title: Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling.
abstract: The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations.
authors: CCRE Therapeutics, The Alfred Centre, Melbourne, Vic., Australia.
authors: Thilanga
authors: T
authors: Ruwanpathirana
authors: CCRE Therapeutics, The Alfred Centre, Melbourne, Vic., Australia.
authors: Alice
authors: A
authors: Owen
authors: Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, The Alfred Centre, Melbourne, Vic., Australia.
authors: Andre M N
authors: AM
authors: Renzaho
authors: Centre for International Health, Department of Epidemiology and Preventive Medicine, Burnet Institute, Monash University, Melbourne, Vic., Australia.
authors: Ella
authors: E
authors: Zomer
authors: School of Public Health, Curtin University, Perth, WA, Australia.
authors: Manoj
authors: M
authors: Gambhir
authors: CCRE Therapeutics, The Alfred Centre, Melbourne, Vic., Australia.|Priment, UCL, London, UK.
authors: Christopher M
authors: CM
authors: Reid
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001315:Australia / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000097:blood / Q000208:ethnology* / Q000517:prevention & control*; D003153:Community Health Services / Q000379:methods; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D012307:Risk Factors; D014171:Transients and Migrants; D014807:Vitamin D / Q000008:administration & dosage*
chemical_list: D014807:Vitamin D
keywords: cardiovascular disease; framingham risk score; markov models; vitamin D deficiency