Background: Literature on the cost of management of rickets and cost-effectiveness of vitamin D supplementation in preventing rickets is lacking. Methods: This study considered the cost-effectiveness of providing free vitamin D supplementation to pregnant women and children <4 years of age with varying degrees of skin pigmentation to prevent rickets in children. Estimates for the prevalence of rickets were calculated using all cases of rickets diagnosed in Central Manchester, UK and census data from the region. Cost of management of rickets were calculated using National Health Service, UK tariffs. The efficacy of vitamin D supplementation was based on a similar programme implemented in Birmingham. Quality of life was assessed using utility estimates derived from a systematic literature review. In this analysis the intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) is below the National Institute for Health and Care Excellence, UK cost-effectiveness threshold of £20,000 per Quality-adjusted life year (QALY). Results: Fifty-seven patients (26 dark, 29 medium and 2 light skin tones) were managed for rickets and associated complications over 4-years. Rickets has an estimated annual incidence of 29•75 per 100,000 children <4 years of age. In the dark skin tone population vitamin D supplementation proved to be cost saving. In a medium skin tone population and light skin tone populations the ICER was £19,295 per QALY and £404,047 per QALY, respectively. Conclusion: Our study demonstrates that a vitamin D supplementation to prevent rickets is cost effective in dark and medium skin tone populations.

No abstract

Background.Chronic obstructive pulmonary disease (COPD) is an under-diagnosed, life-threatening lung disease, which ismainly caused by active smoking, and provokes significant financial burden for the health care sector.COPD is avoidable, therefore strong health policy decisions are crucial in prevention, and to support the policies the analysis of economic impact is an important component in order to illustrate the burden of disease to the society. Therefore, the aim of this study was to estimate annual direct medical costs of newly diagnosed COPD cases in Lithuania. Material and methods. A retrospective,bottom-up, incidence-based cost of illness study included all newly diagnosed COPD patients in Lithuania in 2015. Data was taken from the National Health Insurance Fund under the Ministry of Health (NHIF) database SVEIDRA, and included all cases coded as J44.0, J44.1, J44.8 or J44.9 (6870 cases in total). All costs were assessed from the perspective of health care and consisted of three broad categories: outpatient care related costs, hospital related inpatient care, and reimbursable prescription drugs. The estimated costs are given in 2015 prices and presented in Euros (€). Results. Total direct medical costs of new COPD cases were estimated to be €1,679,879 in 2015. Inpatient costs accounted for €928,054 or 55.2% of the total direct costs, pharmaceutical costs – €633,429 (37.7%), and the outpatient services took €118,396 or 7.1% of the total. The average of total direct costs per-patient was €244.5, and the highest cost was for per-hospitalized patient – €1,176.2. Conclusions. Inpatient services and pharmaceutical costswere the key drivers of directmedical cost of new COPD cases in Lithuania in 2015 accounting for more than half and third of all expenses, respectively.