Substantial cost savings could be made with appropriate vitamin D prescribing

Real-world data from an observational study to assess the impact on health resource utilisation for patients with clinically diagnosed vitamin D deficiency was presented at the RCGP Annual Primary Care Conference in Glasgow.

The study highlights issues around race and the high impact of vitamin D deficiency on the non-white population. It suggests substantial cost savings could be made by CCGs if appropriate vitamin D prescribing were implemented.

Dr Ash Zaman, GP Partner from West Yorkshire, said: €œAs GP services are taking on many secondary care services roles, major topics like cardiovascular disease and diabetes seem to take priority over bone health, which is an area busy GPs are struggling to learn and update their knowledge about.

“As a result of this, I have seen cases of GPs not following accepted guidance on bone health and vitamin D.  The consequences of this could increase long-term costs to the NHS as well as sub-standard care for patients.€

The new study investigated the impact of vitamin D deficiency treatment pathways on health utilisation within the UK, using data within The Health Improvement Network (THIN) database. The study tracked a sample of 11,982 patients who were newly diagnosed as vitamin D deficient with a first diagnosis having been made between 1 January 2015 and 31 December 2016.

Key findings showed a high level of inconsistency in primary care practice in the diagnosis, treatment and maintenance of vitamin D deficiency. Patient demographic data captured in the THIN database also showed that of newly diagnosed patients prescribed vitamin D in a 2-year period, 36% of this population (with ethnicity recorded) were non-white, and 70% of the patients were female.

This means any inconsistencies and/or restrictions in the prescribing of vitamin D therapy disproportionately affect the non-white, female population.

In addition, a broad range of dosing regimens prescribed for diagnosed vitamin D deficiency observed within the THIN data, did not appear to align to recommendations from national guidelines.

Of significance was the observation that in the 12 months following initiation of vitamin D therapy regardless of dose, patients prescribed vitamin D used fewer healthcare resources than in the 12 months prior to diagnosis and treatment.

This could equate to cost savings for the average CCG of £1,444,996 minus treatment costs of £334,890. So, the net or real cost savings per CCG of continuing to manage vitamin D deficient patients might be in the region of £1,110,106.

Jag Sangha, Pharmaceutical Consultant and GP practice-based pharmacist, added: €œAn ageing population continues to place an increased demand on NHS services. Falls, frailty and fracture prevention remain key areas for many health economies attempting to reduce the growing health and social care cost burden.

“Vitamin D deficiency represents a significant risk factor toward adverse bone health, and increased fragility fracture risk which needs to be addressed through systematic and targeted population intervention.”