Key result
Nonselective preoperative 25(OH)D supplementation in PLF patients was calculated to result in a mean cost-savings of $11,213,318 per 10,000 cases, appearing more cost-effective than selective screening.
Why the study?
Inadequate preoperative 25(OH)D levels may increase pseudarthrosis rates after posterolateral fusion, but the cost-effectiveness of preoperative supplementation strategies had not been determined.
Is preoperative 25(OH)D supplementation cost-effective in patients undergoing posterolateral lumbar fusion?
Systematic Review
Is preoperative 25(OH)D supplementation cost-effective in patients undergoing posterolateral lumbar fusion?
Preoperative nonselective vitamin D supplementation is a highly cost-effective strategy to reduce healthcare burden after posterolateral lumbar fusion.
Supports nonselective supplementation to lower PLF costs; extends economic models beyond selective screening.
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.
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Patel et al. (2022) conducted a systematic review in Posterolateral lumbar fusion (PLF). Preoperative 25(OH)D supplementation vs. Selective vs nonselective supplementation was evaluated on 1-year cost-savings per 10,000 PLF cases. Nonselective preoperative 25(OH)D supplementation in PLF patients was calculated to result in a mean cost-savings of $11,213,318 per 10,000 cases, appearing more cost-effective than selective screening.
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