Introduction: Taiwan's national health insurance currently only covers the use of osteoporosis drugs for the secondary prevention of fractures and does not provide coverage for primary prevention. The purpose of this study is to develop a model for analyzing the budgetary impact of the use of osteoporosis medications of primary prevention. Methods: The budget impact model in this study is the “actual medication cost” minus the “medical expenses for all types of fractures that can be avoided by taking osteoporosis medications.” We developed six possible insurance payment plans for primary prevention based on the age of the patients and T-scores and performed eleven steps to estimate the budget impact of each payment plan. Results: The results of this study indicated that there may be 71,220 (T-score ≤ − 3.0, 75 + y/o) to 157,515 (T-score ≤ − 2.5, 65 + y/o) people using the drugs, and the budget impact may be US$26.28–58.98 million in 2019. However, the payment plans may avoid 492–766 fracture events and save medical expenditures for fracture treatment by US$1.30–2.02 million. The average costs for primary prevention within a year will be US$53,386–77,006. Conclusion: The budget impact of using osteoporosis medications to primary prevention of fractures is significant, but it can be compensated due to savings in fracture treatment costs.
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