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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

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Abstract

Summary

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.

Introduction

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.

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Acknowledgments

The authors are deeply indebted to Ms Karen Berg Brigham (URC Eco Ile-de-France (AP-HP), Paris, France) for her insightful comments on the manuscript.

Conflicts of interest

All authors received fees for this work by Merck Sharp Dohme Laboratories France, either as a consulting fee, fees for participation in review activities, or support for travel to meetings for the study. Kevin Zarca reports no relevant financial activities outside this study. Isabelle Durand-Zaleski reports the following as relevant financial activities outside this study: consultancy fees (BMS, Sanofi, Medtronic, Abbott), payment for lectures (BMS, Sanofi), payment for development of educational presentations (BMS, Abbott). Christian Roux reports the following as relevant financial activities outside this study: advisory board membership (MSD, Lilly, Novartis, AMGEN), grants (Lilly, Bongrain, MSD), payment for lectures (MSD, Lilly, AMGEN, UCB). Jean-Claude Souberbielle reports no relevant financial activities outside this study. Anne-Marie Schott reports no relevant financial activities outside this study.

Thierry Thomas reports the following as relevant financial activities outside this study: consultancy fees (AMGEN, Genévrier, GSK, Lilly, Merck, Novartis, Servier), payment for lectures (AMGEN, Genévrier, GSK, Lilly, Merck, Novartis, Servier), grants (Amgen, Chugaï, Merck, Novartis, Pfizer, Roche, Servier, UCB, and Warner-Chilcott). Patrice Fardellone reports the following as relevant financial activities outside this study: board membership (Amgen, MSD, Candia, Roche, Roche-Chugaï), grants (Roche-Chugaï), payment for lectures (Abbvie, Lilly, Pfizer, BMS, UBS, Servier, Ipsen). Claude-Laurent Benhamou reports the following as relevant financial activities outside this study: board membership (Novartis, Lilly, Roche), consultancy (Rottapharm), grants (AMGEN, Servier).

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Authors and Affiliations

  1. Hôpital Hôtel Dieu, URC Eco Ile-de-France (AP-HP), 1 Place du Parvis Notre Dame, 75004, Paris, France

    K. Zarca

  2. Department of Public Health, Henri Mondor-Albert Chenevier Hospitals (AP-HP), Créteil, France

    K. Zarca & I. Durand-Zaleski

  3. URC Eco Ile-de-France (AP-HP), Paris, France

    I. Durand-Zaleski

  4. LIC E4393, Faculty of Medicine, IFR10, University Paris-Est, Créteil, France

    I. Durand-Zaleski

  5. Department of Rheumatology, Cochin Hospital (AP-HP), Paris, France

    C. Roux

  6. Paris-Descartes University, Paris, France

    C. Roux & J-C. Souberbielle

  7. Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, Epidemiology of musculo-skeletal disorders, INSERM U1153, Paris, France

    C. Roux

  8. Department of Physiology/Functional Exploration, Necker Hospital (AP-HP), Paris, France

    J-C. Souberbielle

  9. INSERM U845, Necker Hospital (AP-HP), Paris, France

    J-C. Souberbielle

  10. Department of Epidemiology, Hospices Civils de Lyon, Lyon, France

    A-M. Schott

  11. INSERM U1033, Lyon 1 University, Lyon, France

    A-M. Schott

  12. Department of Rheumatology, University Hospital of Saint-Etienne, Saint-Etienne, France

    T. Thomas

  13. INSERM U1059, University Hospital of Saint-Etienne, Saint-Etienne, France

    T. Thomas

  14. Department of Rheumatology, University Hospital of Amiens, Amiens, France

    P. Fardellone

  15. INSERM U1088, University of Picardie - Jules Verne, Amiens, France

    P. Fardellone

  16. Department of Rheumatology, Hospital of Orleans, Orleans, France

    C-L. Benhamou

  17. ECEVE - UMR1123 - INSERM, Paris, France

    I. Durand-Zaleski

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  1. K. Zarca
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  2. I. Durand-Zaleski
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  3. C. Roux
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  4. J-C. Souberbielle
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Correspondence to K. Zarca.

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Zarca, K., Durand-Zaleski, I., Roux, C. et al. 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. Osteoporos Int 25, 1797–1806 (2014). https://doi.org/10.1007/s00198-014-2698-1

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