Budget Impact Analysis of Fracture Risk Assessment (FRAX) Based Treatment Strategy Selection in Patients With Glucocorticoid-Induced Osteoporosis (GIOP)

OBJECTIVES: This study aims to perform a budget impact analysis of fracture risk assessment(FRAX)-based strategies for treating glucocorticoid-induced osteoporosis(GIOP) patients, as recommended by clinical guidelines. The ultimate goal is to generate evidence for effective fracture prevention in glucocorticoid users.

METHODS: Claims data for GIOP patients from the National Health Insurance Service(NHIS) in 2012-2019 and a literature review including NECA(2010) were used. After the selection process, 2,520,896 patients were included in the analysis of fracture incidence under the current BMD-based reimbursement criteria. A budget impact analysis was conducted on 1,683,936 patients who did not meet the current reimbursement criteria and were not receiving osteoporosis medications. A budget impact for GIOP using the FRAX formula(Ha et al., 2016) was estimated using a Markov model.

RESULTS: The current reimbursement criteria using BMD appear to be restrictive for patients in their 40s, covering only 0.13% of the population, while at least one major osteoporotic fracture occurred in 0.28% of this group(0.36% for males and 0.19% for females). Three fracture risk thresholds(HR=1.0, 1.2, 1.4) of FRAX were utilized in the budget impact scenarios, alongside coverage for the entire GIOP patient population(S1). The highest annual budget impact was observed in S1, amounting to 350 million USD, while the lowest was for HR≥1.4(S4) at 17 million USD. Nevertheless, S1 was the most cost-effective in preventing osteoporotic fractures, with a cost of 100K USD per fracture prevented, compared to 240K USD per fracture for S4.

CONCLUSIONS: This study demonstrated the utility of measuring fracture risk using FRAX in establishing treatment strategies for GIOP patients over current BMD-based strategies. However, reimbursement criteria based on risk prediction require a formula that more accurately predicts fracture incidence in cases where FRAX cannot be used.