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Very cost-effective to fortify plus supplement with Vitamin D (flour and 400 IU for all children) – Aug 2019

The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales

European Journal of Clinical Nutrition (2019) DOI https://doi.org/10.1038/s4be1430-019-0486-x
M. Aguiar, L. Andronis, M. Pallan, W. Högler & E. Frew

VitaminDWiki

Many previous studies have considered flour fortififcation
This is the first study which considered both fortification AND supplementation
Fortification - a paltry 400 IU of vitamin D per 100 grams of flour
Supplementation
   400 IU to all children < age 18
  400 IU to BAME (Black and Asian Minority Ethnic)
  800 IU to all age >65
Note
   UK considers child deficiency to be < 12 ng, Adult < 20 ng
   Many other countries consider < 30 ng to be deficient for everyone
   They consider adding so little Vitamin D that only 25% fewer people will be deficient
   They appear to only consider death as the only outcome of being deficient
   They ignore people who are gluten intolerant (10%?)

 Download the PDF from Sci-Hub via VitaminDWiki

Background
Vitamin D deficiency (VDD) affects the health and wellbeing of millions worldwide. In high latitude countries such as the United Kingdom (UK), severe complications disproportionally affect ethnic minority groups.

Objective
To develop a decision-analytic model to estimate the cost effectiveness of population strategies to prevent VDD.

Methods
An individual-level simulation model was used to compare: (I) wheat flour fortification; (II) supplementation of at-risk groups; and (III) combined flour fortification and supplementation; with (IV) a ‘no additional intervention’ scenario, reflecting the current Vitamin D policy in the UK. We simulated the whole population over 90 years. Data from national nutrition surveys were used to estimate the risk of deficiency under the alternative scenarios. Costs incurred by the health care sector, the government, local authorities, and the general public were considered. Results were expressed as total cost and effect of each strategy, and as the cost per ‘prevented case of VDD’ and the ‘cost per Quality Adjusted Life Year (QALY)’.

Results
Wheat flour fortification was cost saving as its costs were more than offset by the cost savings from preventing VDD. The combination of supplementation and fortification was cost effective (£9.5 per QALY gained). The model estimated that wheat flour fortification alone would result in 25% fewer cases of VDD, while the combined strategy would reduce the number of cases by a further 8%.

Conclusion
There is a strong economic case for fortifying wheat flour with Vitamin D, alone or in combination with targeted vitamin D3 supplementation.

Created by admin. Last Modification: Wednesday August 21, 2019 13:41:03 GMT-0000 by admin. (Version 11)

Attached files

ID Name Comment Uploaded Size Downloads
12508 Fortify plus supplement sci-hub.pdf PDF 2019 admin 20 Aug, 2019 12:16 552.75 Kb 29
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