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101 Cost-effectiveness of vitamin d and exercise in preventing injurious falls among older women
  1. Radhika Patil1,
  2. Päivi Kolu1,
  3. Jani Raitanen1,2,
  4. Jaakko Valvanne3,4,5,6,
  5. Pekka Kannus1,3,7,
  6. Saija Karinkanta1,
  7. Harri Sievänen1,
  8. Kirsti Uusi-Rasi1,8
  1. 1The UKK Institute for Health Promotion Research, Tampere, Finland
  2. 2School of Health Sciences, University of Tampere, Finland
  3. 3School of Medicine, University of Tampere, Finland
  4. 4Purchasing Committee for the Promotion of Senior Citizens’ Welfare, City of Tampere, Finland
  5. 5Gerontology Research Centre, Universities of Jyväskylä and Tampere, Finland
  6. 6Department of Internal and Respiratory Medicine, Tampere University Hospital, Finland
  7. 7Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Finland
  8. 8Research Department, Tampere University Hospital, Finland

Abstract

Background Costs of falling in older persons are high, both to individuals and to society. Both vitamin D and exercise are 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 conducted alongside a previously published 2-year randomised controlled trial 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+) 4) exercise + vitamin D 800 IU/day (D+Ex+). Outcomes were medically attended injurious falls and fall-related health care utilisation 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 €221 for D−Ex−, €708 for D−Ex+ and €3,820 for D+Ex+; bootstrapping indicated 93% probability that each injurious fall avoided by D−Ex+ per person-year costs €708. At a willingness to pay of €3,000 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.

  • Injurious falls
  • exercise
  • vitamin D
  • cost-effectiveness
  • elderly

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