Cost-effectiveness of vitamin D and calcium supplementation in the treatment of elderly women and men with osteoporosis

Hiligsmann, Mickaël; Sedrine, Wafa Ben; Bruyère, Olivier; Evers, Silvia M. A. A.; Rabenda, Véronique; Reginster, Jean-Yves

doi:10.1093/eurpub/cku119

Cited by 37 publications

(60 citation statements)

References 32 publications

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“…Our analysis also only considered the effect of a hip fracture service on the immediate perioperative period, and did not account for the future downstream benefit of increased initiation of osteoporosis treatment, which has been shown to be better in a comanagement model [22,28] and also to be net cost effective [31,32,35], but this is a much more remote benefit. Additionally, although a few studies have reported improved readmission rates with comanagement [5,39], others have reported no change [17,24,28,52].…”

Section: Discussionmentioning

confidence: 99%

“…Highquality economic studies have evaluated the benefits of directing resources toward the focused goal of reducing time to the operating room [19] and the benefits of early initiation of osteoporosis treatment [31,32,35]. Additionally, numerous studies have identified important predictors of perioperative complications, costs, and mortality [5,13,18,41,46,49,53,54,65], suggesting that different patient populations may have different predisposing risk factors, and thus experience different degrees of benefit from a comanagement system.…”

Section: Introductionmentioning

confidence: 99%

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Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. Questions/Purposes We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to ''break even'', and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Methods Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on a full-time basis. Additionally, we evaluated the scenario where the necessary staff was already employed at the hospital and could be dedicated to a comanagement service on a part-time basis, and explored the effect of triaging only patients considered high risk to a comanagement service versus comanaging all geriatric patients. Finally, probabilistic sensitivity analysis was conducted on all critical variables, with broad ranges used for values around which there was higher uncertainty. Results For the base case, universal comanagement was more cost effective than traditional care and risk-stratified comanagement (incremental cost effectiveness ratios of All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…To date, relatively few studies have assessed the public health and economic impact of vitamin D-fortified dairy products given to the general elderly population [14–17]. These studies suggest the public health and economic value of fortified dairy products.…”

Section: Introductionmentioning

confidence: 99%

Public health impact and economic evaluation of vitamin D-fortified dairy products for fracture prevention in France

et al. 2016

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SummaryThe recommended intake of vitamin D-fortified dairy products can substantially decrease the burden of osteoporotic fractures and seems an economically beneficial strategy in the general French population aged over 60 years.IntroductionThis study aims to assess the public health and economic impact of vitamin D-fortified dairy products in the general French population aged over 60 years.MethodsWe estimated the lifetime health impacts expressed in number of fractures prevented, life years gained, and quality-adjusted life years (QALY) gained of the recommended intake of dairy products in the general French population over 60 years for 1 year (2015). A validated microsimulation model was used to simulate three age cohorts for both women and men (60–69, 70–79, and >80 years). The incremental cost per QALY gained of vitamin D-fortified dairy products compared to the absence of appropriate intake was estimated in different populations, assuming the cost of two dairy products per day in base case.ResultsThe total lifetime number of fractures decreased by 64,932 for the recommended intake of dairy products in the general population over 60 years, of which 46,472 and 18,460 occurred in women and men, respectively. In particular, 15,087 and 4413 hip fractures could be prevented in women and men. Vitamin D-fortified dairy products also resulted in 32,569 QALYs and 29,169 life years gained. The cost per QALY gained of appropriate dairy intake was estimated at €58,244 and fall below a threshold of €30,000 per QALY gained in women over 70 years and in men over 80 years.ConclusionVitamin D-fortified dairy products have the potential to substantially reduce the burden of osteoporotic fractures in France and seem an economically beneficial strategy, especially in the general population aged above 70 years.

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“…Therefore calcium supplementation should only be targeted to those who do not get sufficient calcium from their diet and who are at high risk for osteoporosis and/or fracture 15 . Indeed, cost-benefit analyses have revealed that vitamin D and calcium supplementation is cost-effective for women and men with osteoporosis aged over 60 years and should therefore be administrated in these populations including those also taking other osteoporotic treatments 16 . In addition, patients with documented osteoporosis will derive further benefit in terms of fracture prevention from the addition of an antiresorptive agent 17 .…”

Section: Introductionmentioning

confidence: 99%

Phase IV randomized preference study in patients eligible for calcium and vitamin D supplementation

Thomasius

Nip

Ivan

2016

Current Medical Research and Opinion

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Cost-effectiveness of vitamin D and calcium supplementation in the treatment of elderly women and men with osteoporosis

Cited by 37 publications

References 32 publications

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Public health impact and economic evaluation of vitamin D-fortified dairy products for fracture prevention in France

Phase IV randomized preference study in patients eligible for calcium and vitamin D supplementation

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