Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

Objectives: To evaluate the health outcomes and economics associated with the current guidance relating to the prevention of falls in the elderly through vitamin D supplementation. Setting: UK. Participants: UK population aged 60 years and above. Interventions: A Markov health state transition model simulated patient transitions between key fall-related outcomes using a 5-year horizon and annual cycles to assess the costs and benefits of empirical treatment with colecalciferol 800 iu daily. Primary and secondary outcome measures: Costs and health outcomes attributable to fall prevention following vitamin D supplementation. Results: Our model shows that treating the UK population aged 60 years and above with 800 iu colecalciferol would, over a 5-year period: (1) prevent in excess of 430 000 minor falls; (2) avoid 190 000 major falls; (3) prevent 1579 acute deaths; (4) avoid 84 000 person-years of long-term care and (5) prevent 8300 deaths associated with increased mortality in long-term care. The greatest gains are seen among those 75 years and older. Based on reduction in falls alone, the intervention in all adults aged 65+ is cost-saving and leads to increased quality adjusted life years. Treating all adults aged 60+ incurs an intervention cost of 2.70bn pound over 5 years, yet produces a -3.12bn pound reduction in fall-related costs; a net saving of 420M pound. Increasing the lower bound age limit by 5-year increments increases budget impact to -1.17bn pound, -1.75bn pound, and -2.06bn pound for adults 65+, 70+ and 75+, respectively. Conclusions: This study shows that treatment of the elderly UK population with colecalciferol 800 iu daily would be associated with reductions in mortality and substantial cost-savings through fall prevention.