Preventing Vitamin D Deficiency (VDD): A systematic review of economic evaluations

Background: Vitamin D Deficiency (VDD) is a public health concern worldwide. If untreated, it can lead to reduced quality of life and escalated costs brought about by ill-health. Preventive programmes to improve population vitamin D status exist but little is known about their the costeffectiveness.
This information is vital so that decision-makers adopt efficient strategies and optimise use of public resources.
Aims: Systematically review and critically appraise economic evaluations of population strategies to prevent VDD.
Methods: The databases reviewed were MEDLINE, EMBASE, Econlit, NHS EED, CEA and RepEc. All full economic evaluations of VDD prevention strategies were included. Interventions considered were food fortification, supplementation and public health campaigns. Data extracted included type of evaluation, population and setting, the measure of benefits and main results.
Results: Of the 2492 records screened, 14 studies were included. The majority of studies focused on supplementation within at-risk groups with the primary objective of either preventing fractures or falls in older adults. There was insufficient economic evidence to draw conclusions about the costeffectiveness of population strategies. No study was identified that offered a direct comparison of the two main alternative population strategies: food fortification versus supplementation.
Conclusion: Whilst there is a growing body of evidence on the cost-effectiveness of micro-nutrient programmes, there is a paucity of data on vitamin D fortification and how fortification programmes compare to population supplementation programmes. We highlight research gaps, and offer
suggestions of what is required to undertake population-based cost-effective analysis.