CALCIFEDIOL VERSUS CHOLECALCIFEROL IN HYPOVITAMINOSIS D: A REGIONAL COST ANALYSIS IN SPAIN
Author(s)
Yoana I. Markova Sulay, MSc1, Yolanda Soto-Serrano, MSc1, Alvaro Hidalgo Vega, PhD2.
1Weber, Madrid, Spain, 2University of Castilla-La Mancha, Toledo, Spain and Fundación Weber, Madrid, Spain.
1Weber, Madrid, Spain, 2University of Castilla-La Mancha, Toledo, Spain and Fundación Weber, Madrid, Spain.
OBJECTIVES: To estimate the economic impact on the Spanish National Health System (SNHS) of choosing between cholecalciferol and calcifediol for the treatment of vitamin D deficiency (hypovitaminosis D), following the inclusion of cholecalciferol in the reference pricing system (Order SND/1074/2024), and to quantify the regional variation in potential cost savings in Spain.
METHODS: A cost analysis was conducted from the SNHS perspective with a one-year time horizon. Calcifediol and the leading cholecalciferol brands representing 90.01% of the cholecalciferol market were included, considering only reimbursed presentations. Unit costs were obtained from the official list prices (Bot Plus, 2026). Annual sales data were sourced from IQVIA (2025). The base case used label-recommended dosing. A one-way sensitivity analysis was developed, using four dosing regimens recommended by the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM), stratified by clinical profile (insufficiency vs. severe deficiency) and patient population (general vs. at-risk).
RESULTS: Replacing all cholecalciferol with calcifediol would generate annual SNHS savings of €12,774,377, while the inverse scenario would increase expenditure by €26,388,491. Savings were consistent across all 19 Spanish regions, ranging from €13,270 (Ceuta) to €1,794,378 (Andalusia), proportional to prescription volume. The three highest-impact regions Andalusia, Catalonia (€1,694,705) and Madrid (€1,600,686) accounted for 39.1% of total potential savings. Smaller regions like La Rioja and the Balearic Islands showed relative savings exceeding 20% of their current vitamin D expenditure, indicating the efficiency gap is not confined to high-volume prescriptions. Sensitivity analyses confirmed calcifediol's cost dominance across all dosing scenarios and patient subgroups.
CONCLUSIONS: The choice of treatment for hypovitaminosis D in primary care has a direct and significant economic impact on the SNHS expenditure on medicines. Even after the reference pricing reform reduced cholecalciferol costs, calcifediol remains the cost-dominant option for vitamin D deficiency treatment across all clinical scenarios and regions in Spain.
METHODS: A cost analysis was conducted from the SNHS perspective with a one-year time horizon. Calcifediol and the leading cholecalciferol brands representing 90.01% of the cholecalciferol market were included, considering only reimbursed presentations. Unit costs were obtained from the official list prices (Bot Plus, 2026). Annual sales data were sourced from IQVIA (2025). The base case used label-recommended dosing. A one-way sensitivity analysis was developed, using four dosing regimens recommended by the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM), stratified by clinical profile (insufficiency vs. severe deficiency) and patient population (general vs. at-risk).
RESULTS: Replacing all cholecalciferol with calcifediol would generate annual SNHS savings of €12,774,377, while the inverse scenario would increase expenditure by €26,388,491. Savings were consistent across all 19 Spanish regions, ranging from €13,270 (Ceuta) to €1,794,378 (Andalusia), proportional to prescription volume. The three highest-impact regions Andalusia, Catalonia (€1,694,705) and Madrid (€1,600,686) accounted for 39.1% of total potential savings. Smaller regions like La Rioja and the Balearic Islands showed relative savings exceeding 20% of their current vitamin D expenditure, indicating the efficiency gap is not confined to high-volume prescriptions. Sensitivity analyses confirmed calcifediol's cost dominance across all dosing scenarios and patient subgroups.
CONCLUSIONS: The choice of treatment for hypovitaminosis D in primary care has a direct and significant economic impact on the SNHS expenditure on medicines. Even after the reference pricing reform reduced cholecalciferol costs, calcifediol remains the cost-dominant option for vitamin D deficiency treatment across all clinical scenarios and regions in Spain.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE367
Topic
Economic Evaluation
Disease
Nutrition