Decision analytic modelling of the prevention of vitamin D deficiency in England and Wales

[摘要] Vitamin D deficiency (VDD) is widespread in England and Wales, affecting both children and adults by increasing their risk of poor bone health. In order to inform public decisions on the prevention of VDD, a decision analytic model was developed to compare four alternatives to prevent population VDD: wheat flour fortification, supplementation of at-risk groups, a combination of wheat flour and supplementation, and no intervention. Methods used to inform the model development stage included literature reviews, expert consultation, and preference-based questionnaires to elicit proxy utility values. An individual-level simulation Markov model was chosen to simulate the costs and benefits of each alternative. A cost-effectiveness and cost-utility analysis were undertaken for the base case analysis, using a 90-year time horizon. A societal perspective was chosen to account for private and public costs of implementing each of the alternatives. Parameter uncertainty was tested through deterministic and probabilistic sensitivity analyses. Moreover, in order to inform decisions under uncertainty, a value of information analysis was undertaken. The model results support the decision to implement interventions to prevent VDD, namely a combined strategy of at-risk groups supplementation and wheat flour fortification. Furthermore, this thesis contributes evidence on methodological considerations for modelling micronutrient interventions.

[发布机构] University:University of Birmingham;Department:School of Health and Population Sciences, Health Economics Unit

[关键词] R Medicine;RA Public aspects of medicine;RA0421 Public health. Hygiene. Preventive Medicine