血清25-羟基维生素D用于中国65岁及以上人群骨折风险筛查的成本效用分析OA

Objective This study aims to evaluate the health benefits and economic value of serum 25(OH)D screening among adults aged 65 and above in China.Methods A decision tree and a Markov model were developed to simulate the health benefits and costs of the"screening"strategy(screening group)versus the"non-screening"strategy(non-screening group)in the Chinese population aged 65 years and older.In both strategies,supplementation of vitamin D and calcium was based on individual willingness,except for vitamin D-sufficient individuals identified in the screening group,who did not supplement.Key baseline,clinical,cost,and utility parameters were derived from published literature,public databases,and expert interviews.One-way and probabilistic sensitivity analyses were conducted to assess parameter uncertainty.3 scenario analyses performed,targeting perimenopausal women,a region with a severely aged population(Sichuan Province),and varying levels of supplementation willingness.Results In the non-screening group,the willingness to supplement vitamin D and calcium among 25(OH)D-deficient individuals was 25.00%;in the screening group,the willingness rose to 65.00%among the same deficient population.Compared with the non-screening group,the screening group gained 0.014 incremental QALYs per person and saved 197.12 CNY in total lifetime costs per person.One-way sensitivity analysis showed that the incremental cost-utility ratio(ICUR)consistently remained below the willingness-to-pay threshold(95 749 CNY/QALY)regardless of parameter variation.Probabilistic sensitivity analysis showed that the screening strategy was dominant in 88.32%of simulations.Across all three scenarios—high-risk perimenopausal women(≥50 years),a region with a severely aged population(Sichuan Province),and varying assumptions regarding patient willingness to supplement—the screening strategy consistently demonstrated either cost savings(dominance)or a favorable cost-utility profile.Conclusion 25(OH)D screening in adults aged 65 and above can reduce fracture risk,improve health outcomes,and alleviate economic burden,representing a dominant strategy.