Uptake of an exercise class and use of bone density measurement after advice by the health insurance fund: results from the osteoporotic fracture prevention program in rural areas (OFRA)

Roigk, Patrick; Büchele, Gisela; Rehm, Martin; Schulz, Claudia; König, Hans‐Helmut; Becker, Clemens; Rapp, Kilian

doi:10.1007/s40520-020-01506-2

Cited by 2 publications

(5 citation statements)

References 31 publications

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“…23 16.7% received DXA bone density measurement and 51.8% advice on safety in the living environment. 19 Intervention costs were 260.10€ per individual. 62.85€ occurred before and 197.25€ during OFRA (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, we calculated a share of costs for the IG as follows: Of 9681 IG individuals, 29.6% (n = 2866) attended a class. 19 As recorded by the SVLFG, there were 1733 classes during the period from October 2015 to December 2017 with an average participation rate of 11.2, 20 which equals n = 19,410 class participants. Of those, 2866 belonged to the IG, which is a share of 14.8%.…”

Section: Intervention Costsmentioning

confidence: 99%

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Health-Economic Evaluation of the German Osteoporotic Fracture Prevention Program in Rural Areas (OFRA): Mobility and Falls Prevention Classes, Examination of Bone Health, and Consultation on Safety in the Living Environment

et al. 2022

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Background Fragility fractures are one of the leading causes of disability in older adults. Yet, evidence for effectiveness and cost-effectiveness of preventive approaches combining bone health and fall prevention is rare. Objective To conduct a health-economic evaluation of the German osteoporotic fracture prevention program in rural areas (OFRA). Design Secondary cluster–randomized intervention study based on routine data. Participants All districts in five federal states in Germany were cluster-randomized as intervention or control districts. OFRA was offered to community-living (a) women aged 75–79 years or (b) women and men aged 70–84 years with a prior fragility fracture in the intervention districts. Individuals who meet these criteria in the control districts were assigned to the control group. Intervention OFRA comprised mobility and falls prevention classes, examination of bone health by bone density measurement, and consultation on safety in the home living environment. Main Measures We measured health-care costs and effectiveness in terms of time to fragility fracture or death within 1 year after initial contact, based on health insurance claims data. Implementation costs were recorded by the intervention performers. We calculated an incremental cost-effectiveness ratio (ICER) and employed the net-benefit approach to construct a cost-effectiveness acceptability curve (CEAC). Key Results There were 9408 individuals in the intervention group and 27,318 in the control group. Mean time to fragility fracture or death (difference: 0.82 days) and health-care costs (difference: 111.73€, p < .01) were reduced, but mean intervention costs (difference: 260.10€) increased total costs (difference: 148.37€, p < .001) in the intervention group. The ICER per fracture-free year of survival was 66,094.63€. The CEAC showed no acceptable probability of cost-effectiveness at a reasonable willingness to pay. Conclusion OFRA showed reduced rates of fragility fractures, but had high implementation costs, resulting in an unfavorable ICER. The cost-effectiveness of OFRA may improve with a longer follow-up.

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Section: Resultsmentioning

confidence: 99%

Section: Intervention Costsmentioning

confidence: 99%

Health-Economic Evaluation of the German Osteoporotic Fracture Prevention Program in Rural Areas (OFRA): Mobility and Falls Prevention Classes, Examination of Bone Health, and Consultation on Safety in the Living Environment

et al. 2022

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“…Information who attended an exercise class was not available in the routine claims data. However, this information was derived by telephone interviews in a random subsample of 780 individuals [ 16 ]. The uptake of an exercise class was nearly 30% in the approached individuals in the intervention group, more than half participated in all six class sessions, and 59% stated of having continued with the home-based exercise after the end of the classes.…”

Section: Discussionmentioning

confidence: 99%

“…Fractures which did not need hospitalization were not captured. Furthermore, no information about falls or participation in an exercise class (beyond the information from a telephone interview of a random subgroup [ 16 ]) was available on an individual basis. The usual design for cluster-randomized trials is to assemble clusters of participants prior to randomization as this reduces important biases.…”

Section: Discussionmentioning

confidence: 99%

“…The study database was merged with the routine data collection system of the health insurance company to gain data on incident fractures, reimbursed DXA measurements, new prescriptions of specific anti-osteoporotic drugs (bisphosphonates and denosumab; ATC-codes: M05BA, M05BB, M05BX) prescribed after discharge and dispensed by community pharmacists, nursing home admission, and death. Information about uptake of a “Trittsicher”-mobility and falls prevention exercise class was derived from a telephone interview of a random subsample of 780 selected individuals of the intervention districts since this information was not available in the routine data collection system [ 16 ]. The information on advice given to individuals on “safety in the living environment” was extracted from the records of feedback from the prevention managers to the telecentres.…”

Section: Methodsmentioning

confidence: 99%

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Effect of an osteoporotic fracture prevention program on fracture incidence in routine care: a cluster-randomized trial

Rapp

Lamb

Roigk

et al. 2022

BMC Med

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Background Fractures are a major health problem in aging societies. Preventive approaches combining bone health and fall prevention are rare. The osteoporotic fracture prevention program in rural areas (OFRA) is a health care fund-driven program for older people in randomly selected districts in Germany. The components of the program were falls prevention exercise classes, examination of bone health by a dual-energy X-ray absorptiometry (DXA) scan, and a consultation about “safety in the living environment.” The aim of this study was to evaluate this complex preventive intervention in a routine health care setting. Methods This cluster-randomized trial was performed from October 2015 to October 2018 and took place in 186 administrative districts in five federal states, 47 districts served as intervention districts, and 139, as controls. Within these districts, we included (a) all community-living women and men aged 70–85 years with prior fragility fractures and (b) all community-living women aged 75–80 years. The analysis used routine data collected by a health insurance company. The primary endpoint was all fragility fractures combined. Fracture types, mortality, and nursing home admission were explorative endpoints. Cox frailty models were used for comparative analyses with a median follow-up time of 365 days (interquartile range: 0 days). Results Nine thousand four hundred eight individuals were approached to participate in one of the program components, 27,318 individuals served as controls. The mean age was 78.7 years. Of those approached to participate, nearly 30% joined the exercise classes. DXA measurement was reimbursed for 13.6%, and 51.8% received advice about measures to increase “safety in the living environment.” The incidence of fragility fractures did not differ between the intervention and the control group (HR 0.94; 95% CI 0.80–1.11). However, femoral fractures, the most frequent fracture type, were reduced in the intervention group (HR 0.76; 95% CI 0.59–0.99). Mortality and nursing home admission did not differ between the intervention and the control group. Conclusions A comprehensive fracture prevention program for older people living in rural areas was implemented. The program did not affect the primary endpoint of all fragility fractures combined. It has to be considered that we used a modified intention to treat approach based on geographic randomization and information about endpoints relied exclusively on routine data of the health care insurance. Trial registration German Clinical Trials Register DRKS-ID: 00009000

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Uptake of an exercise class and use of bone density measurement after advice by the health insurance fund: results from the osteoporotic fracture prevention program in rural areas (OFRA)

Cited by 2 publications

References 31 publications

Health-Economic Evaluation of the German Osteoporotic Fracture Prevention Program in Rural Areas (OFRA): Mobility and Falls Prevention Classes, Examination of Bone Health, and Consultation on Safety in the Living Environment

Health-Economic Evaluation of the German Osteoporotic Fracture Prevention Program in Rural Areas (OFRA): Mobility and Falls Prevention Classes, Examination of Bone Health, and Consultation on Safety in the Living Environment

Effect of an osteoporotic fracture prevention program on fracture incidence in routine care: a cluster-randomized trial

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