Cost-effectiveness analysis of hip fracture prevention with vitamin D supplementation: a Markov micro-simulation model applied to the French population over ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-04-02

AUTHORS

K. Zarca, I. Durand-Zaleski, C. Roux, J-C. Souberbielle, A-M. Schott, T. Thomas, P. Fardellone, C-L. Benhamou

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.IntroductionVitamin 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.MethodsA 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.ConclusionsPopulation 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. More... »

PAGES

1797-1806

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00198-014-2698-1

DOI

http://dx.doi.org/10.1007/s00198-014-2698-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1030489320

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24691648


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39 schema:description 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.IntroductionVitamin 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.MethodsA 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.ConclusionsPopulation 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.
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45 schema:keywords ConclusionsPopulation
46 D insufficiency
47 D serum levels
48 D supplementation
49 D treatment
50 French population
51 Markov micro-simulation model
52 QALY
53 ability
54 acceptability curves
55 adaptation
56 adequate treatment
57 analysis
58 check
59 cost
60 cost-effective strategy
61 cost-effectiveness analysis
62 cost-effectiveness ratio
63 cost-effectiveness threshold
64 curves
65 data
66 effect
67 efficiency
68 elderly population
69 fracture occurrence
70 fracture prevention
71 fractures
72 greater effect
73 greater probability
74 hip fracture
75 hip fracture occurrence
76 hip fracture prevention
77 incidence
78 incremental cost-effectiveness ratio
79 initiation
80 insufficiency
81 level checks
82 levels
83 micro-simulation model
84 model
85 months
86 objective
87 occurrence
88 parameters
89 population
90 prevention
91 previous hip fracture
92 primary prevention
93 probability
94 range
95 ratio
96 realistic range
97 reimbursement schedules
98 schedule
99 screen
100 sensitivity analysis
101 serum levels
102 society
103 strategies
104 study
105 study population
106 supplementation
107 supplementation strategies
108 threshold
109 treat
110 treatment
111 treatment adaptation
112 vitamin D insufficiency
113 vitamin D serum levels
114 vitamin D supplementation
115 vitamin D supplementation strategies
116 vitamin D treatment
117 years
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