The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden.

OBJECTIVE The objective of this study was to examine the economics of administering calcium and vitamin D3 to post-menopausal women in Sweden. We focus primarily on the cost-effectiveness of treating older women for whom clear evidence of efficacy is available. We supplement this information, however, with estimates of the cost-effectiveness of treating certain high-risk groups of younger women, while acknowledging the greater uncertainty involved. METHODS We developed a Markov model for analyzing the occurrence and timing of hip fractures, based almost entirely on peer-reviewed data from Sweden. In a 3-year randomized clinical trial, the combination of calcium and vitamin D3 was shown to reduce the risk of hip fractures by 27%. Costs for treating hip fractures were based on 1,080 women who were hospitalized in Stockholm. RESULTS Treatment of 70-year-old women was cost saving at efficacy as low as two-thirds that seen in the clinical trials, and upwards. Even at modest rates of efficacy, treatment of the high-risk 50- and 60-year-old cohorts was generally cost-effective and in some cases even cost saving. Particularly cost-effective was treatment of women with identified osteoporosis or a maternal family history of hip fracture. CONCLUSION Simulation results suggest a role for lifetime treatment of older women with calcium and vitamin D3 in Sweden. While there is more uncertainty underlying the treatment of younger women, our simulation results suggest that treatment may also be cost saving or at least cost-effective for many cohorts of high-risk 50- and particularly 60-year-old women, in particular those with osteoporosis or a maternal family history of hip fracture.