Cost-benefit analysis of calcium and vitamin D supplements.

If all adults with osteoporosis in the European Union (EU) and United States (US) used calcium and vitamin D supplements, it could prevent more than 500,000 fractures/year in the EU and more than 300,000/year in the US and save approximately €5.7 billion and US $3.3 billion annually. PURPOSE: Evaluate the cost-effectiveness of calcium/vitamin D supplementation for preventing osteoporotic fractures. METHODS: A cost-benefit analysis tool was used to estimate the net cost savings from reduced fracture-related hospital expenses if adults with osteoporosis in the EU and US used calcium/vitamin D supplements. A 14% relative risk reduction of fracture with calcium/vitamin D supplementation from a recent systematic review and meta-analysis of randomized, controlled trials was used as the basis for the benefit estimate. Other model inputs were informed by epidemiologic, clinical, and cost data (2016-2017) obtained via the medical literature or public databases. Analyses estimated the total number of avoided fractures and associated cost savings with supplement use. Net cost benefit was calculated by subtracting the supplements' market costs from those savings. RESULTS: The > 30 million persons in the EU and nearly 11 million in US with osteoporosis experience about 3.9 million and 2.3 million fractures/year and have annual hospital costs exceeding €50 billion and $28 billion. If all persons with osteoporosis used calcium and vitamin D supplements, there would be an estimated 544,687 fewer fractures/year in the EU and 323,566 fewer in the US, saving over €6.9 billion and $3.9 billion; the net cost benefit would be €5,710,277,330 and $3,312,236,252, respectively. CONCLUSIONS: Calcium and vitamin D supplements are highly cost-effective, and expanded use could considerably reduce fractures and related costs. Although these analyses included individuals aged ≥ 50 years, the observed effects are likely driven by benefits observed in those aged ≥ 65 years.

Should women be advised to use calcium supplements during pregnancy? A decision analysis.

Adequate calcium intake during pregnancy is important in the prevention of pre-eclampsia. A substantial proportion of pregnant women do not meet the recommended daily calcium intake, even in developed countries. Nonetheless, calcium supplementation is not routinely advised to pregnant women in most countries. We aimed to predict the impact of advising pregnant women to use calcium supplements (1,000 mg/day) on the number of cases of pre-eclampsia prevented and related health care costs. By use of a decision-analytic model, we assessed the expected impact of advising calcium supplementation to either (1) all pregnant women, (2) women at high risk of developing pre-eclampsia, or (3) women with a low dietary calcium intake compared with current care. Calculations were performed for a hypothetical cohort of 100,000 pregnant women living in a high-income country, although input parameters of the model can be adjusted so as to fit other settings. The incidence of pre-eclampsia could be reduced by 25%, 8%, or 13% when advising calcium supplementation to all pregnant women, women at high risk of pre-eclampsia, or women with a low dietary calcium intake, respectively. Expected net financial benefits of the three scenarios were of €4,621,465, €2,059,165, or €2,822,115 per 100,000 pregnant women, respectively. Advising pregnant women to use calcium supplements can be expected to cause substantial reductions in the incidence of pre-eclampsia as well as related health care costs. It appears most efficient to advise calcium supplementation to all pregnant women, not subgroups only.

[Cost effectiveness of calcium supplement in reducing preeclampsia-related maternal mortality in Colombia]. / Costo efectividad del suplemento de calcio para reducir la mortalidad materna asociada a preeclampsia en Colombia.

Objectives To estimate the cost-effectiveness of administering calcium (1200 mg per day) starting in week 14 of pregnancy to all pregnant women compared to not supplying it to reduce the incidence of preeclampsia. Methods A decision tree was built in TreeAge® with outcome measured in life years gained (LYG) associated with the reduction in maternal deaths. Costs were included from the perspective of the health system in Colombia and expressed in Colombian pesos in 2014 (COP). The discount rate was 0 %. We performed sensitivity univariate and probabilistic analyses for costs and effectiveness. Results Compared to no intervention, calcium supplement is a dominant alternative. If the incidence of preeclampsia is lower than 51.7 per 1 000 pregnant women or the cost per tablet of calcium of 600 mg is greater than COP $507.85, calcium supplement is no longer a cost-effective alternative in Colombia for a threshold of COP $ 45 026 379 (3 times the Colombian per capita GDP of 2013 per LYG). Conclusions Supplying calcium to all pregnant women from week 14 of gestation is a dominant alternative compared to no intervention, which saves 200 LYG, while it decreases costs to the order of COP$5 933 million per 100.000 pregnant women.

Chicken eggshell as suitable calcium source at home.

AIM: Taken into consideration that the deficiency of calcium (Ca) in the diet is a common problem, the aim of this work was to study the chicken eggshell as Ca source at home. It was evaluated: (1) different mechanisms to process eggshells and find an easy way to determine the required amount of Ca at home and; (2) the flavor and the texture for eggshell fortified food. METHODS: Chemical and mechanical methods of eggshell processing were evaluated. Changes in flavor and texture were evaluated in volunteers coordinated by a professional chef. RESULTS: A single eggshell contains 2.07 ± 0.18 g of Ca; therefore half an eggshell could provide the amount of Ca needed by adult human beings per day. The best way to use chicken eggshell as Ca dietary supplement is powdered to add to bread, pizza or spaghetti as there were small changes in texture and no changes in flavor.

Utilization of seafood processing by-products: medicinal applications.

Large amount of underutilized by-products are generated from the seafood processing plants annually. Consequently, researches have been initiated to investigate those discarded materials and have identified a number of bioactive compounds including bioactive peptides, collagen and gelatin, oligosaccharides, fatty acids, enzymes, calcium, water-soluble minerals, and biopolymers. Bioactive peptides derived from fish by-products have shown various biological activities including antihypertensive and antioxidant activities and hence may be a potential material for biomedical and food industries. Collagen and gelatin are currently used in diverse fields including food, cosmetic, and biomedical industries. Other than that, they are promising drug carriers for the treatment of cancer. Many studies have reported that chitin, chitosan, and their derivatives possess biologically active polysaccharides and hence they are potential agents for many applications. Further, those compounds have also showed potential activities such as antioxidant, antibacterial, antiviral, antihypertensive, anticancer, etc. Hence, seafood by-products are valuable natural resources that show range of functionalities and hence potential materials for biomedical and nutraceutical industries.

The search for good compliance: economic aspects of a conveyed combination pharmaco-therapy, exemplified by an osteoporosis therapy.

The discussion of adequate compliance in health care often refers to a lack of information between patients and physicians. In our setting, we show that contract arrangements as well as the distribution of information are important for an adequate alignment of the interest of patients and physicians. The analysis emphasises the benefit of organised pharmaco-therapy enhancing the concomitant compliance. Therefore, the results can work as a proxy for the need of good economic-based approaches discussing compliance in chronic diseases.

The consumer cost of calcium from food and supplements.

Nutritional authorities encourage consumers to include calcium-rich foods in their daily diets. However, consumer purchases are driven not only by health considerations and dietary preferences, but also by cost. This study assessed the cost of calcium from a wide variety of food sources, as well as supplements, based on retail prices in Seattle, San Francisco, Raleigh, NewYork City, and Washington, D.C., while controlling for seasonal variation. Costs were adjusted based on calcium absorption fractions. Calcium carbonate supplements emerged as the least expensive source of calcium, at roughly one-third the cost of the least expensive food source of calcium. The least expensive food sources of calcium were Total cereal, skim milk, and calcium-fortified orange juice from frozen concentrate. This information is useful for dietitians, health professionals, and consumers in meeting calcium requirements on a budget.

Absorbability and cost effectiveness in calcium supplementation.

BACKGROUND: Cost-effectiveness of calcium supplementation depends not only on the cost of the product but on the efficiency of its absorption. Published cost-benefit analyses assume equal bioavailability for all calcium sources. Some published studies have suggested that there are differences in both the bioavailability and cost of the major calcium supplements. DESIGN: Randomized four period, three-way cross-over comparing single doses of off-the-shelf commercial calcium supplements containing either calcium carbonate or calcium citrate compared with a no-load blank and with encapsulated calcium carbonate devoid of other ingredients; subjects rendered fully vitamin D-replete with 10 microg/day 25(OH)D by mouth, starting one week prior to the first test. SUBJECTS: 24 postmenopausal women METHODS: Pharmacokinetic analysis of the increment in serum total and ionized calcium and the decrement in serum iPTH induced by an oral calcium load, based upon multiple blood samples over a 24-hour period; measurement of the rise in urine calcium excretion. Data analyzed by repeated measures ANOVA. Cost calculations based on average retail prices of marketed products used in this study from April through October, 2000. RESULTS: All three calcium sources (marketed calcium carbonate, encapsulated calcium carbonate and marketed calcium citrate) produced identical 24-hour time courses for the increment in total serum calcium. Thus, these were equally absorbed and had equivalent bioavailability. Urine calcium rose slightly more with the citrate than with the carbonate preparations. but the difference was not significant. Serum iPTH showed the expected depression accompanying the rise in serum calcium, and there were no significant differences between products. CONCLUSION: Given the equivalent bioavailability of the two marketed products, the cost benefit analysis favors the less expensive carbonate product.