COST EFFECTIVENESS OF ROUTINE MONITORING OF VITAMIN B12 AND FOLATE IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS.

Hogg, C.; Cernat E.; Gomez-Lopez L.; Iglesias N.; Steele J.; Goldthorpe J.

COST EFFECTIVENESS OF ROUTINE MONITORING OF VITAMIN B12 AND FOLATE IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS.

All Authors

Hogg, C.

Cernat E.

Gomez-Lopez L.

Iglesias N.

Steele J.

Goldthorpe J.

LTHT Author

Hogg, Charlotte
Cernat, Elena
Gomez-Lopez, Lilianne
Iglesias, Natalia
Steele, Julie
Goldthorpe, Jenny

LTHT Department

Leeds Children's Hospital
Children's Dietetic Team

Non Medic

Pharmacist
Dietitian
Nurse Specialist

Publication Date

2024

Item Type

Conference Abstract

Abstract

Patients on home parenteral nutrition (HPN) receive 5mg of vitamin B12 and 400mg of folate with every bag of PN and require regular monitoring of micronutrients,1 including serum vitamin B12 and folate levels. A review of the literature and guidelines highlighted a discrepancy in the recommended frequency of the monitoring for these vitamins between different societies2 and NICE guidelines.3 The dose recommended by NICE guidelines is 1000mg IM hydroxocobalamin every 3 months (equivalent to approximately 11mg/day) and 5 mg daily for 4 months of oral folate, in case of deficiency. Also, NICE guidelines state that 'ongoing monitoring (of vitamin B12 and folate) is unnecessary unless a lack of compliance with treatment is suspected' in case of anaemia secondary to vitamin B12 or folate deficiency2. In our hospital, the cost of measuring serum vitamin B12 is 0.95 and for folate is 0.51. The objective of the study was to determine the cost effectiveness of regular monitoring of vitamin B12 and folate on HPN patients and explore if it can be safely reduced to prevent unnecessary expenditure of healthcare resources without causing harm to patients. We retrospectively reviewed 24 patients (age range 11 months - 18 years) over a 2-year period (2020-2022). The minimum number of days on PN per week was 2 and maximum 7. 68.2% of vitamin B12 samples were above the reference range, 30.7% within the reference range and 1.1% below the reference range. For folate, 39.4% were above the reference range, 60.1% were within the reference range and 0.5% were below the reference range. Any low results were further investigated, and it showed that patients were not using PN at that time. For each patient, the total cost of monitoring vitamin B12 and folate during those 2 years was 261.50 on average. Conclusions 1. Vitamin B12 and folate levels were all above or within the reference range in this cohort in 98.9-99.5% of the sample. 2. The dose of vitamin B12 given with every PN bag (5 mg/bag) was less than the recommended by NICE for patients that need IM treatment (11mg/day); potentially better levels are reached with IV administration. 3. The dose of folate given with every PN bag (400mg/bag) was less than the recommended by NICE for patients that required oral supplementation (5mg/day/7 days a week/4 months); potentially better levels are reached with IV administration. 4. The annual total cost of vitamin B12 and folate monitoring per year per patient in this study was 131. 5. We recommend to decrease the measurement of serum vitamin B12 and folate from three monthly to once a year for patients receiving PN at least 2 days per week. This would be an estimated cost saving of 75%.