{
  "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 0.6mL (Dalivit®) plus vitamin E liquid 50mg plus phytomenadione 1mg (Konakion® ampoules) to a fat soluble vitamin combination product designed for children with cystic fibrosis containing 1600 units vitamin A, 600 units vitamin D, 40mg vitamin E and 2mg phytomenadione in 0.1mL in a medium chain triglyceride oil base (Paravit CF®).Aim The aim of this study was to assess the efficacy and cost effectiveness of the new regimen compared to the original one.Method 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. Vitamin levels and international normalised ratio (INR) were recorded at around 6 and 12 months at which point the vitamin supplements were stopped.Results Five children met the criteria in each vitamin regimen group. 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 102-137nmol/L (normal range 50-100nmol/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 transaminases, 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 (104-155nmol/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.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 References Paediatric Formulary Committee BNF for Children (online) London: BMJ, Pharmaceutical Press, and RCPCH Publications http://www.medicinescomplete.com [Accessed on 3 Nov 2024].Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clinical Therapeutics 2001;23(8):1296–1310.",
  "authors": [
    {
      "affiliations": [
        "Leeds Children’s Hospital, UK"
      ],
      "name": "Penny North-Lewis"
    }
  ],
  "title": "P41 Cost effectiveness of fat soluble vitamin preparations in children with biliary atresia",
  "uid": "9aea66d4-da89-5adc-9b85-2f2ced9575f7"
}