The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales

Eur J Clin Nutr. 2020 May;74(5):825-833. doi: 10.1038/s41430-019-0486-x. Epub 2019 Aug 20.


Background: Vitamin D deficiency (VDD) affects the health and wellbeing of millions worldwide. In high latitude countries such as the United Kingdom (UK), severe complications disproportionally affect ethnic minority groups.

Objective: To develop a decision-analytic model to estimate the cost effectiveness of population strategies to prevent VDD.

Methods: An individual-level simulation model was used to compare: (I) wheat flour fortification; (II) supplementation of at-risk groups; and (III) combined flour fortification and supplementation; with (IV) a 'no additional intervention' scenario, reflecting the current Vitamin D policy in the UK. We simulated the whole population over 90 years. Data from national nutrition surveys were used to estimate the risk of deficiency under the alternative scenarios. Costs incurred by the health care sector, the government, local authorities, and the general public were considered. Results were expressed as total cost and effect of each strategy, and as the cost per 'prevented case of VDD' and the 'cost per Quality Adjusted Life Year (QALY)'.

Results: Wheat flour fortification was cost saving as its costs were more than offset by the cost savings from preventing VDD. The combination of supplementation and fortification was cost effective (£9.5 per QALY gained). The model estimated that wheat flour fortification alone would result in 25% fewer cases of VDD, while the combined strategy would reduce the number of cases by a further 8%.

Conclusion: There is a strong economic case for fortifying wheat flour with Vitamin D, alone or in combination with targeted vitamin D3 supplementation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Cholecalciferol / administration & dosage
  • Cholecalciferol / economics
  • Cost-Benefit Analysis
  • England / epidemiology
  • Ethnicity / statistics & numerical data
  • Female
  • Flour* / economics
  • Food, Fortified* / economics
  • Humans
  • Male
  • Middle Aged
  • Minority Groups / statistics & numerical data
  • Triticum*
  • Vitamin D Deficiency / diet therapy
  • Vitamin D Deficiency / economics*
  • Vitamin D Deficiency / epidemiology
  • Vitamin D Deficiency / prevention & control*
  • Vitamin D* / administration & dosage
  • Vitamin D* / economics
  • Wales / epidemiology
  • Young Adult


  • Vitamin D
  • Cholecalciferol