Cost-effectiveness analysis of hip fracture prevention with vitamin D supplementation: a Markov micro-simulation model applied to the French population over 65 years old without previous hip fracture

Zarca, Kevin; Durand‐Zaleski, Isabelle; Roux, Christian; Jc, Souberbielle; Schott, Anne-Marie; Thomas, Thierry; Fardellone, Patrice; Cl, Benhamou

doi:10.1007/s00198-014-2698-1

Cited by 21 publications

(45 citation statements)

References 35 publications

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“…These data are consistent with cost-effectiveness assessments of universal vitamin D supplementation in older adults in the USA 9 and also in Western European populations but using fractures as the primary modifiable outcome. 10 11 …”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

2015

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ObjectivesTo evaluate the health outcomes and economics associated with the current guidance relating to the prevention of falls in the elderly through vitamin D supplementation.SettingUK.ParticipantsUK population aged 60 years and above.InterventionsA Markov health state transition model simulated patient transitions between key fall-related outcomes using a 5-year horizon and annual cycles to assess the costs and benefits of empirical treatment with colecalciferol 800 iu daily.Primary and secondary outcome measuresCosts and health outcomes attributable to fall prevention following vitamin D supplementation.ResultsOur model shows that treating the UK population aged 60 years and above with 800 iu colecalciferol would, over a 5-year period: (1) prevent in excess of 430 000 minor falls; (2) avoid 190 000 major falls; (3) prevent 1579 acute deaths; (4) avoid 84 000 person-years of long-term care and (5) prevent 8300 deaths associated with increased mortality in long-term care. The greatest gains are seen among those 75 years and older. Based on reduction in falls alone, the intervention in all adults aged 65+ is cost-saving and leads to increased quality adjusted life years. Treating all adults aged 60+ incurs an intervention cost of £2.70bn over 5 years, yet produces a −£3.12bn reduction in fall-related costs; a net saving of £420M. Increasing the lower bound age limit by 5-year increments increases budget impact to −£1.17bn, −£1.75bn, and −£2.06bn for adults 65+, 70+ and 75+, respectively.ConclusionsThis study shows that treatment of the elderly UK population with colecalciferol 800 iu daily would be associated with reductions in mortality and substantial cost-savings through fall prevention.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

2015

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“…The identified studies spanned a period of 20 years, with the earliest being published in 1995 and the majority emerging between 2012 and 2016. Studies were carried out in the UK (15)(16)(17)(18)(19), the USA (20,21), Australia (22,23), France (24), Finland (25), Sweden (26) and Germany (27). Additionally, there was one multi-country study that carried out cost-effectiveness analyses in seven European countries (28).…”

Section: General Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Additionally, there was one multi-country study that carried out cost-effectiveness analyses in seven European countries (28). The majority of studies (n=7) evaluated supplementation strategies of vitamin D alone in the adult population (16,17,20,21,(23)(24)(25). Other studies investigated calcium and vitamin D interventions either through oral supplements (n=4) (15,22,26,28) or food fortification (n=1) (27).…”

Section: General Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Eight studies evaluated interventions using supplements with vitamin D alone (16-18, 20-22, 24, 25) ( Table 1) and all except one (18) focused on the elderly population. Five were cost-utility analyses using quality-adjusted life-years (QALYs) to measure benefits (16,20,21,23,24), two were costeffectiveness analyses (17,25) and one was a cost-consequence analysis (18). Three studies compared universal supplementation against screening for VDD followed by supplementation (18,21,24), three studies evaluated vitamin supplements against interventions to prevent falls (20,23,25) and two evaluated supplements against current care to prevent fractures (17) and falls (16) .…”

Section: Supplementation With Vitamin D Alonementioning

confidence: 99%

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Preventing vitamin D deficiency (VDD): a systematic review of economic evaluations

Aguiar

Andronis

Pallan

et al. 2017

European Journal of Public Health

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“… 7 , 8 Additionally, studies have shown that calcium and vitamin D supplementation is a cost-effective method of preventing future fragility fractures in patients who have sustained a hip fracture. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

A Missed Opportunity in Bone Health: Vitamin D and Calcium Use in Elderly Femoral Neck Fracture Patients Following Arthroplasty

Sprague

Madden

Slobogean

et al. 2017

Geriatr Orthop Surg Rehabil

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Introduction:Introduction: Adequate calcium and vitamin D from diet and supplementation is recommended for elderly hip fracture patients. Using data from the multinational hip fracture arthroplasty trial (HEALTH), we determined the proportion of patients who consistently took vitamin D and calcium and which characteristics/prescribing practices were associated with consistency of supplement use.Methods:HEALTH is a multicenter randomized trial of elderly hip fracture patients treated with hemi-arthroplasty and total hip arthroplasty. Patients were categorized as consistent users, inconsistent users, or nonusers of calcium and vitamin D. We used multinomial regression to determine the characteristics associated with calcium and vitamin D use.Results:603 HEALTH participants were included in the analysis. 34.7% of patients never took vitamin D within 12 months after surgery, 26.2% took vitamin D inconsistently, and 39.1% took vitamin D consistently. 36.0% of patients never took calcium within 12 months after surgery, 28.4% took calcium inconsistently, and 35.7% took calcium consistently. There was great variation in prescribed/recommended doses. Compared to nonusers, consistent users of the supplements were more likely to be female, North American, prescribed/recommended vitamin D and/or calcium postoperatively, and presented to a facility with comprehensive fragility fracture protocols.Conclusions:A low proportion of elderly hip fracture patients are consistently taking vitamin D and calcium, which may contribute to poorer bone health. Surgeons should be educated to prescribe/ recommend vitamin D and calcium, institutions should develop comprehensive fragility fracture protocols and patient education strategies to ensure that patients with osteoporosis receive bone health management beyond fracture care.

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Cost-effectiveness analysis of hip fracture prevention with vitamin D supplementation: a Markov micro-simulation model applied to the French population over 65 years old without previous hip fracture

Abstract: Population screening for vitamin D insufficiency followed by treatment based on the vitamin D serum level is the most cost-effective strategy for preventing hip fracture occurrence in the population over 65 years old.

Cited by 21 publications

References 35 publications

Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

Preventing vitamin D deficiency (VDD): a systematic review of economic evaluations

A Missed Opportunity in Bone Health: Vitamin D and Calcium Use in Elderly Femoral Neck Fracture Patients Following Arthroplasty

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