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Calcium-vitamin D supplementation is cost effective


Clinical bottom line

Use of calcium and vitamin D supplementation to prevent hip fractures is cost saving in older women in institutions.


H Lilliu et al. Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Maturitas 2003 44: 299-305.


Bandolier 37-4 reported a study of calcium-vitamin D supplementation in older institutionalised women in France that demonstrated supplementation prevented hip fractures. The NNT to prevent hip fractures was about 20, and that for all fractures was 14. Bandolier speculated that the treatment was probably cost effective. This new economic analysis shows supplementation to be cost saving.


This was a retrospective economic analysis of the randomised trial reported in Bandolier 37, which has subsequently been replicated with similar results. It took the data from that study in terms of hip fractures only (not all fractures), together with costs of supplementation, days of treatment, and costs of hip fracture for seven European countries (Belgium, France, Germany, Holland, Spain, Sweden, UK). It calculated the incremental cost-effectiveness ratio for each country.


Daily cost of supplementation ranged from Euro 0.29 to Euro 0.54, and cost of fracture was Euro 7,032 to Euro 19,682. The costs of fracture were taken from literature sources, and these were initial costs, with usually a one-year period.

The average period of treatment in the supplementation group was 625 days. In the supplementation group of 1176 women there were 136 hip fractures, while in the placebo group of 1127 women there were 184 hip fractures.

The calculated net financial benefit ranged from Euro 70,000 to Euro 711,000 per 1,000 women treated. Supplementation cost was 8-24% of the total cost of hip fractures. The largest saving was in the UK, with one of the lowest cost of supplementation, and one of the highest costs for a hip fracture.


These results confirm the view that calcium-vitamin D supplementation should be cost effective in elderly institutionalised women. It probably underestimates the saving, taking into account only hip fractures, rather than all non-vertebral fractures, and including costs of hip fractures only for the first year.

This is a clear and understandable example of the use of a health economic analysis to underscore implementation. It implies that supplementation is likely to be cost effective for all patients at risk of hip fracture, where that risk approaches that similar to, or below, that in the original study.