Cost-utility of vitamin D supplementation to prevent acute respiratory infections in children

Jefferson Antonio Buendía1, Diana Guerrero Patiño1
1Research group in Pharmacology and Toxicology “INFARTO,” Department of Pharmacology and Toxicology, University of Antioquia, Medellin, Colombia

Tóm tắt

Abstract Introduction Increasing evidence has demonstrated the effectiveness and safety of vitamin D supplementation to prevent acute respiratory infections in children. More economic evaluations incorporating the new evidence and in the pediatric population are needed to know the efficiency of this treatment. This study aimed to determine the cost-utility of vitamin D supplementation to prevent acute respiratory infections in pediatric patients. Methods A decision tree model was used to estimate the cost and quality-adjusted life-years (QALYs) of vitamin D supplementation in healthy school children between 1 and 16 years. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of $19,000. Results The base-case analysis showed that vitamin D supplementation was associated with lower costs and higher QALYs than strategy without this supplementation. The QALYs per person estimated in the model for those treatments were 0,99 with vitamin D supplementation and 0,98 without vitamin D supplementation. The total costs per person were US$ 1354 for vitamin D supplementation and US$ 1948 without vitamin D supplementation. This position of absolute dominance of vitamin D supplementation makes it unnecessary to estimate the incremental cost-effectiveness ratio. Conclusion In conclusion, our study shows that Vitamin D supplementation is a cost-effective strategy to prevent ARI in pediatric patients, from a societal perspective.

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Tài liệu tham khảo

McAllister DA, Liu L, Shi T, Chu Y, Reed C, Burrows J, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health. 2019;7(1):e47–e57.

Howie SRC, Murdoch DR. Global childhood pneumonia: the good news, the bad news, and the way ahead. Lancet Glob Health. 2019;7(1):e4–e5.

Verway M, Bouttier M, Wang TT, Carrier M, Calderon M, An BS, et al. Vitamin D induces interleukin-1beta expression: paracrine macrophage epithelial signaling controls M. tuberculosis infection. PLoS Pathog. 2013;9(6):e1003407.

Urry Z, Chambers ES, Xystrakis E, Dimeloe S, Richards DF, Gabrysova L, et al. The role of 1alpha,25-dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3 + and IL-10 + CD4 + T cells. Eur J Immunol. 2012;42(10):2697–708.

Vargas Buonfiglio LG, Cano M, Pezzulo AA, Vanegas Calderon OG, Zabner J, Gerke AK, et al. Effect of vitamin D3 on the antimicrobial activity of human airway surface liquid: preliminary results of a randomised placebo-controlled double-blind trial. BMJ Open Respir Res. 2017;4(1):e000211.

Cariolou M, Cupp MA, Evangelou E, Tzoulaki I, Berlanga-Taylor AJ. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis. BMJ Open. 2019;9(5):e027666.

Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021;9(5):276–92.

Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.

Jat KR. Vitamin D deficiency and lower respiratory tract infections in children: a systematic review and meta-analysis of observational studies. Trop Doct. 2017;47(1):77–84.

Bergman P, Lindh AU, Bjorkhem-Bergman L, Lindh JD. Vitamin D and respiratory tract infections: a systematic review and Meta-analysis of Randomized controlled trials. PLoS ONE. 2013;8(6):e65835.

Mao S, Huang S. Vitamin D supplementation and risk of respiratory tract infections: a meta-analysis of randomized controlled trials. Scand J Infect Dis. 2013;45(9):696–702.

Charan J, Goyal JP, Saxena D, Yadav P. Vitamin D for prevention of respiratory tract infections: a systematic review and meta-analysis. J Pharmacol Pharmacother. 2012;3(4):300–3.

Salud. IdETe. Manual metodológico para la elaboración de evaluaciones de efectividad, seguridad y validez diagnóstica de tecnologías en salud. 2014.

Salud INd. Informe de evento. Infeccion Respiratoria Aguda Bogota, Colombia: INS. ; 2017 [Available from: https://www.ins.gov.co/buscador-eventos/Informesdeevento/Informe%20IRA%20Final%202017.pdf.

(DANE) DNdE. Archivo nacional de datos 2019 [Available from: https://sitios.dane.gov.co/anda-index/.

(IHME) IfHMaE. Colombia Seattle. WA: University of Washington; 2021. [Available from: www.healthdata.org.

Carroll AE, Downs SM. Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. J Pediatr. 2009;155(1):21–5.

Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic evaluation reporting Standards (CHEERS) statement. Value Health. 2013;16(2):e1–5.

Moyano Ariza L. Estimación de costo-enfermedad por neumonía y bronquiolitis en niños menores de 5 años en Colombia. 2019.

Ministerio de salud C. Sistema de Informacion de Precios de Medicamentos (SISMED) 2021 [03/07/2121]. Available from: www.sispro.gov.co/central-prestadores-de-servicios/Pages/SISMED-Sistema-de-Informacion-de-Precios-de-Medicamentos.aspx.

Sakai M, Shimbo T, Omata K, Takahashi Y, Satomura K, Kitamura T, et al. Cost-effectiveness of gargling for the prevention of upper respiratory tract infections. BMC Health Serv Res. 2008;8:258.

Berber A, Del-Rio-Navarro BE. Cost-effectiveness analysis of OM-85 vs placebo in the prevention of acute respiratory tract infections (ARTIs) in children that attend day-care centers. Health Econ Rev. 2019;9(1):12.

Zagar S, Lofler-Badzek D. Broncho-Vaxom in children with rhinosinusitis: a double-blind clinical trial. ORL J Otorhinolaryngol Relat Spec. 1988;50(6):397–404.

Pessey JJ, Megas F, Arnould B, Baron-Papillon F. Prevention of recurrent rhinopharyngitis in at-risk children in France: a cost-effectiveness model for a nonspecific immunostimulating bacterial extract (OM-85 BV). PharmacoEconomics. 2003;21(14):1053–68.

Ravasio R. Economic analysis of the immunostimulant OM-85 for the Prevention of Paediatric Recurrent Upper Respiratory Tract Infections. Global & Regional Health Technology Assessment. 2015;2(3):GRHTA5000200.

Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015(2):CD006895.

Chiappini E, Santamaria F, Marseglia GL, Marchisio P, Galli L, Cutrera R, et al. Prevention of recurrent respiratory infections: inter-society Consensus. Ital J Pediatr. 2021;47(1):211.

Yin J, Xu B, Zeng X, Shen K. Broncho-Vaxom in pediatric recurrent respiratory tract infections: a systematic review and meta-analysis. Int Immunopharmacol. 2018;54:198–209.

Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2016;12:CD005978.

Esposito S, Jones MH, Feleszko W, Martell JAO, Falup-Pecurariu O, Geppe N et al. Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement. Microorganisms. 2020;8(11).

Cho HE, Myung SK, Cho H. Efficacy of Vitamin D Supplements in Prevention of Acute Respiratory Infection: A Meta-Analysis for Randomized Controlled Trials. Nutrients. 2022;14(4).