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. 2001 Jan;47:79–86.

Vitamin B12 injections versus oral supplements. How much money could be saved by switching from injections to pills?

C van Walraven 1, P Austin 1, C D Naylor 1
PMCID: PMC2014701  PMID: 11212437

Abstract

OBJECTIVE: To estimate savings, using a third-party payer perspective, if all elderly patients currently receiving vitamin B12 (cobalamin) injections were switched to high-dose oral therapy. DESIGN: We modeled high-dose oral B12 supplement costs to include drugs, pharmacists' fees, and one-time conversion costs consisting of two physician visits and laboratory monitoring. The number of vitamin-injection visits avoided by switching to oral therapy was predicted using a multivariate model that considered covariates for overall patient illness. SETTING: Ontario family physicians' and internists' practices. PARTICIPANTS: Population-based administrative databases for Ontario were used to identify all people between 65 and 100 years who received parenteral vitamin B12 during 1995 and 1996. MAIN OUTCOME MEASURES: The cost of parenteral vitamin B12 for each patient, including drugs, injections, pharmacists' fees, and injection-associated physician visits, was measured directly from the databases. RESULTS: The annual cost of parenteral vitamin B12 therapy averaged $145.88 per person and totaled a maximum $25 million over 5 years. Converting all patients to high-dose oral B12 and treating them for 5 years would cost $7.4 million. Depending on how many vitamin-injection visits are avoided by switching to oral therapy, between $2.9 million and $17.6 million would be saved. Switching to oral B12 administration saved costs as long as 16.3% of injection-associated visits were avoided. CONCLUSION: Switching all patients from B12 injections to oral cobalamin therapy could result in substantial savings.

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Selected References

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  1. Altay C., Cetin M. Oral treatment in selective vitamin B12 malabsorption. J Pediatr Hematol Oncol. 1997 May-Jun;19(3):245–246. doi: 10.1097/00043426-199705000-00012. [DOI] [PubMed] [Google Scholar]
  2. Berlin H., Berlin R., Brante G. Oral treatment of pernicious anemia with high doses of vitamin B12 without intrinsic factor. Acta Med Scand. 1968 Oct;184(4):247–258. doi: 10.1111/j.0954-6820.1968.tb02452.x. [DOI] [PubMed] [Google Scholar]
  3. Berlin R., Berlin H., Brante G., Pilbrant A. Vitamin B12 body stores during oral and parenteral treatment of pernicious anaemia. Acta Med Scand. 1978;204(1-2):81–84. doi: 10.1111/j.0954-6820.1978.tb08402.x. [DOI] [PubMed] [Google Scholar]
  4. Berlin R. Vitamin B 12 injections. Br Med J (Clin Res Ed) 1985 Jul 6;291(6487):56–56. doi: 10.1136/bmj.291.6487.56-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Delva M. D. Vitamin B12 replacement. To B12 or not to B12? Can Fam Physician. 1997 May;43:917–922. [PMC free article] [PubMed] [Google Scholar]
  6. Elia M. Oral or parenteral therapy for B12 deficiency. Lancet. 1998 Nov 28;352(9142):1721–1722. doi: 10.1016/S0140-6736(05)79821-4. [DOI] [PubMed] [Google Scholar]
  7. Hathcock J. N., Troendle G. J. Oral cobalamin for treatment of pernicious anemia? JAMA. 1991 Jan 2;265(1):96–97. [PubMed] [Google Scholar]
  8. Kuzminski A. M., Del Giacco E. J., Allen R. H., Stabler S. P., Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998 Aug 15;92(4):1191–1198. [PubMed] [Google Scholar]
  9. Laupacis A., Feeny D., Detsky A. S., Tugwell P. X. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992 Feb 15;146(4):473–481. [PMC free article] [PubMed] [Google Scholar]
  10. Lederle F. A. Cyanocobalamin--a case for withdrawal. J R Soc Med. 1993 May;86(5):308–309. [PMC free article] [PubMed] [Google Scholar]
  11. Lederle F. A. Oral cobalamin for pernicious anemia. Medicine's best kept secret? JAMA. 1991 Jan 2;265(1):94–95. [PubMed] [Google Scholar]
  12. Lederle F. A. Oral cobalamin for pernicious anemia: back from the verge of extinction. J Am Geriatr Soc. 1998 Sep;46(9):1125–1127. doi: 10.1111/j.1532-5415.1998.tb06651.x. [DOI] [PubMed] [Google Scholar]
  13. Markle H. V. Cobalamin. Crit Rev Clin Lab Sci. 1996;33(4):247–356. doi: 10.3109/10408369609081009. [DOI] [PubMed] [Google Scholar]
  14. Middleton J., Wells W. Vitamin B12 injections: considerable source of work for the district nurse. Br Med J (Clin Res Ed) 1985 Apr 27;290(6477):1254–1255. doi: 10.1136/bmj.290.6477.1254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Naglie G., Tansey C., Krahn M. D., O'Rourke K., Detsky A. S., Bolley H. Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65. CMAJ. 1999 Mar 23;160(6):805–811. [PMC free article] [PubMed] [Google Scholar]
  16. Pruthi R. K., Tefferi A. Pernicious anemia revisited. Mayo Clin Proc. 1994 Feb;69(2):144–150. doi: 10.1016/s0025-6196(12)61041-6. [DOI] [PubMed] [Google Scholar]
  17. Savage D., Lindenbaum J. Relapses after interruption of cyanocobalamin therapy in patients with pernicious anemia. Am J Med. 1983 May;74(5):765–772. doi: 10.1016/0002-9343(83)91064-1. [DOI] [PubMed] [Google Scholar]
  18. Sonnenberg F. A., Roberts M. S., Tsevat J., Wong J. B., Barry M., Kent D. L. Toward a peer review process for medical decision analysis models. Med Care. 1994 Jul;32(7 Suppl):JS52–JS64. [PubMed] [Google Scholar]
  19. Stabler S. P., Lindenbaum J., Allen R. H. Vitamin B-12 deficiency in the elderly: current dilemmas. Am J Clin Nutr. 1997 Oct;66(4):741–749. doi: 10.1093/ajcn/66.4.741. [DOI] [PubMed] [Google Scholar]
  20. Verhaeverbeke I., Mets T., Mulkens K., Vandewoude M. Normalization of low vitamin B12 serum levels in older people by oral treatment. J Am Geriatr Soc. 1997 Jan;45(1):124–125. doi: 10.1111/j.1532-5415.1997.tb01000.x. [DOI] [PubMed] [Google Scholar]
  21. WAIFE S. O., JANSEN C. J., Jr, CRABTREE R. E., GRINNAN E. L., FOUTS P. J. Oral vitamin B12 without intrinsic factor in the treatment of pernicious anemia. Ann Intern Med. 1963 May;58:810–817. doi: 10.7326/0003-4819-58-5-810. [DOI] [PubMed] [Google Scholar]
  22. Watts D. T. Vitamin B12 replacement therapy: how much is enough? Wis Med J. 1994 May;93(5):203–205. [PubMed] [Google Scholar]

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