Bone Abstracts

Introduction: Rickets is characterised by defective mineralisation of the growth plate and osteoid, caused by deficiency of vitamin-D and/or of dietary calcium. Rickets continues to be reported in the UK, especially in children from dark-skinned ethnic groups. Literature on the cost of management of rickets and cost-effectiveness of vitamin D supplementation is lacking worldwide.

Methods: The analysis considers the cost-effectiveness of an intervention in five groups of skin pigmentation (whole population, white, light, dark and combination of light and dark), where vitamin-D supplements would be provided free of charge to children aged 0–4 years and pregnant women in order to prevent rickets in comparison to no supplementation. Analysis was conducted in the Central Manchester area where all cases of rickets from 1-January-2009 to 31-December-2014 were identified. Cost of management of rickets was calculated from National Health Service, UK tariffs. Rickets prevalence estimates were calculated using census data from 2011. Quality of life was assessed using counterfactual utility estimates gathered from a systematic literature review and population baseline utility. Intervention efficacy was gathered from literature reporting similar intervention implemented in Birmingham. Incremental cost effectiveness ratio (ICER) was also calculated for Quality-Adjusted Life Years (QALYs) gain threshold of £20–30,000, which is a yardstick used by the National Institute for Health Care Excellence, UK when evaluating cost-effectiveness of new or existing drugs/technology.

Results: During the study period, 57 children were managed for rickets of which 26 were dark and 29 were light skin pigmented. Rickets incidence was 29.75/year/100,000 children under 4 years. Average cost of management of rickets was related to associated complications and was highest in dark-skinned children (£7,305). ICER for dark-skinned children and pregnant women was <£0 and within the QALY threshold. Therefore, cost-effective and budget-saving. In other groups ICER did not cross the threshold (white=£1,352,599, light=£64,375) and, therefore, not cost-effective. On combining data for light and dark pigmented children and pregnant women, ICER was marginally above the QALY threshold of £33,131.

Conclusion: Vitamin-D supplementation for dark-skinned children and pregnant women, but not for the wider UK population, seems to be cost-effective in preventing rickets as per the QALYs gained.

Disclosure: Only data collection was supported by Internis pharma.