Cost-effectiveness of preventing hip fractures in the elderly population using vitamin D and calcium

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Abstract
Recent evidence suggests that vitamin D and calcium can reduce the incidence of hip fracture amongst elderly women. We estimated the costs of using either parenteral vitamin D alone, or oral vitamin D plus calcium, in a number of treatment strategies. These were: all women in a community setting; women with low body mass index (BMI) in the community; women in nursing homes; women with low BMI in nursing homes. The cost per averted fracture amongst women living in the community through the use of parenteral vitamin D alone was £946, and the cost per averted hip fracture was £2317. Inclusion of calcium significantly increased the cost to £14 240 for any fracture and £22 379 for hip fractures. However, targeting either treatment on women with the lowest BMI reduced the cost of averting a hip fracture, as did targeting women living in nursing homes. After removing cost savings from treatment costs, savings to the NHS occurred for all parenteral vitamin D strategies but only one of the oral vitamin D and calcium strategies. Preventing fractures with injectable vitamin D is likely to produce savings for the NHS. The addition of calcium will increase costs significantly, unless the intervention is targeted on those at high risk.

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