Comparison of cost-effectiveness of vitamin D screening with that of universal supplementation in preventing falls in community-dwelling older adults

J Am Geriatr Soc. 2013 May;61(5):707-14. doi: 10.1111/jgs.12213. Epub 2013 Apr 30.


Objectives: To compare the cost-effectiveness of population screening for vitamin D insufficiency with that of universal vitamin D supplementation in community-dwelling older adults.

Design: A Markov decision model simulating follow-up over a 36-month period. Published data were used to estimate values for the model, including costs (measured in 2011 U.S. dollars), utilities (measured in quality-adjusted life years (QALYs)), and probabilities.

Setting: Decision analysis simulation from a societal perspective.

Participants: Hypothetical cohort of community-dwelling women and men aged 65 to 80.

Measurements: Net monetary benefit (NMB) was calculated by subtracting the incremental cost of the strategy from the product of incremental QALYs and willingness-to-pay threshold. A higher NMB indicates greater cost-effectiveness.

Results: In women aged 65 to 80, population screening was slightly more cost-effective than universal supplementation, with an incremental NMB of $224 compared with $189 (P < .001). Population screening in men was also more cost-effective than universal supplementation (incremental NMB $298 vs $260, P < .001). Results differed according to age group. In those aged 65, population screening had cost-effectiveness similar to that of universal supplementation in women ($59 vs $71) and men ($114 vs $120), whereas in those aged 80, population screening was substantially more cost-effective than universal supplementation in women ($563 vs $428) and men ($703 vs $571).

Conclusion: Population screening and universal supplementation for vitamin D insufficiency are cost-effective strategies in community-dwelling older women and men. In the oldest old, population screening may be more cost-effective than universal supplementation.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / pharmacology
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Dietary Supplements / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Markov Chains
  • Mass Screening / economics*
  • Mass Screening / methods
  • Quality-Adjusted Life Years
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • Vitamin D / pharmacology*
  • Vitamin D Deficiency / economics
  • Vitamin D Deficiency / epidemiology
  • Vitamin D Deficiency / prevention & control*


  • Bone Density Conservation Agents
  • Vitamin D