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

Created August 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

Many previous studies have considered flour fortification 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%?) * Germany does not fortify ANY food with vitamin D, is considering 1000 IU from bread – Nov 2013 * 5000 IU of vitamin D in daily bread resulted in 50 ng and improved quality of life– May 2014 * Which is perhaps 10X higher fortification than proposed by this study * Best thing since sliced bread (vitamin D bread was patented and baked in 1929) * Vitamin D food fortification – many trials listed – Aug 2018

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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.

Tags: Fortification