BACKGROUND: Vitamin D deficiency is associated with an increased risk of fractures, particularly in the elderly population. Serum 25(OH)D is currently regarded as the most reliable indicator of vitamin D status. Supplementation with vitamin D and calcium has the potential to decrease fracture risk in individuals with vitamin D deficiency.

OBJECTIVES: The objective of this study is to evaluate the cost-effectiveness of the 25(OH)D screening strategy compared to non-screening for the prevention of fracture from the societal perspective among the population over 65 years old in China.

METHODS: A decision tree and Markov model were combined to estimate lifetime costs and quality-adjusted life-years (QALYs) for screening and non-screening strategies (with or without vitamin D and calcium supplementation). The effectiveness of vitamin D and calcium supplementation in reducing fracture risk was derived from the published meta-analysis. The proportion of the population who would take the supplements and the dosage was obtained through in-depth interviews. Epidemiologic, clinical, and cost data were collected from published literature or public databases. Uncertainties regarding key parameters were evaluated using deterministic and probabilistic sensitivity analyses.

RESULTS: Compared to the non-screening strategy, the screening strategy provides 0.014 additional QALY. The lifetime total costs per person were lower for the screening strategy at ¥11,140 compared with ¥11,287 for the non-screening strategy, i.e., a saving of ¥147 with ICER of ¥-1,939 per QALY gained. For every 10,000 patients screened for vitamin D deficiency, approximately 87 hip fractures and 2 vertebral fractures could be avoided. Both DSA and PSA confirmed the stability of the results.

CONCLUSIONS: Compared to the non-screening strategy, population-based 25(OH)D screening was projected to be cost-saving, resulting in increased QALY gains for primary prevention of fractures among the population over 65 years old in China.