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800 IU of vitamin D does not prevent enough falls to be cost effective - July 2015

Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT.

Osteoporos Int. 2015 Jul 24. [Epub ahead of print]
Patil R1, Kolu P, Raitanen J, Valvanne J, Kannus P, Karinkanta S, Sievänen H, Uusi-Rasi K.

1The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland, radhika.patil at uta.fi.

This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older home-dwelling Finnish women. Given a willingness to pay of <euro>3000 per injurious fall prevented, the exercise intervention had an 86 % probability of being cost-effective in this population.

INTRODUCTION:
The costs of falling in older persons are high, both to the individual and to society. Both vitamin D and exercise have been suggested to reduce the risk of falls. This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older Finnish women.

METHODS:
Economic evaluation was based on the results of a previously published 2-year randomized controlled trial (RCT) where 409 community-dwelling women aged 70 to 80 years were recruited into four groups: (1) no exercise + placebo (D-Ex-), (2) no exercise + vitamin D 800 IU/day (D+Ex-), (3) exercise + placebo (D-Ex+), and (4) exercise + vitamin D 800 IU/day (D+Ex+). The outcomes were medically attended injurious falls and fall-related health care utilization costs over the intervention period, the latter evaluated from a societal perspective based on 2011 unit costs. Incremental cost-effectiveness ratios (ICER) were calculated for the number of injurious falls per person-year prevented and uncertainty estimated using bootstrapping.

RESULTS:
Incidence rate ratios (95 % CI) for medically attended injurious falls were lower in both Ex+ groups compared with D-Ex-: 0.46 (0.22 to 0.95) for D-Ex+, 0.38 (0.17 to 0.81) for D+Ex+. Step-wise calculation of ICERs resulted in exclusion of D+Ex- as more expensive and less effective. Recalculated ICERs were <euro>221 for D-Ex-, <euro>708 for D-Ex+, and <euro>3820 for D+Ex+; bootstrapping indicated 93 % probability that each injurious fall avoided by D-Ex+ per person year costs <euro>708. At a willingness to pay <euro>3000 per injurious fall prevented, there was an 85.6 % chance of the exercise intervention being cost-effective in this population.

CONCLUSIONS:
Exercise was effective in reducing fall-related injuries among community-dwelling older women at a moderate cost. Vitamin D supplementation had marginal additional benefit. The results provide a firm basis for initiating feasible and cost-effective exercise interventions in this population.

PMID: 26205890 10.1007/s00198-015-3240-9 Publisher wants $40 for the PDF


See also VitaminDWiki

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