Cost-effectiveness of vitamin D supplementation in older adults with vitamin D deficiency in Ireland.

Laurence Francis Lacey, David J Armstrong, Emily Royle, Pamela Magee, L Kirsty Pourshahidi, Sumantra Ray, J J Strain, Emeir McSorley

Journal: BMJ nutrition, prevention & health 2022;5(1):98-105

PMID: 35814728

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Plain Language Summary

Clinical vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentration below <30nmol/L) increases the risk of excess mortality and disease. Vitamin D deficiency, as measured by serum 25(OH)D, is particularly high among older Irish adults. The aim of this study was to investigate the cost-effectiveness of vitamin D3 supplementation in older adults in Ireland, with year-round vitamin D deficiency. This study investigated three age groups: (1) ≥50 years, (2) ≥60 years and (3) ≥70 years. Results show that cost-effectiveness of vitamin D3 supplementation is most robust in adults ≥70 years. Furthermore, the results of the cost-effectiveness analysis are most sensitive to the mortality risk reduction following vitamin D3 supplementation. Authors conclude by proposing the implementation of a GP-monitored, vitamin D3 supplementation programme for adults ≥70 years of age.

Abstract

BACKGROUND

This study investigated the cost-effectiveness of vitamin D supplementation in older adults in Ireland, with year-round vitamin D deficiency (serum 25-hydroxyvitamin D concentration <30 nmol/L) (13% of Irish adults), from the perspective of the Health Service Executive.

METHODS

Three age groups were investigated: (1) ≥50 years, (2) ≥60 years and (3) ≥70 years. Based on the clinical literature, vitamin D supplementation may: (1) decrease all-cause mortality by 7% and (2) reduce hip fractures by 16% and non-hip fractures by 20%. A discount rate of 4% was applied to life years and quality-adjusted life years (QALYs) gained, and healthcare costs. The annual healthcare costs per patient used in the model are based on the average annual health resource use over the 5-year time horizon of the model.

RESULTS

The cost/QALY estimates in all three age groups are below the usually acceptable cost-effectiveness threshold of €20 000/QALY. The most cost-effective and least costly intervention was in adults ≥70 years. For this age group, the average annual costs and outcomes would be approximately €5.6 million, 1044 QALYs gained, with a cost/QALY of approximately €5400. The results are most sensitive to the mortality risk reduction following vitamin D supplementation.

CONCLUSION

The cost-effectiveness of vitamin D supplementation is most robust in adults ≥70 years. Clinical uncertainty in the magnitude of the benefits of vitamin D supplementation could be further addressed by means of: (1) performing a clinical research study or (2) conducting a pilot/regional study, prior to reaching a decision to invest in a nationwide programme.

Address: Lacey Solutions Limited, Skerries, County Dublin, Ireland.; Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, UK.; Department of Rheumatology, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK.; NNEdPro Global Centre for Nutrition and Health St John's Innovation Centre, Cambridge, UK.; Fitzwilliam College and School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK.

DOI: 10.1136/bmjnph-2021-000382