Impact of a national reimbursement policy on anti-osteoporosis medication prescription at discharge after hip-fracture surgery in Japan: an interrupted time-series analysis.

UNLABELLED: A 2022 pay-for-performance fee in Japan increased the rate of post-hip-fracture osteoporosis treatment (primarily oral agents) by 20.8 percentage points and tripled the annual uptake trend in an interrupted time-series analysis of 78,224 patients. Financial incentives embedded within national fee schedules may help close gaps in secondary fracture prevention.

PURPOSE: Although osteoporosis treatment is essential for preventing secondary fractures, many patients remain untreated after hip-fracture surgery. Accordingly, Japan introduced a three-stage reimbursement add-on, the Secondary Fracture Prevention Continuous Management Fee (SFP-CMF) in April 2022. We assessed its real-world impact on anti-osteoporosis medication prescription at discharge.

METHODS

Using data from Japan's Diagnosis Procedure Combination Per-Diem Payment System (DPC/PDPS) covering 172 acute-care hospitals in Aichi Prefecture, we identified a retrospective cohort of adults aged ≥ 65 years who underwent hip-fracture surgery between the first quarter of 2015 and fourth quarter of 2023. Quarterly initiation rates for any osteoporosis medication were analyzed using segmented interrupted time-series regression to estimate changes in level and slope associated with the 2022 reimbursement policy, with brief route-specific description (oral vs. injectable).

RESULTS

We included 78,224 patients (59,547 pre-intervention; 18,677 post-intervention). Before the policy, discharge prescription increased slowly (+ 1.4 percentage points [pp]/year; 95% CI 1.0-1.8; p < 0.001). SFP-CMF introduction was followed by an immediate + 20.8 pp change (95% CI 14.9-26.7; p < 0.001) and a + 17.8 pp/year post-intervention slope (95% CI 13.6-22.1; p < 0.001) over the subsequent 7-quarter (1.75-year) period. Most gains were attributable to oral agents (vitamin D analogs, bisphosphonates); injectables rose briefly but subsequently declined.

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. The concomitant decline in injectables suggests that route-specific implementation merits monitoring, and further evaluation across post-discharge phases and fracture outcomes is warranted.