Do reductions in out-of-pocket expenses for dual energy X-ray absorptiometry scans translate to reduced fracture incidence amongst older Australians? A population-based study
This study aimed to compare fracture incidence in the elderly pre- and post-revision of bone density scan reimbursement guidelines, which changed in 2007. Fracture incidence by age group was calculated using population-specific data. Guideline changes did not appear to reduce fracture incidence in the study region located in south-eastern Australia.
In 2007, Medicare Australia revised reimbursement guidelines whereby individuals aged 70 years and over received reduced out-of-pocket expenses for dual energy X-ray absorptiometry (DXA) scans. The current study aims to determine whether fracture incidence in the elderly has changed since the revision of reimbursement guidelines.
Keyword searches of the two major radiological centres servicing the Barwon Statistical Division (BSD) were used to identify incident fractures for residents aged 75 years and over for 2006 and 2012. Pathological fractures were excluded. Fracture incidence by age strata (75–79 years, 80–84 years and 85+ years) were calculated using population-specific data from the Australian Bureau of Statistics (2006 and 2012). Standardised fracture ratios were calculated for men and women.
In total, 996 fracture events were identified for BSD residents during 2006 and 1260 identified in 2012. The standardised fracture ratios between 2006 and 2012 were 1.12 (95%CI 1.11, 1.25) for men and 1.08 (95%CI 1.11, 1.16) for women.
The change in reimbursement guidelines appears to have had little impact on reducing fracture incidence during this time frame for elderly men and women, in fact, fracture rates increased. Future research should investigate osteoporosis management following DXA over a longer time frame.
KeywordsFracture incidence Policy evaluation Reimbursement Bone mineral density
The study was supported by the Australian National Health and Medical Research Council (NHMRC; project 628582), the Geelong Region Medical Research Foundation and Amgen Europe (GmBH); however, the funding bodies played no part in the design or conduct of the study, the collection, management, analysis and interpretation of the data or in the preparation or review of the manuscript. SLB-O and LJW are supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowships (1107510 and 1064272, respectively) and KLH-K is supported by an Alfred Deakin Postdoctoral Research Fellowship.
Compliance with ethical standards
Conflict of interest
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