title: 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: We performed a cost-effectiveness analysis of four vitamin D supplementation strategies for primary prevention of hip fracture among the elderly population and found that the most cost-effective strategy was screening for vitamin D insufficiency followed by adequate treatment to attain a minimum 25(OH) serum level.
  
  
  BACKGROUND
  Vitamin D supplementation has a demonstrated ability to reduce the incidence of hip fractures. The efficiency of lifetime supplementation has not yet been assessed in the population over 65 years without previous hip fracture. The objective was to analyze the efficiency of various vitamin D supplementation strategies for that population.
  
  
  METHODS
  A Markov micro-simulation model was built with data extracted from published studies and from the French reimbursement schedule. Four vitamin D supplementation strategies were evaluated on our study population: (1) no treatment, (2) supplementation without any serum level check; (3) supplementation with a serum level check 3 months after initiation and subsequent treatment adaptation; (4) population screening for vitamin D insufficiency followed by treatment based on the vitamin D serum level.
  
  
  RESULTS
  "Treat, then check" and "screen and treat" were two cost-effective strategies and dominated "treat without check" with incremental cost-effectiveness ratios of €5,219/quality-adjusted life-years (QALY) and €9,104/QALY, respectively. The acceptability curves showed that over €6,000/QALY, the "screen and treat" strategy had the greatest probability of being cost-effective, and the "no treatment" strategy would never be cost-effective if society were willing to spend over €8,000/QALY. The sensitivity analysis showed that among all parameters varying within realistic ranges, the cost of vitamin D treatment had the greatest effect and yet remained below the WHO cost-effectiveness thresholds.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hôpital Hôtel Dieu, URC Eco Ile-de-France (AP-HP), 1 Place du Parvis Notre Dame, 75004, Paris, France, kevin.zarca@urc-eco.fr.
authors.forename: K
authors.initials: K
authors.lastname: Zarca
authors.forename: I
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: C
authors.initials: C
authors.lastname: Roux
authors.forename: J-C
authors.initials: JC
authors.lastname: Souberbielle
authors.forename: A-M
authors.initials: AM
authors.lastname: Schott
authors.forename: T
authors.initials: T
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: Fardellone
authors.forename: C-L
authors.initials: CL
authors.lastname: Benhamou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006620:Hip Fractures / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics; D017059:Models, Econometric; D010024:Osteoporosis / Q000188:drug therapy / Q000191:economics; D058866:Osteoporotic Fractures / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D014807:Vitamin D / Q000191:economics* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000175:diagnosis; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D