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.
Highlights
Vitamin D is a fat-soluble nutrient required for calcium and phosphorus homeostasis and for skeletal mineralization
Skin pigmentation interferes with sub-cutaneous vitamin D synthesis; as a result, deficiency prevalence is as high as 80% in population with darker skin tones and they are at a higher risk of developing skeletal and extra-skeletal manifestation of Vitamin D deficiency than people with a lighter skin tone [3, 4]
Vitamin D deficiency is associated with other health outcomes, prevalence of which would change if prevalence of vitamin D deficiency changed [15]
Summary
Vitamin D is a fat-soluble nutrient required for calcium and phosphorus homeostasis and for skeletal mineralization. Musculoskeletal outcomes of vitamin D deficiency includes rickets and osteomalacia in children, osteomalacia in adults, reduced muscle strength and increased risk of falls [3]. Nonmusculoskeletal manifestations of vitamin D deficiency include increased risk of cancers, cardiovascular diseases, auto-immune diseases, all-cause mortality, infectious diseases, and age-related macular degeneration [1, 3]. The prevalence of vitamin D deficiency in the general population in England and Wales is 23% [3]. Skin pigmentation interferes with sub-cutaneous vitamin D synthesis; as a result, deficiency prevalence is as high as 80% in population with darker skin tones and they are at a higher risk of developing skeletal and extra-skeletal manifestation of Vitamin D deficiency than people with a lighter skin tone [3, 4]. Literature on the cost of management of rickets and cost-effectiveness of vitamin D supplementation in preventing rickets is lacking
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