RESUMEN
Given the growth of supplements specifically designed for children in Canada, this study examines the nutrient levels of these products, and evaluates them in light of the US Health and Medical Division (HMD)-formerly the Institute of Medicine-and Health Canada's recommendations. Content analysis was used to document the nutrient levels of child-targeted vitamins, minerals and fish oils/omega-3s (n = 80) in Calgary, Alberta, Canada. Products were assessed according to HMD and Health Canada dosage recommendations for children, and the percentage of Estimate Average Requirements (EAR), Adequate Intakes (AI), and Tolerable Upper Intakes Level (UL) calculated. Median EAR/AI/UL percentages and quartiles were calculated for each nutrient, and estimates for the adequate intake recommendations plotted with box plots. Sixty five percent of the products assessed were multivitamins; the median dose was higher than AI recommendations for vitamins A, B6, B12, and C, as well as thiamin, riboflavin, pantothenic acid, and biotin. Substantial variation in vitamin, mineral, or fish oil dosage was found between similar supplements-with nutrients such as vitamin B12 ranging from 83% to 5557% of AI. Such findings matter because the very existence of these products suggests that children should be taking them, yet more research is needed on their potential (adverse) effects over both the short and long term. The substantial variation in dosages between products also raises questions about the (perhaps unnecessary) fortification of our children, as well as the expectations that parents know-or are even aware of-appropriate nutrient levels for their kids.
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Suplementos Dietéticos/análisis , Suplementos Dietéticos/economía , Suplementos Dietéticos/estadística & datos numéricos , Mercadotecnía/economía , Mercadotecnía/estadística & datos numéricos , Minerales/economía , Vitaminas/economía , Adolescente , Alberta , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: Vitamin K is thought to be involved in both bone health and maintenance of neuromuscular function. We tested the effect of vitamin K2 supplementation on postural sway, falls, healthcare costs, and indices of physical function in older people at risk of falls. DESIGN: Parallel-group double-blind randomized placebo-controlled trial. SETTING: Fourteen primary care practices in Scotland, UK. PARTICIPANTS: A total of 95 community-dwelling participants aged 65 and older with at least two falls, or one injurious fall, in the previous year. INTERVENTION: Once/day placebo, 200 µg or 400 µg of oral vitamin K2 for 1 year. MEASUREMENTS: The primary outcome was anteroposterior sway measured using sway plates at 12 months, adjusted for baseline. Secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Timed Up & Go Test, quality of life, health and social care costs, falls, and adverse events. RESULTS: Mean participant age was 75 (standard deviation [SD] = 7) years. Overall, 58 of 95 (61%) were female; 77 of 95 (81%) attended the 12-month visit. No significant effect of either vitamin K2 dose was seen on the primary outcome of anteroposterior sway (200 µg vs placebo: -.19 cm [95% confidence interval [CI] -.68 to .30; P = .44]; 400 µg vs placebo: .17 cm [95% CI -.33 to .66; P = .50]; or 400 µg vs 200 µg: .36 cm [95% CI -.11 to .83; P = .14]). Adjusted falls rates were similar in each group. No significant treatment effects were seen for other measures of sway or secondary outcomes. Costs were higher in both vitamin K2 arms than in the placebo arm. CONCLUSION: Oral vitamin K2 supplementation did not improve postural sway or physical function in older people at risk of falls. J Am Geriatr Soc 67:2102-2107, 2019.
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Accidentes por Caídas/estadística & datos numéricos , Equilibrio Postural , Vitamina K 2/administración & dosificación , Vitaminas/administración & dosificación , Anciano , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Masculino , Vitamina K 2/economía , Vitaminas/economíaRESUMEN
INTRODUCTION: Patients with morbid obesity undergoing metabolic surgery are prone to develop vitamin and mineral deficiencies, which may worsen in time. In order to prevent these deficiencies after metabolic surgery, all patients are advised to take daily multivitamin supplementation. The aim of the study was to assess the cost-effectiveness of specially developed multivitamins (WLS Forte®) for metabolic surgery and over-the-counter (standard) multivitamin supplementation (sMVS). METHODS: This cost-effectiveness analysis was preformed alongside an RCT for the Netherlands. Between June 2011 and March 2012, a total of 148 patients were randomized to one tablet daily of either WLS Forte® or sMVS. The patients were followed for 12 months. Data on costs within the health sector and outside the health sector were collected. The primary outcome is financial and logistic advantages, in terms of less patient visits to the outpatient department and the relevant costs to the employer due to absenteeism. RESULTS: In total, 10 (14%) patients in the WLS Forte® group versus 23 (30%) patients in the sMVS group developed a deficiency. The costs for the WLS forte® supplement were 38 versus 23 for sMVS. Additional return visits and associated costs for medical staff were the largest costs, up to 43% in the sMVS group. Total costs for supplementation with sMVS were 243 versus 134 for WLS Forte®. CONCLUSION: Preventing deficiencies with WLS Forte® seem initially more expensive than sMVS. However, treatment with WLS Forte® resulted in less vitamin and mineral deficiencies, which eventually resulted in less overall costs.
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Absentismo , Atención Ambulatoria/economía , Avitaminosis/prevención & control , Derivación Gástrica/efectos adversos , Vitaminas/economía , Vitaminas/uso terapéutico , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Avitaminosis/economía , Avitaminosis/etiología , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Adulto JovenRESUMEN
OBJECTIVE: We tested a novel intervention for reducing demand for ineffective health remedies. The intervention aimed to empower participants to overcome the illusion of causality, which otherwise drives erroneous perceptions regarding remedy efficacy. DESIGN: A laboratory experiment adopted a between-participants design with six conditions that varied the amount of information available to participants (N = 245). The control condition received a basic refutation of multivitamin efficacy, whereas the principal intervention condition received a full contingency table specifying the number of people reporting a benefit vs. no benefit from both the product and placebo, plus an alternate causal explanation for inefficacy over placebo. MAIN OUTCOME MEASURES: We measured participants' willingness to pay (WTP) for multivitamin products using two incentivized experimental auctions. General attitudes towards health supplements were assessed as a moderator of WTP. We tested generalisation using ratings of the importance of clinical-trial results for making future health purchases. RESULTS: Our principal intervention significantly reduced participants' WTP for multivitamins (by 23%) and increased their recognition of the importance of clinical-trial results. CONCLUSION: We found evidence that communicating a simplified full-contingency table and an alternate causal explanation may help reduce demand for ineffective health remedies by countering the illusion of causality.
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Comportamiento del Consumidor/economía , Comportamiento del Consumidor/estadística & datos numéricos , Suplementos Dietéticos/economía , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Vitaminas/economía , Adolescente , Adulto , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Adulto JovenRESUMEN
There is clinical uncertainty as to the testing of serum 25--Hydroxy vitamin D (25[OH]D) concentrations and when to use high-dose supplementation. Data show that there has been a rapid increase in the number of tests performed within the Northumbria Healthcare NHS Foundation Trust over the past 8 years and an increase in high-dose supplementation over the past 5 years. We performed a retrospective analysis of the 25(OH)D test requests over the period from January to -October 2017. A total of 17,405 tests were performed in this time period. The overall average concentration was 57.5 nmol/L and this figure was similar across age groups, although a larger proportion of patients aged over 75 had a concentration <25 nmol/L. Test requests were classified into 'appropriate', 'inappropriate' and 'uncertain' categories based on current expert opinion. We found that between 70.4% and 77.5% of tests could be inappropriate, depending on whether the 'uncertain' categories of falls and osteoporosis are considered to be justified. Tiredness, fatigue or exhaustion was the reason for testing in 22.4% of requests. We suggest that a more rational approach to testing, and subsequent treating, could lead to reductions in costs to the healthcare system and patients.
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Suplementos Dietéticos , Uso Excesivo de los Servicios de Salud , Deficiencia de Vitamina D/diagnóstico , Accidentes por Caídas , Adulto , Anciano , Fosfatasa Alcalina/sangre , Colecalciferol/economía , Colecalciferol/uso terapéutico , Técnicas de Laboratorio Clínico/economía , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Femenino , Humanos , Hipocalcemia/sangre , Hipocalcemia/epidemiología , Hipofosfatemia/sangre , Hipofosfatemia/epidemiología , Masculino , Persona de Mediana Edad , Osteoporosis/diagnóstico , Estudios Retrospectivos , Medicina Estatal , Reino Unido/epidemiología , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/dietoterapia , Deficiencia de Vitamina D/epidemiología , Vitaminas/economía , Vitaminas/uso terapéuticoRESUMEN
Despite the knowledge that a well-balanced diet provides most of the nutritional requirements, the use of supplemental vitamins is widespread among adults in the United States. Evidence from large randomized controlled trials over the last 2 decades does not support vitamin supplementation for the reduction of cardiovascular risk factors or clinical outcomes. Many of the vitamins used in common practice likely are safe when consumed in small doses, but long-term consumption of megadoses is not only expensive but has the potential to cause adverse effects. Therefore, a need exists to revisit this issue, reminding the public and healthcare providers about the data supporting the use of vitamins for cardiovascular disease, and the potential for harm and the expense associated with their unnecessary use. In this review, we highlight the scientific evidence from randomized controlled studies regarding the efficacy and safety of vitamin supplementation for primary and secondary prevention of cardiovascular diseases and outcomes. We also draw attention to issues related to widespread and indiscriminate use of vitamin supplements and the need to educate the public to curtail unnecessary consumption and expense by limiting their use based on strong scientific evidence.
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Enfermedades Cardiovasculares/prevención & control , Vitaminas/uso terapéutico , Ácido Ascórbico/economía , Ácido Ascórbico/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Análisis Costo-Beneficio , Suplementos Dietéticos/economía , Medicina Basada en la Evidencia , Humanos , Vitamina A/economía , Vitamina A/uso terapéutico , Complejo Vitamínico B/economía , Complejo Vitamínico B/uso terapéutico , Vitamina D/economía , Vitamina D/uso terapéutico , Vitamina E/economía , Vitamina E/uso terapéutico , Vitamina K/economía , Vitamina K/uso terapéutico , Vitaminas/economíaRESUMEN
OBJECTIVE: The study evaluates the economic benefit of population-wide vitamin D and Ca food fortification in Germany. DESIGN: Based on a spreadsheet model, we compared the cost of a population-wide vitamin D and Ca food-fortification programme with the potential cost savings from prevented fractures in the German female population aged 65 years and older. SETTING: The annual burden of disease and the intervention cost were assessed for two scenarios: (i) no food fortification; and (ii) voluntary food fortification with 20 µg (800 IU) of cholecalciferol (vitamin D3) and 200 mg of Ca. The analysis considered six types of fractures: hip, clinical vertebral, humerus, wrist, other femur and pelvis. SUBJECTS: Subgroups of the German population defined by age and sex. RESULTS: The implementation of a vitamin D and Ca food-fortification programme in Germany would lead to annual net cost savings of 315 million and prevention of 36 705 fractures in the target population. CONCLUSIONS: Vitamin D and Ca food fortification is an economically beneficial preventive health strategy that has the potential to reduce the future health burden of osteoporotic fractures in Germany. The implementation of a vitamin D and Ca food-fortification programme should be a high priority for German health policy makers because it offers substantial cost-saving potential for the German health and social care systems.
Asunto(s)
Calcio/administración & dosificación , Análisis Costo-Beneficio/economía , Suplementos Dietéticos/economía , Alimentos Fortificados/economía , Fracturas Óseas/prevención & control , Vitamina D/administración & dosificación , Anciano , Anciano de 80 o más Años , Calcio/economía , Análisis Costo-Beneficio/estadística & datos numéricos , Suplementos Dietéticos/estadística & datos numéricos , Femenino , Alimentos Fortificados/estadística & datos numéricos , Fracturas Óseas/economía , Alemania , Humanos , Evaluación de Programas y Proyectos de Salud/economía , Evaluación de Programas y Proyectos de Salud/métodos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Vitamina D/economía , Vitaminas/administración & dosificación , Vitaminas/economíaRESUMEN
Prevalence and patterns of dietary supplement (DS) use by U.S. Army soldiers differ from the civilian population. Longitudinal trends in use of DSs by civilians have been examined, but are unavailable in subpopulations such as military service members. The present study examined longitudinal changes in DS use by soldiers. A standardized questionnaire on DS use was administered in 2006-2007 (N = 989) and 2010-2011 (N = 1196) to convenience samples of active duty soldiers. Data were weighted for total population demographics of age, sex, and rank. Regular use of DSs by soldiers increased significantly (56% ± 1.6% vs. 64% ± 1.7%; p ≤ 0.001) over the 4 years primarily because of an increase of DS use among the youngest 18- to 24-year-old soldiers (43.0% ± 2.5% vs 62.3% ± 2.4%; p ≤ 0.01). Protein (22% ± 1.4% vs. 26% ± 1.5%; p ≤ 0.001) and combination (10.0% ± 1.0% vs. 24% ± 1.4%; p ≤ 0.001) product consumption also increased over the 4 years. Individual vitamin and mineral use - including iron, magnesium, selenium, and vitamins A, B6, B12, and D - significantly increased as well (p ≤ 0.05). In addition, expenditures on DSs by soldiers increased over time (p < 0.01). Reasons reported by soldiers for DS use suggest use increased to meet the occupational demands of military service. Educational interventions to minimize inappropriate use of DSs by soldiers are necessary to reduce adverse events resulting from unnecessary use of DSs and the financial burden associated with their use.
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Dieta , Suplementos Dietéticos , Conocimientos, Actitudes y Práctica en Salud , Personal Militar , Adolescente , Adulto , Factores de Edad , Estudios de Cohortes , Dieta/efectos adversos , Dieta/economía , Dieta/tendencias , Encuestas sobre Dietas , Suplementos Dietéticos/efectos adversos , Suplementos Dietéticos/economía , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Caracteres Sexuales , Clase Social , Oligoelementos/administración & dosificación , Oligoelementos/efectos adversos , Oligoelementos/economía , Estados Unidos , Vitaminas/administración & dosificación , Vitaminas/efectos adversos , Vitaminas/economía , Adulto JovenAsunto(s)
Suplementos Dietéticos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Vitaminas/efectos adversos , Factores de Edad , Suplementos Dietéticos/economía , Servicio de Urgencia en Hospital/economía , Humanos , Estados Unidos , United States Food and Drug Administration , Vitaminas/economíaRESUMEN
OBJECTIVE: The aim of this study was to examine the association between dietary supplement use and sociodemographic factors in an Australian university population. Additionally, reasons for use of specific dietary supplements were explored. METHODS: A cross-sectional online questionnaire was completed by 1633 students and staff members of Griffith University, Queensland, Australia (76% female). The questionnaire collected information on sociodemographic characteristics, use of dietary supplements, and reasons for use of each dietary supplement reported. Multiple regression analyses were used to describe the relationship between demographic factors and dietary supplement use. Pearson χ(2) was used to identify correlations between frequency of dietary supplement use and selected demographic factors. Frequency distributions were used to explore the reasons for use of each dietary supplement reported. RESULTS: Vitamin or mineral use and use of "other" dietary supplements was reported by 69% and 63% of participants, respectively. Age, sex, ethnicity, and physical activity were independently associated with dietary supplement use. Age, sex, and income were associated with acute use of specific dietary supplements during illness or injury. The reasons for use of specific dietary supplements were closely aligned with marketed claims. Broad reasons of health were commonly reported for use of most dietary supplements. CONCLUSIONS: Use of dietary supplements in this population reflects that of other countries. Individuals were unsure of the benefits and risks associated with dietary supplementation. Health professionals should account for dietary supplements when assessing diet. These results also warrant consideration by regulating bodies and public health officers to ensure safe practices.
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Suplementos Dietéticos , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Estado Nutricional , Adolescente , Adulto , Estudios Transversales , Países Desarrollados , Suplementos Dietéticos/efectos adversos , Suplementos Dietéticos/economía , Femenino , Aceites de Pescado/administración & dosificación , Aceites de Pescado/efectos adversos , Aceites de Pescado/economía , Humanos , Internet , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Queensland , Factores Socioeconómicos , Estudiantes , Oligoelementos/administración & dosificación , Oligoelementos/efectos adversos , Oligoelementos/economía , Universidades , Vitaminas/administración & dosificación , Vitaminas/efectos adversos , Vitaminas/economía , Recursos Humanos , Adulto JovenRESUMEN
The conquest of pellagra is commonly associated with one name: Joseph Goldberger of the US Public Health Service, who in 1914 went south, concluded within 4 months that the cause was inadequate diet, spent the rest of his life researching the disease, and--before his death from cancer in 1929--found that brewer's yeast could prevent and treat it at nominal cost. It does Goldberger no discredit to emphasize that between 1907 and 1914 a patchwork coalition of asylum superintendents, practicing physicians, local health officials, and others established for the first time an English-language competence in pellagra, sifted through competing hypotheses, and narrowed the choices down to two: an insect-borne infection hypothesis, championed by the flamboyant European Louis Westerna Sambon, and the new "vitamine hypothesis," proffered by Casimir Funk in early 1912 and articulated later that year by two members of the American Clinical and Climatological Association, Fleming Mant Sandwith and Rupert Blue. Those who resisted Goldberger's inconvenient truth that the root cause was southern poverty drew their arguments largely from the Thompson-McFadden Pellagra Commission, which traces back to Sambon's unfortunate influence on American researchers. Thousands died as a result.
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Suplementos Dietéticos/historia , Pelagra/historia , Saccharomyces cerevisiae , United States Public Health Service/historia , Vitaminas/historia , Suplementos Dietéticos/economía , Costos de la Atención en Salud , Historia del Siglo XX , Humanos , Estado Nutricional , Pelagra/diagnóstico , Pelagra/mortalidad , Pelagra/prevención & control , Pelagra/terapia , Pobreza/historia , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiología , United States Public Health Service/economía , Vitaminas/economía , Vitaminas/uso terapéuticoRESUMEN
PURPOSE: To determine if providing high dose anti-oxidant vitamins and zinc treatment age-related eye disease study (AREDS formulation) to patients with intermediate age-related macular degeneration (AMD) aged 40-79 years from Singapore is cost-effective in preventing progression to wet AMD. METHODS: A hypothetical cohort of category 3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly) for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen). Costs were estimated for the above scenarios from the providers' perspective, and cost-effectiveness was measured by cost per disability-adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs were discounted at an annual rate of 3%. RESULTS: Over 5400 patients could be prevented from progressing to wet AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was cost-effective compared to placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more cost-effective compared to AREDS formulation followed by bevacizumab. CONCLUSION: Prophylactic treatment with AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore.
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Antioxidantes/administración & dosificación , Costos de los Medicamentos , Agudeza Visual/fisiología , Vitaminas/administración & dosificación , Degeneración Macular Húmeda/prevención & control , Zinc/administración & dosificación , Adulto , Anciano , Antioxidantes/economía , Análisis Costo-Beneficio , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Singapur/epidemiología , Factores de Tiempo , Vitaminas/economía , Degeneración Macular Húmeda/economía , Degeneración Macular Húmeda/epidemiología , Zinc/economíaAsunto(s)
Conservadores de la Densidad Ósea/administración & dosificación , Enfermedad Crónica/prevención & control , Suplementos Dietéticos , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación , Conservadores de la Densidad Ósea/efectos adversos , Conservadores de la Densidad Ósea/economía , Enfermedad Crónica/economía , Esquema de Medicación , Costos de los Medicamentos , Métodos Epidemiológicos , Fracturas Óseas/prevención & control , Humanos , Factores de Riesgo , Vitamina D/efectos adversos , Vitamina D/economía , Vitaminas/efectos adversos , Vitaminas/economíaRESUMEN
OBJECTIVE: To evaluate and provide a real-life view of the operation of the Healthy Start vitamins scheme. SETTING: The study took place in primary care and community settings that served rural, urban and ethnically diverse populations, in two sentinel sites: London, and Yorkshire and the Humber. An online consultation and stakeholder workshops elicited views from across England. PARTICIPANTS: 669 health and social care practitioners including health visitors, midwives, public health practitioners, general practitioners, paediatricians and support staff participated in focus group discussions (n=49) and an online consultation (n=620). 56 participants representing health and social care practitioners, policymakers, service commissioners, and voluntary and independent sectors took part in stakeholder workshops. METHODS: Three-phase multimethod study comprising focus group discussions, an online consultation and stakeholder workshops. Qualitative data were analysed thematically and quantitative data from the online survey were analysed using descriptive statistics. RESULTS: Study participants were concerned about the low uptake of Healthy Start vitamin supplements and the consequences of this for health outcomes for women and young children. They experienced Healthy Start vitamin distribution as logistically complex, requiring the time, resources and creative thinking of a range of local and regional practitioners from senior strategists to administrative support workers. In the light of this, many participants argued that moving to universal provision of vitamin supplements would be more cost-effective than the current system. CONCLUSIONS: There is consistency of views of health practitioners that the current targeted system of providing free vitamin supplements for low-income childbearing women and young children via the Healthy Start programme is not fulfilling its potential to address vitamin deficiencies. There is wide professional and voluntary sector support for moving from the current targeted system to provision of free vitamin supplements for all pregnant and new mothers, and children up to their fifth birthday.
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Actitud del Personal de Salud , Avitaminosis/prevención & control , Suplementos Dietéticos/estadística & datos numéricos , Costos de la Atención en Salud , Pobreza , Vitaminas/uso terapéutico , Avitaminosis/economía , Preescolar , Costos y Análisis de Costo , Suplementos Dietéticos/economía , Femenino , Grupos Focales , Humanos , Masculino , Embarazo , Vitaminas/economíaRESUMEN
Because of concern that United States (US) chronic hemodialysis patients are at high risk for the development of vitamin deficiencies, the great majority of such patients are routinely supplemented with a multivitamin. This policy is supported by major US dialysis providers and nonprofit organizations. Yet routine multivitamin supplementation expands hemodialysis patients' already large pill burden, probably accounts for many millions of dollars in annual costs, and in light of previous reports may even carry with it the possibility of increased risk of adverse outcomes. An analysis of the benefits of routine multivitamin supplementation in US patients is therefore in order. We performed a systematic review of the medical literature between 1970 and 2014 using the Ovid MEDLINE database to address this question. We conclude that there is insufficient evidence to support routine multivitamin use and recommend that the decision to supplement be made on an individual basis.
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Diálisis Renal , Vitaminas/administración & dosificación , Adulto , Avitaminosis/prevención & control , Suplementos Dietéticos/efectos adversos , Costos de los Medicamentos , Humanos , Necesidades Nutricionales , Insuficiencia Renal Crónica/terapia , Estados Unidos , Vitaminas/efectos adversos , Vitaminas/economíaRESUMEN
OBJECTIVE: Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). MATERIALS AND METHODS: A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. RESULTS: Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. CONCLUSION: Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).
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Análisis Costo-Beneficio , Diarrea/prevención & control , Suplementos Dietéticos , Malaria/prevención & control , Deficiencia de Vitamina A/prevención & control , Vitamina A/uso terapéutico , Vitaminas/uso terapéutico , Preescolar , Colombia/epidemiología , Árboles de Decisión , Diarrea/economía , Diarrea/etiología , Diarrea/mortalidad , Suplementos Dietéticos/economía , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Malaria/economía , Malaria/etiología , Malaria/mortalidad , Masculino , Programas Nacionales de Salud/economía , Resultado del Tratamiento , Vitamina A/economía , Deficiencia de Vitamina A/economía , Deficiencia de Vitamina A/etiología , Vitaminas/economíaRESUMEN
The article presents the results of clinical economic analysis of effect of different immune correcting preparations on rate of respiratory infections in 548 frequently ill children of early school age. It is established that preventive immune correction with lysates of bacteria or glucosaminyl muramyl dipeptide in aggregate with vitamin mineral complex results in statistically significant decreasing of rate of respiratory infections and dramatic decreasing of direct and indirect costs of treatment of infectious diseases of respiratory ways. The preventive application of juice of cone-flower herb or interferon in aggregate with vitamnin mineral complex statistically significantly decreases rate of respiratory infections and negligibly decreases direct and indirect costs of their treatment.
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Acetilmuramil-Alanil-Isoglutamina/análogos & derivados , Adyuvantes Inmunológicos/farmacología , Antivirales/farmacología , Investigación sobre Servicios de Salud , Interferones/farmacología , Evaluación de Resultado en la Atención de Salud , Preparaciones de Plantas/farmacología , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Vitaminas/farmacología , Acetilmuramil-Alanil-Isoglutamina/economía , Acetilmuramil-Alanil-Isoglutamina/farmacología , Adyuvantes Inmunológicos/economía , Antivirales/economía , Niño , Humanos , Interferones/economía , Preparaciones de Plantas/economía , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/prevención & control , Vitaminas/economíaRESUMEN
INTRODUCTION: Vitamin D is related to resistance to chronic diseases, physiological parameters and functional measures. All of these relationships underscore the potential benefits of cholecalciferol or D3 (nutritional vitamin D) in cancer. This is the first study designed to obtain conclusive evidence on the effect of cholecalciferol in advanced patients with cancer. The main goal is to assess its effects on the patient's perceived quality of life. Cholecalciferol's impact on fatigue and physical performance, as well as its cost utility, will also be assessed. METHODS AND ANALYSIS: A randomised triple-blind phase II/III placebo-controlled multicentre trial has been designed. Patients satisfying the inclusion and exclusion criteria will be randomly assigned to receive cholecalciferol or placebo. Eligible patients will be adults with a locally advanced or metastatic or inoperable solid cancer in palliative care, who have given signed informed consent and have matched inclusion and exclusion criteria. The randomisation will be based on a computer-generated procedure and centralised by the pharmacy service of the coordinating centre. The assigned treatment will be administered by the hospital's pharmacy to conceal group allocation for patients and healthcare providers. Cholecalciferol (4000 IU/day) or placebo, starting at day 15 and continuing up to day 42, will be added to palliative care treatment. Outpatient visits will be scheduled every 14 days. ETHICS AND DISSEMINATION: Ethical approval was received from the Medical Ethical Commitee of the HUAV (CEIC-1169). Participants and their families will receive the research findings which will also be disseminated on local and national media, presented at national and international meetings of the specialty, and published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: EudraCT: 2013-003478-29.