Health Care Cost Reduction – Introduction
The purpose of this study is to provide the Dietary Supplement Education Alliance (DSEA) and its members with updates to earlier analyses of the health benefits and associated cost effects of daily use of four selected supplements.
A number of age-related diseases contribute significantly to whether an older person can maintain his or her independence, including coronary heart disease (CHD), osteoporosis, and age-related macular degeneration (AMD).
Over one third of adults over age-65 experience falls each year, many of which result in a hip fracture. Hip fractures can be devastating, as they cause the greatest number of deaths and lead to the most severe health problems of any age-related diseases. In addition, they are extremely costly, as they require a hospital stay to repair the hip, with 50% of patients going to a skilled nursing home (or inpatient rehabilitation facility) for a stay that lasts anywhere from a few weeks to over three months. Up to 25% of community dwelling older adults who sustain hip fractures remain institutionalized for a whole year.5
AMD affects activities central to independent living, which include reading, driving, and writing, which are considerably impaired through the loss of central vision, for example. AMD is the leading cause of irreversible blindness in persons over age 65. Research studies have shown that preventive measures, such as smoking avoidance and good nutrition, practiced throughout oneís life can help reduce the risk of these conditions, thereby avoiding or delaying a loss of independence or the onset of functional disability. Visual impairment is one of the top four reasons for loss of independence. Furthermore, eighteen percent of all hip fractures among seniors have been attributed to age-related vision loss.
The transition to greater dependency, whether by getting more help at home or through moving to a nursing facility, places considerable financial burden on the older person, his or her family, and the health care system. 2 Studies have shown that there are additional medical and other costs that occur in the year when an older person makes the transition to dependency at home or moves to a nursing facility. The prevention (or even delay) in the loss of independence has implications both economically and also for the individualís quality of life.
We used Congressional Budget Office cost accounting methodology to determine the economic impact on Medicare and others that could result from daily supplement use. Four supplement/disease combinations were examined and earlier estimates of cost effects were updated.6,7 These supplements had been selected because the rigor and validity of the available scientific literature met critical evidentiary thresholds. The supplements are:
- Calcium with Vitamin D
- Folic Acid
- Omega-3 Fatty Acids
- Lutein with Zeaxanthin
We had found significant scientific agreement concerning the improvement in health status and reduction in health care and other expenditures for calcium with Vitamin D and folic acid in the first study. We found a well-developed literature concerning the role of omega-3 fatty acids in reducing the risk of coronary events (myocardial infarction and ischemia) and atherosclerosis, including a comprehensive review of the literature by the Agency for Healthcare Research and Quality8 in the second study.9
The literature is less well-developed for lutein, although studies date back fifteen years. Currently clinical trials are being conducted at the National Institutes of Health to isolate the effects of lutein on macular pigment density and determine the optimal dosage. Additionally, the Agence Francaise de Securite Sanitaire des Aliments, which is a French organization comparable to the U.S. Food and Drug Agency (FDA), evaluated the scientific merit of the health claims that have been made concerning luteinís protective effect on the lens and retina. Their evaluation found that the assertion that lutein contributes to the protection of the retina and lens from oxidation is substantiated by the scientific evidence.10
5Magaziner J, Hawkes W, Hebel JR, et al. (2000). Recovery from hip fracture by eight areas of function. Journal of Gerontology: Medical Sciences. 55A(9): M498-507.
6DaVanzo JE, Dobson A, et al. (2004) A Study of the Health and Cost Effects of Five Dietary Supplements. Falls Church, VA: The Lewin Group.
7DaVanzo JE, Dobson A, et al. (2006) An Evidence-Based Study of the Role of Dietary Supplements in Helping Seniors Maintain their Independence. Falls Church, VA: The Lewin Group.
8Agency for Healthcare Research and Quality (2004). Health Effects of Omega-3 Fatty Acids on Cardiovascular Disease. (Publication No. 04-E009-2).
9For this study, we updated the earlier literature reviews.
10Agence Francaise de Securite Sanitaire des Aliments. Maisons-Alfort, le 23 janvier 2004.