In response to a recommendation from the Chief Medical Officer for England, the Department of Health asked the National Institute for Health and Care Excellence (NICE) to examine the cost effectiveness of moving the Healthy Start vitamin programme from the current targeted offering to a universal offering. (See the scope.)

The impetus for this work was growing concern about the prevalence of disease related to vitamin D deficiency, for example the occurrence of rickets and hypocalcaemic fits among children (Diagnosis and management of vitamin D deficiency Pearce and Cheetham 2010; Incidence of symptomatic vitamin D deficiency Callaghan et al. 2006).

In addition, there were concerns about the proportion of women following advice on folic acid supplementation (Prevention of neural tube defects: a cross-sectional study of the uptake of folic acid supplementation in nearly half a million women Bestwick et al. 2014).

The Chief Medical Officer's annual report for 2012 Our children deserve better: prevention pays (Department of Health) notes: 'There is a growing body of evidence to suggest that providing free vitamins to targeted groups has not led to high enough levels of uptake. This, in turn, has therefore not impacted on reducing the morbidity associated with vitamin deficiency'.

This special report summarises the findings of an economic modelling exercise and a cost effectiveness review[2] of the vitamins contained within the Healthy Start supplements. (These supplements are referred to throughout this report as Healthy Start vitamins.) It has not considered the cost effectiveness of the Healthy Start food vouchers or other components of the scheme. The methods and range of data sources used to develop the economic model are described in detail in the modelling report.

The report has been produced for the Chief Medical Officer. It is also relevant for the Department of Health and others responsible for public health policy.

The Scientific Advisory Committee on Nutrition (SACN) is currently reviewing the dietary reference values for vitamin D. This report should be read in conjunction with SACN's final recommendations.

In addition, it should be noted that other options for increasing the folate status of women planning, or in the early stages of, a pregnancy, have been proposed. For example, SACN's proposal to fortify flour with folic acid in the UK, while retaining existing advice on supplementation (SACN Report to CMO on folic acid and colorectal cancer risk Public Health England).

This report is not intended to inform development of a NICE guideline but will complement NICE's existing guideline on increasing the uptake of vitamin D supplements among at risk groups.

For more details see the cost effectiveness review and the modelling report.

[2] The effectiveness of giving the groups of interest supplements containing these nutrients, and the composition of the supplements, was previously considered in the Scientific review of the Welfare Food Scheme published by the Department of Health.