Cost-Effectiveness of Vitamin D Supplementation in Pregnant Woman and Young Children in Preventing Rickets: A Modeling Study

Abstract

Background: Literature on the cost of management of rickets and cost-effectiveness of vitamin D supplementation in preventing rickets is lacking. Methods: This study considered the cost-effectiveness of providing free vitamin D supplementation to pregnant women and children <4 years of age with varying degrees of skin pigmentation to prevent rickets in children. Estimates for the prevalence of rickets were calculated using all cases of rickets diagnosed in Central Manchester, UK and census data from the region. Cost of management of rickets were calculated using National Health Service, UK tariffs. The efficacy of vitamin D supplementation was based on a similar programme implemented in Birmingham. Quality of life was assessed using utility estimates derived from a systematic literature review. In this analysis the intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) is below the National Institute for Health and Care Excellence, UK cost-effectiveness threshold of £20,000 per Quality-adjusted life year (QALY). Results: Fifty-seven patients (26 dark, 29 medium and 2 light skin tones) were managed for rickets and associated complications over 4-years. Rickets has an estimated annual incidence of 29•75 per 100,000 children <4 years of age. In the dark skin tone population vitamin D supplementation proved to be cost saving. In a medium skin tone population and light skin tone populations the ICER was £19,295 per QALY and £404,047 per QALY, respectively. Conclusion: Our study demonstrates that a vitamin D supplementation to prevent rickets is cost effective in dark and medium skin tone populations.

Recomendaciones de la OMS sobre cuidados maternos y neonatales para una experiencia posnatal positiva

“…Un estudio de modelización de la relación costoeficacia del uso de suplementos de vitamina D en mujeres embarazadas y lactantes y menores de 4 años realizado en Reino Unido, donde el raquitismo tiene una incidencia anual estimada de 29,75 por 100 000 menores de 4 años, puso de manifiesto que los suplementos de vitamina D en poblaciones con un tono de piel oscuro aportaron un ahorro de costos. En las poblaciones de tono de piel medio y en las de tono de piel claro, la relación costo-eficacia incremental fue de £ 19 295 por AVAC y £ 404 047 por AVAC, respectivamente (217). En general, los suplementos supusieron un ahorro de costos en los participantes con un tono de piel oscuro, tuvieron una relación costo-eficacia favorable en los participantes con un tono de piel medio, pero no tuvieron una relación costo-eficacia favorable en los participantes con un tono de piel claro.…”

Demographic and clinical predictors of vitamin D status in pregnant women tested for deficiency in Western Australia

“…veiled women in some locations in Australia; populations living at high latitudes) and routine supplementation may be a cost-effective way to manage these specific situations. 53 Further, we support the reinforcement of guidelines for screening for vitamin D deficiency at the first antenatal clinic to potentially at-risk women to optimise the benefits of vitamin D sufficiency throughout pregnancy on both maternal and foetal health outcomes.…”

Barriers to adequate nutrition care for child malnutrition in a low-resource setting: Perspectives of health care providers

“…Cost-effectiveness (determining the expected gains and cost per gain) is central to the health system's success. Therefore, health system resources should be directed to health services after making cost-effective analyses to decide on proper resource allocation, e.g., allocating resources for nutrition care technology, such as nutritional supplements, and specific community groups ( 39 , 40 ).…”