Vitamin D supplementation is a cost-effective intervention after posterolateral lumbar fusion: a systematic review

IF 0.2 Q4 ORTHOPEDICS

Current Orthopaedic Practice Pub Date : 2022-11-21 DOI:10.1097/BCO.0000000000001188

Dhiraj Patel, Matthew Lippel, David J. Lunardini, R. Monsey, Chason Ziino

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引用次数: 0

Abstract

Background: This study investigated the role of preoperative supplementation of 25(OH)D, a precursor of the active form of vitamin D, as a cost-effective strategy to decrease pseudarthrosis rates and overall healthcare burden after posterolateral fusion (PLF). Previous literature has emphasized the importance of vitamin D in bone health maintenance, spinal health, and outcomes in spinal fusion. Inadequate preoperative 25(OH)D levels may increase pseudarthrosis rates after PLF. Thus, a cost-estimation model was developed to determine the cost-effectiveness of both selective and nonselective 25(OH)D supplementation in PLF. Methods: Prevalence and cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean, lower, and upper bounds of 1-year cost-savings were calculated for both supplementation scenarios. Results: Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost-savings of $10,978,440 ($9,969,394 to $11,987,485) per 10,000 PLF cases. Nonselective 25(OH)D supplementation of all PLF patients was calculated to result in a mean cost-savings of $11,213,318 ($10,204,272 to $12,222,363) per 10,000 cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where revision PLF costs exceed $781.89 and prevalence of 25(OH)D deficiency ≥0.612%. Nonselective supplementation is cost-effective in clinical scenarios where revision PLF cost ≥$198.09 and prevalence of 25(OH)D deficiency ≥0.1645%. Conclusions: This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce overall healthcare burden after PLF. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the relatively lower cost of 25(OH)D supplementation compared with serum assays. Level of Evidence: Level III

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补充维生素D是腰椎后外侧融合术后一种具有成本效益的干预措施：一项系统综述

背景：本研究探讨了术前补充25（OH）D（活性维生素D的前体）作为一种成本效益高的策略在降低后外侧融合术（PLF）后假关节发生率和整体医疗负担方面的作用。先前的文献强调了维生素D在骨骼健康维护、脊柱健康和脊柱融合结果中的重要性。术前25（OH）D水平不足可能会增加PLF后假关节发生率。因此，开发了一个成本估算模型来确定PLF中选择性和非选择性补充25（OH）D的成本效益。方法：通过系统综述从已发表的文献中获得患病率和费用数据。血清25（OH）D测定和补充的成本从公共使用数据中获得。计算了两种补充方案的1年成本节约的平均值、下限和上限。结果：经计算，术前25（OH）D筛查和随后的选择性25（OHD）D补充可使每10000例PLF病例的平均成本节省10978440美元（9969394美元至11987485美元）。经计算，所有PLF患者的非选择性25（OH）D补充剂的平均成本为每10000例节省11213318美元（10204272美元至12222363美元）。单变量调整预测，在PLF翻修费用超过781.89美元、25（OH）D缺乏症患病率≥0.612%的临床情况下，选择性补充是一种具有成本效益的策略。在PLF修整费用≥198.09美元、25促进术前补充25（OH）D作为一种降低PLF后整体医疗负担的成本效益机制的作用。非选择性补充似乎比选择性补充更具成本效益，这可能是因为与血清测定相比，补充25（OH）D的成本相对较低。证据级别：三级

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来源期刊

Current Orthopaedic Practice ORTHOPEDICS-

CiteScore

0.60

自引率

0.00%

发文量

107

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Current Orthopaedic Practice is a peer-reviewed, general orthopaedic journal that translates clinical research into best practices for diagnosing, treating, and managing musculoskeletal disorders. The journal publishes original articles in the form of clinical research, invited special focus reviews and general reviews, as well as original articles on innovations in practice, case reports, point/counterpoint, and diagnostic imaging.