Effect of Dietary Supplements on Health Care Cost Reduction Study Updates. The Dietary Supplement Education Alliance May 2007

Transcription

1 Effect of Dietary Supplements on Health Care Cost Reduction Study Updates The Dietary Supplement Education Alliance May 2007

2 Introduction Nutrition is an input to and foundation for health and development. Interaction of infection and malnutrition is well-documented. Better nutrition means stronger immune systems, less illness and better health. Healthy children learn better. Healthy people are stronger, are more productive and more able to create opportunities to gradually break the cycles of both poverty and hunger in a sustainable way. Better nutrition is a prime entry point to ending poverty and a milestone to achieving better quality of life. World Health Organization, 2006

3 Study Purpose To provide the Dietary Supplement Education Alliance (DSEA) and its affiliated members with updates to earlier analyses of the health benefits and cost effects of selected dietary supplements Review scientific literature for health benefits Extract findings from peer reviewed articles and apply to a health insurance framework Monetize costs and savings of dietary supplement use Determine if use of supplements is cost effective within an insurance framework

4 The Potential Suboptimal intake of some vitamins, above levels causing classic vitamin deficiency, is a risk factor for chronic diseases and common in the general population, especially the elderly. it appears prudent for all adults to take vitamin supplements. Robert H. Fletcher, MD, MSc (Harvard School of Public Health) Kathleen M. Fairfield, MD, DrPH (Harvard Medical School) JAMA. 2002; 287:

5 The Dietary Supplements Selected for this Study Are Calcium with Vitamin D Folic Acid Omega-3 Fatty Acids Lutein with Zeaxanthin

6 Conceptual Framework for the Study Does the supplement produce a physiological effect as shown by a change in biological markers? Does the physiological effect create a change in health status? Effect on Biological Markers Clinical Effects from Change in Biological Markers Cost Effects from Reduced Health Care Utilization Is the change in health status associated with a decrease in health care expenditures?

7 Study Methods Review Literature Levels of Evidence RCT Cohort Study Cross sectional study Case Series Case Control study Single Case Report Opinions of expert based on experience

8 Study Methods - Cost Estimation Cost 1. Size of the at-risk population 2. Cost of supplement 3. Take up rate Benefit 4. Number of users achieving therapeutic effect 5. Reduction in health service utilization Net Savings Net Savings = Benefits less Costs

9 Key Study Findings Surveys of dietary intake and physical and laboratory data reveal that the typical American diet does not always provide a sufficient level of vitamins and/or minerals. The Nutrition and Your Health: Dietary Guidelines for Americans acknowledges that some Americans may need a vitamin and/or mineral supplement to meet specific nutrient needs. Dept. of Health and Human Services (HHS) and Dept. of Agriculture (USDA)

10 Key Study Findings Existing evidence-based research indicates positive health effects: Calcium and vitamin D reduce bone loss and/or osteoporosis, especially among post-menopausal women Folic acid reduces the occurrence of neural tube defects (NTDs) if women consume the supplement before they become pregnant, and continue to do so in the early stages of pregnancy Omega-3 fatty acids reduce the relative risk of coronary heart disease (CHD) Lutein with zeaxanthin reduce the risk of age-related macular degeneration (AMD)

11 Key Study Findings Calcium with Vitamin D There is considerable evidence supporting: the association of reduced bone loss and reduced fractures, with the best evidence supporting a reduction in hip fractures a reduction not only in the cost of the hospitalization to repair the hip, but also the post-acute stay for some proportion of patients in a skilled nursing facility Cost offsets result from the potential avoidance of approximately 776,000 hospitalizations for hip fractures over five years, as well as avoided skilled nursing facility stays for some proportion of patients. The five-year estimated net cost effect associated with avoidable hospitalization for hip fracture is approximately $16.1 billion.

12 Key Study Findings Folic Acid Of the approximately 44 million American women who are of childbearing age and not taking folic acid, if just 11.3 million began taking 400 mcg. of folic acid on a daily basis periconceptionally, 600 babies would be born without NTDs, saving as much as $344,700,000 in the first year as a result. Over five years, taking into account the cost of the supplement, $1.4 billion could potentially be saved.

13 Key Study Findings Omega-3 Fatty Acids The estimate of the potential five-year ( ) savings in health care expenditures resulting from a reduction in the occurrence of coronary heart disease (CHD) among the over age-65 population through daily intake of approximately 1800 mg of omega-3 is $3.2 billion. Approximately 374,301 hospitalizations and associated physician fees due to CHD could be avoided.

14 Key Study Findings Lutein with Zeaxanthin The estimate of the five-year ( ) potential net savings from avoided transitions to dependency associated with a reduction in the relative risk of age-related macular degeneration (AMD) through daily intake of 6-10 mg of lutein with zeaxanthin is $3.6 billion. Across the five year period, approximately 190,927 individuals could avoid the transition to dependence either in the community or a nursing facility that would accompany a loss of central vision resulting from advanced AMD.

15 Conclusions A growing body of scientific research is beginning to provide important clues about how diet choices affect health. In some areas, the relationship between specific foods or dietary supplements and particular health outcomes is fairly clear; in other cases, more research is needed. The rapid expansion of the population age 60 and older has a number of economic implications. The people in this group, about 18 percent of the population, account for about 30 percent of all health care expenditures.