and
reimbursements over essentially the same time
period. RESULTS:
The three most frequently
prescribed drugs are alendronate (utilization
reached 600,000 scripts in the 1st quarter 2004);
risedronate whose use increased from 90 scripts in
the 2nd quarter 1999 to 400,000 in the 1st quarter
2004; and raloxifene with utilization of 190,000
scripts in the 1st quarter 2004. Each of these
drugs has an AWP per daily dose in the
$2.00-to-$4.00 range. Interestingly, the Medicaid
cost per prescription for risedronate decreased
from $300 in 1999 to $80 in 2004. Though not
widely prescribed, the AWP for tiludronate is much
higher than for its competitors at $15.00 per
daily dose. CONLUSIONS:
There is no indication
that market shares or prices of branded
medications are responding to new entry in the
anti-osteoporosis drug market. Movement in prices
and utilization are driven much more by dosage and
compliance issues. |
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