A Cost Analysis of Systematic Vitamin D Supplementation in the Elderly Versus Supplementation Based On Assessed Requirements - A Cost Analysis of Systematic Vitamin D Supplementation in the Elderly Versus Supplementation Based On Assessed Requirements - Open Access Pub

Hypovitaminosis D is common among older people and treatment with vitamin D is associated with reduced risk of falls and fractures. This paper provides a cost analysis of assessing the vitamin D status of and providing the pharmaceuticals for elderly citizens in Kalmar County, Sweden (population approximately 230,000). Four hypothetical interventions were analyzed: (a) systematic vitamin D/calcium supplementation to all elderly (≥75 years), (b) assessment of vitamin D status in elderly and supplementation to those with insufficient levels, (c) systematic vitamin D/calcium supplementation to all nursing-home residents, and (d) assessment of vitamin D status in nursing-home residents and supplementation to those with insufficient levels. The calculations were based on an estimated reduction in overall costs due to the assessed number of hip fractures after vitamin D/calcium supplementation. The annual net economic benefit of vitamin D/calcium supplementation was estimated at (a) €304,000, (b) €860,000, (c) €755,000, and (d) €740,000. The provision of systematic vitamin D supplementation to nursing-home residents would provide a substantial net economic benefit to society and assessment of the vitamin D status before starting supplementation does not seem to be necessary. Although assessment of all elderly citizens would be more comprehensive, the true proportion with insufficient vitamin D levels in the general population is uncertain and to reaching consensus on the most advantageous daily vitamin D intake, vitamin D blood levels are necessary. Also, systematic supplementation to all elderly would result in other outcomes that could be worth the cost, but that remains to be evaluated. DOI10.14302/issn.2474-7785.jarh-17-1724 Vitamin D is essential for skeletal metabolism, muscle function, calcium homeostasis, and the immune system 1. It has also been presented as a preventive factor for chronic diseases such as cardiovascular disease, type 2 diabetes, autoimmune diseases, and various cancers 2, 3, 4, and for non-vertebral and hip fractures in older patients 2, 3, 5. Furthermore, low vitamin D levels are reported to be associated with increased mortality among the elderly in Sweden 6, 7. The main source of vitamin D is from sensible sun exposure, and other sources are food and dietary supplements 1, 8. People at risk of insufficient vitamin D levels include the elderly and individuals with limited sun exposure, such as those in nursing homes 9. Moreover, the elderly often avoid direct sunlight and also have a reduced capacity to synthesize vitamin D in