[en] BACKGROUND: The supplementation with vitamin D and calcium has been recommended for elderly, specifically those with increased risk of fractures older than 65 years. This study aims to assess the cost-effectiveness of vitamin D and calcium supplementation in elderly women and men with osteoporosis and therefore to assess if this recommendation is justified in terms of cost-effectiveness. METHODS: A validated model for economic evaluations in osteoporosis was used to estimate the cost per quality-adjusted life-year (QALY) gained of vitamin D/calcium supplementation compared with no treatment. The model was populated with cost and epidemiological data from a Belgian health-care perspective. Analyses were conducted in women and men with a diagnosis of osteoporosis (i.e. bone mineral density T-score </=-2.5). A literature search was conducted to describe the efficacy of vitamin D and calcium in terms of fracture risk reduction. RESULTS: The cost per QALY gained of vitamin D/calcium supplementation was estimated at euro40 578 and euro23 477 in women and men aged 60 years, respectively. These values decreased to euro7912 and euro10 250 at the age of 70 years and vitamin D and calcium supplementation was cost-saving at the age of 80 years, meaning that treatment cost was less than the costs of treating osteoporotic fractures of the no-treatment group. CONCLUSION: This study suggests that vitamin D and calcium supplementation is cost-effective for women and men with osteoporosis aged over 60 years. From an economic perspective, vitamin D and calcium should therefore be administrated in these populations including those also taking other osteoporotic treatments.
Disciplines :
General & internal medicine
Author, co-author :
Hiligsmann, Mickaël ; Université de Liège - ULiège > Département des sciences de la santé publique > Département des sciences de la santé publique
Ben Sedrine, Wafa
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Evers, Silvia M.
Rabenda, Véronique ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Language :
English
Title :
Cost-effectiveness of vitamin D and calcium supplementation in the treatment of elderly women and men with osteoporosis.
Publication date :
2015
Journal title :
European Journal of Public Health
ISSN :
1101-1262
eISSN :
1464-360X
Publisher :
Oxford University Press, Oxford, United Kingdom
Volume :
25
Issue :
1
Pages :
20-25
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
(c) The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Svedbom A, Hernlund E, Ivergard M, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 2013;8:137.
Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007;92: 1415-23.
Tang BM, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007;370:657-66.
Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013; 24:23-57.
Rizzoli R, Boonen S, Brandi ML, et al. The role of calcium and vitamin D in the management of osteoporosis. Bone 2008;42:246-9.
Si L, Winzenberg TM, Palmer AJ. A systematic review of models used in cost-effectiveness analyses of preventing osteoporotic fractures. Osteoporos Int 2014;25:51-60.
Hiligsmann M, Ethgen O, Bruyere O, et al. Development and validation of a Markov microsimulation model for the economic evaluation of treatments in osteoporosis. Value Health 2009;12:687-96.
Hiligsmann M, Ben Sedrine W, Bruyere O, Reginster JY. Cost-effectiveness of strontium ranelate in the treatment of male osteoporosis. Osteoporos Int 2013;24: 2291-300.
Hiligsmann M, Rabenda V, Gathon HJ, et al. Potential clinical and economic impact of nonadherence with osteoporosis medications. Calcif Tissue Int 2010;86:202-10.
Hiligsmann M, Reginster JY. Cost effectiveness of denosumab compared with oral bisphosphonates in the treatment of post-menopausal osteoporotic women in belgium. Pharmacoeconomics 2011;29:895-911.
Hiligsmann M, Ben Sedrine W, Reginster JY. Cost-effectiveness of bazedoxifene compared with raloxifene in the treatment of postmenopausal osteoporotic women. J Bone Miner Res 2013;28:807-15.
Hiligsmann M, Bruyere O, Roberfroid D, et al. Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000-2007). Arthritis Care Res 2012;64:744-50.
Melton LJ III, Gabriel SE, Crowson CS, et al. Cost-equivalence of different osteo-porotic fractures. Osteoporos Int 2003;14:383-8.
Hiligsmann M, Ethgen O, Richy F, Reginster JY. Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcif Tissue Int 2008;82: 288-92.
Silverman SL, Minshall ME, Shen W, et al. The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum 2001;44:2611-9.
Salaffi F, Cimmino MA, Malavolta N, et al. The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. J Rheumatol 2007;34:1551-60.
Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007;92: 1415-23.
Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 2000;11:669-74.
Johansson H, Kanis JA, McCloskey EV, et al. A FRAX(R) model for the assessment of fracture probability in Belgium. Osteoporos Int 2011;22:453-61.
Kanis JA, Oden A, Johnell O, et al. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 2001;12:417-27.
Haentjens P, Magaziner J, Colon-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-90.
Kanis JA, Oden A, Johnell O, et al. Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 2004;15:108-12.
Kanis JA, Oden A, Johnell O, et al. The components of excess mortality after hip fracture. Bone 2003;32:468-73.
Cleemput I, van Wilder P, Huybrechts M, Vrijens F. Belgian methodological guidelines for pharmacoeconomic evaluations: toward standardization of drug reimbursement requests. Value Health 2009;12:441-9.
Hiligsmann M, Gathon HJ, Bruyere O, et al. Hospitalisation costs of hip fractures in Belgium. Osteoporos Int 2011:Abstract. 11th ECCEO.
Autier P, Haentjens P, Bentin J, et al. Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int 2000;11:373-80.
Reginster JY, Gillet P, Ben Sedrine W, et al. Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 1999;15:507-14.
Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009;169:551-61.
Zethraeus N, Borgstrom F, Strom O, et al. Cost-effectiveness of the treatment and prevention of osteoporosis-a review of the literature and a reference model. Osteoporos Int 2007;18:9-23.
Strom O, Borgstrom F, Sen SS, et al. Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries-an economic evaluation based on the fracture intervention trial. Osteoporos Int 2007;18: 1047-61.
Kanis JA, Oden A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012;23: 2239-56.
Rejnmark L, Avenell A, Masud T, et al. Vitamin D with calcium reduces mortality: patient level pooled analysis of 70, 528 patients from eight major vitamin D trials. J Clin Endocrinol Metab 2012;97:2670-81.
Lin J, Manson JE, Lee IM, et al. Intakes of calcium and vitamin D and breast cancer risk in women. Arch Intern Med 2007;167:1050-9.
Wang L, Manson JE, Song Y, Sesso HD. Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010;152: 315-23.
Moyer VA. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013;158:691-6.
Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012;367:40-9.