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Summary <p>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.</p> Purpose <p>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.</p> Methods <p>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&#xa0;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).</p> Results <p>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 &lt; 0.001). SFP-CMF introduction was followed by an immediate + 20.8&#xa0;pp change (95% CI 14.9–26.7; p &lt; 0.001) and a + 17.8&#xa0;pp/year post-intervention slope (95% CI 13.6–22.1; p &lt; 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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年10月15日

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  • Yasuhiko Takegami,
  • Takahiro Imaizumi,
  • Kikue Sato,
  • Yusuke Osawa,
  • Hiroto Funahashi,
  • Shiro Imagama

摘要

Summary

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.