Costs of vitamin D testing and prescribing among children in primary care

Basatemür, Emre; Hunter, Rachael; Horsfall, Laura; Sutcliffe, Alastair; Rait, Greta

doi:10.1007/s00431-017-2986-9

Cited by 28 publications

(29 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is the first study to report UK estimates of incidence rates of vitamin D prescribing in children using a comprehensive case definition for vitamin D prescription. An earlier study based in England included only 156 general practices and reported a marked increase in the diagnosis of vitamin D deficiency and prescription costs of single-ingredient vitamin D products in children between 2000 and 2014 28 53. Our study reports similar trends but provides data from a much larger number of practices across the whole of the UK, with detailed socio-demographic prescribing patterns and extending the data to 2016.…”

Section: Discussionsupporting

confidence: 54%

“…The US,20 Canada,21 Australia,22 23 France24 and the UK25 26 have all reported a significant increase in laboratory vitamin D testing, with as much as a 90-fold increase over a 10-year period 22 23. In England, there has also been a marked increase in the number of vitamin D prescriptions issued by general practitioners (GPs) in primary care, with annual spending on vitamin D prescriptions increasing from £0.5 to £40 million between 2007 and 2016,27 a rising trend that was partly attributed to vitamin D prescriptions issued for children 28…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

et al. 2019

Self Cite

View full text Add to dashboard Cite

ObjectiveTo examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.DesignPopulation-based cohort study.SettingUK general practice health records from The Health Improvement Network.ParticipantsChildren aged 0 to 17 years who were registered with their general practices for at least 3 months.Outcome measuresAnnual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.ResultsAmong 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.ConclusionsThere has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.

show abstract

Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…In order to prevent unnecessary vitamin D testing in primary care, the Turkish Ministry of Health vitamin D Scientific Board published a guideline about the indications of vitamin D testing ( 9 ). In the UK, a 17-fold increase in vitamin D testing and prescription costs, from £1,647 in 2008 to £28,913 in 2014 per 100,000 patient-years has been reported ( 10 ), perhaps increased testing leads a dramatic increase in the diagnosis of vitamin D deficiency as well. The overvaluing of 25-OHD measurements without accompanying ALP or PTH measurements ( 11 ) and diagnosing ‘vitamin D deficiency’ based on diverse thresholds have resulted in an increased use of high-dose vitamin D ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Status Across Age Groups in Turkey: Results of 108,742 Samples from a Single Laboratory

Mutlu¹,

Aksu²,

Bereket³

et al. 2020

Jcrpe

View full text Add to dashboard Cite

Objective: The aim was to determine vitamin D status in the general population in Turkey between 2011 and 2016, and to evaluate the effectiveness of the national vitamin D supplementation programme. Methods: Serum 25-hydroxyvitamin D (25-OHD) measurement data were retrieved from an internationally accredited laboratory, operating nationwide. A total of 108,742 measurements of 25-OHD were analyzed using the cut-off values of 0-11 ng/mL, 12-19 ng/mL, 20-49 ng/mL, 50-70 ng/mL and >70 ng/mL for vitamin D deficiency, insufficiency, sufficiency, possibly harmful and excess respectively. Results: The mean±standard deviation 25-OHD level was 21.6±13.3 ng/mL. Mean 25-OHD concentrations by age groups were: 37.3 ng/mL, 30.1 ng/mL and 23.7 ng/mL for <1, 1-10 and 11-18 year old groups, respectively. Mean 25-OHD levels of children <1 year and 1-3 years of age were significantly higher than those found in other age groups. The prevalence of vitamin D deficiency (<12 ng/mL) was lowest in children at 1-3 years of age (5%). In subjects older than 18 years of age, mean 25-OHD levels were 18.2 ng/mL, 20.1 ng/mL, 21.9 ng/mL and 21.1 ng/mL for age groups 19-30, 31-50, 51-70 and >70 years, respectively. Conclusion: Successful implementation of the national vitamin D supplementation programme, appears to have nearly eliminated vitamin D deficiency for children under 1-years of age. However, the positive impact of the vitamin D supplementation diminishes as children get older suggesting that supplementation may be required in the older children and adults. In addition, improved awareness of the benefits and risks of excess vitamin D should prevent unnecessary and excessive use of vitamin D supplements.

show abstract

“…There is a consensus that population-wide screening for vitamin D deficiency by measuring serum 25(OH)D concentrations in asymptomatic low-risk patients should not be done (111, 112, 113, 114). There is, however, no consensus on indications for 25(OH)D testing in patients at risk of vitamin D deficiency with suggested indications ranging from almost no testing to relatively wide testing according to the Endocrine Society Clinical Practice Guideline (Table 4).…”

Section: Practical Vitamin D Testing and Supplementationmentioning

confidence: 99%

Vitamin D testing and treatment: a narrative review of current evidence

Pilz

Zittermann

Trummer

et al. 2019

Endocrine Connections

206

154

View full text Add to dashboard Cite

Vitamin D testing and treatment is a subject of controversial scientific discussions, and it is challenging to navigate through the expanding vitamin D literature with heterogeneous and partially opposed opinions and recommendations. In this narrative review, we aim to provide an update on vitamin D guidelines and the current evidence on the role of vitamin D for human health with its subsequent implications for patient care and public health issues. Vitamin D is critical for bone and mineral metabolism, and it is established that vitamin D deficiency can cause rickets and osteomalacia. While many guidelines recommend target serum 25-hydroxyvitamin D (25[OH]D) concentrations of ≥50 nmol/L (20 ng/mL), the minimum consensus in the scientific community is that serum 25(OH)D concentrations below 25–30 nmol/L (10–12 ng/mL) must be prevented and treated. Using this latter threshold of serum 25(OH)D concentrations, it has been documented that there is a high worldwide prevalence of vitamin D deficiency that may require public health actions such as vitamin D food fortification. On the other hand, there is also reason for concern that an exploding rate of vitamin D testing and supplementation increases costs and might potentially be harmful. In the scientific debate on vitamin D, we should consider that nutrient trials differ from drug trials and that apart from the opposed positions regarding indications for vitamin D treatment we still have to better characterize the precise role of vitamin D for human health.

show abstract

Costs of vitamin D testing and prescribing among children in primary care

Cited by 28 publications

References 14 publications

Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

Vitamin D Status Across Age Groups in Turkey: Results of 108,742 Samples from a Single Laboratory

Vitamin D testing and treatment: a narrative review of current evidence

Contact Info

Product

Resources

About