SWITCHING FAT SOLUBLE VITAMIN PREPARATIONS IN CHILDREN WITH BILIARY ATRESIA: A SINGLE-CENTRE CLINICAL AND COST-EFFICIENT APPROACH.

North-Lewis, P.; Jayaprakash, K.

SWITCHING FAT SOLUBLE VITAMIN PREPARATIONS IN CHILDREN WITH BILIARY ATRESIA: A SINGLE-CENTRE CLINICAL AND COST-EFFICIENT APPROACH.

All Authors

North-Lewis, P.

Jayaprakash, K.

LTHT Author

North-Lewis, Penny
Jayaprakash, Kavitha

LTHT Department

Medicines Management & Pharmacy Services
Clinical Pharmacy
Leeds Children's Hospital
Children's Liver Unit

Non Medic

Paediatric Liver Pharmacist

Publication Date

2025

Item Type

Conference Abstract

Abstract

Infants with biliary atresia are typically discharged with multiple medicines following their Kasai portoenterostomy procedure. These include fat soluble vitamin supplements given whilst the child remains cholestatic and continued for the first year. A nationwide shortage of the licensed vitamin E liquid (alpha tocopheryl) in the UK, forced a change from a triple vitamin regimen consisting of a standard multivitamin preparation containing vitamin A 5000 units and vitamin D 400 units in 0.6 mL (Dalivit) plus vitamin E liquid 50 mg plus phytomenadione 1 mg (Konakion ampoules) to a fat soluble vitamin combination product designed for children with cystic fibrosis containing 1600 units vitamin A, 600 units vitamin D, 40 mg vitamin E and 2 mg phytomenadione in 0.1 mL in an MCT oil base (Paravit CF). The aim of this study was to assess the efficacy and cost effectiveness of the new regimen compared to the original one. Infants with biliary atresia who underwent a Kasai portoenterostomy and cleared their jaundice with a full year of follow up on each of the vitamin regimens, from 2021 to 2024 were included. Those whose Kasai operations failed were excluded as their vitamin requirements were highly variable depending on their clinical course and timing of transplantation. Five children met the criteria in each vitamin regimen group. Vitamin levels and INR were recorded at around 6 and 12 months at which point the vitamin supplements were stopped. The first group (triple vitamin regimen) were 2 male, 4 Caucasian, 1 Asian, all cleared their jaundice by a median of 4 months (range: 3.5-6 months) and maintained normal liver function tests. One child had an episode of cholangitis. The vitamin levels and INR were normal by 6 months in all 5 children and remained so at 12 months. Of note 3 children had vitamin D levels above the normal range with levels of 102-137 nmol/L (normal range 50-100 nmol/L). The second group (single combination preparation) were 3 male, all Caucasian and cleared their jaundice by a median of 3 months (range: 1.5-5 months), although 2 had intermittent raised ALT, 1 with presumed cholangitis. The vitamin levels and INR were normal by 6 months in 4/5 children. One had a low vitamin A level which normalised by 12 months. Vitamin D levels were high in 3/5 children (104-155 nmol/L). The triple vitamin regimen has an indicative NHS cost of <=150 per month per patient. The single combination preparation has a cost of <=40 per month.1 The overall cost saving to the healthcare system is <=1,300 for 1 year of treatment per patient. In conclusion, the switch to a single combination product was of similar efficacy to the previous triple agent regimen and was more cost effective, saving NHS resources including consumables (only 1 oral syringe needed instead of 3) as well as reducing drug costs. It also decreases the medicine burden for parents, and this is likely to improve adherence and quality of life.2 .