Cost of intramuscular versus oral vitamin B12 in Primary Care Josep Vidal-Alaball, Christopher C Butler and Christopher Po...
Upcoming SlideShare
Loading in …5

Cost of intramuscular versus oral vitamin B12 in Primary Care


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Cost of intramuscular versus oral vitamin B12 in Primary Care

  1. 1. Cost of intramuscular versus oral vitamin B12 in Primary Care Josep Vidal-Alaball, Christopher C Butler and Christopher Potter Department of General Practice / Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Cardiff <ul><li>Background </li></ul><ul><li>Vitamin B 12 (cobalamin) deficiency is common, especially amongst the elderly where prevalence ranges from 1.5 and 4.6 % 1 . </li></ul><ul><li>Vitamin B 12 deficiency causes anaemia, chronic tiredness, loss of appetite and mood disturbance. If left untreated, serious neurological and neuropsychiatric complications occur. </li></ul><ul><li>Vitamin B 12 was isolated in 1948 2 , and is now widely used for treatment of vitamin B 12 deficiency. </li></ul><ul><li>The vitamin was initially administered intramuscularly although several studies have since demonstrated equal efficacy of the oral route 3 4 . </li></ul><ul><li>This is probably because following its binding to intrinsic factor free Vitamin B 12 can be absorbed passively in the terminal ileum as well as actively. </li></ul><ul><li>Passive diffusion accounts for 1.2% of total absorption unaffected by pernicious anaemia or gastro-duodenal surgical resection 5 6 . </li></ul><ul><li>High doses of Vitamin B 12 (1,000 µcg) may be acceptable and safe alternative to parenteral route. </li></ul><ul><li>Despite the availability of oral therapy Vitamin B 12 is rarely prescribed in this form, other than in Sweden where in 2000, 73% of the total Vitamin B 12 prescribed was oral 7 . </li></ul><ul><li>Doctors may be unaware of the oral route or concerned about its unpredictable absorption 8 . </li></ul><ul><li>In the UK, oral Vitamin B 12 is not currently available in high doses. </li></ul><ul><li>Intramuscular injections are a considerable source of work for health care professionals 9 . </li></ul><ul><li>Intramuscular administration often involves a special trip to a health facility or a home visit by a health professional with the associated costs that this entails 8 . </li></ul><ul><li>Oral treatment could therefore save considerable Health Service resources. </li></ul><ul><li>Aims </li></ul><ul><li>To establish whether savings could be make by changing patients from intramuscular to oral vitamin B 12 in Primary Care. </li></ul><ul><li>Method </li></ul><ul><li>Health economic analyses identified, measured and cost estimated the resources used in the current treatment of vitamin B 12 deficiency with intramuscular vitamin B 12 . </li></ul><ul><li>We are performing a cost minimisation analysis because the effectiveness of both intramuscular and oral vitamin B 12 treatments is similar with similar consequences. </li></ul>Preliminary results Cost of resources used in parenteral treatment compared with oral treatment: References 1. van Walraven C, Naylor C. Use of vitamin B12 injections among elderly patients by primary care practitioners in Ontario. Canadian Medical Association Journal 1999;161:146-9. 2. Rickes E, Brink N, Koniuszy F, Wood T, Folkers K. Crystalline vitamin B12. Science 1948;107:396. 3. Spies T, Stone R, Lopez G, Milanes F, Toca R, Aramburu T. Vitamin B12 by mouth in pernicious and nutritional macrocytic anaemia and sprue. Lancet 1949;2:454-6. 4. Ross G, Mollin D, Cox E, Ungley C. Hematologic responses and concentration of vitamin B12 in serum and urine following oral administration of vitamin B12 without intrinsic factor. Blood 1954;9:473-88. 5. Berlin H, Berlin R, Brante G. Oral treatment of pernicious anemia with high doses of vitamin B12 without intrinsic factor. Acta Medica Scandinavica 1968;184(4):247-58. 6. Berlin R, Berlin H, Brante G, Pilbrant A. Vitamin B12 body stores during oral and parenteral treatment of pernicious anaemia. Acta Medica Scandinavica 1978;204(1-2):81-4. 7. Norberg B. Oral high-dose cyanocobalamin - a contagious concept. Rondel , 2001. 8. Lederle FA. Oral cobalamin for pernicious anemia. Medicine's best kept secret? Journal of the American Medical Association 1991;265(1):94-5. 9. Middleton, J. and Wells, W. Vitamin B12 injections: considerable source of work for the district nurse, British Medical Journal Clinical Research Ed 1985; 290 : 1254-5. Effectiveness estimation We have conducted a systematic review on the use of oral vitamin B 12 for the treatment of vitamin B 12 deficiency. The review concluded that oral vitamin B 12 is a effective as intramuscular vitamin B 12 in treating vitamin B 12 deficiency. <ul><li>Conclusions </li></ul><ul><li>Based on initial exploratory analysis it appears that cost savings from oral therapy are likely mainly from decreased visits for injections. </li></ul><ul><li>We estimated that there will be an initial increase in costs associated with converting patients to the oral route. </li></ul>SAPC, Glasgow 2004 =