@article{ref1,
title="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",
journal="Journal of general internal medicine",
year="2022",
author="Konnopka, Claudia and Büchele, Gisela and Rothenbacher, Dietrich and Roigk, Patrick and Rapp, Kilian and König, Hans-Helmut",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="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. <br><br>OBJECTIVE: To conduct a health-economic evaluation of the German osteoporotic fracture prevention program in rural areas (OFRA). <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0884-8734",
doi="10.1007/s11606-022-07691-2",
url="http://dx.doi.org/10.1007/s11606-022-07691-2"
}