BMJ open · 2026
Impact of vitamin D non-reimbursement policy on therapy discontinuation in the general and rheumatic population in the Netherlands: a cross-sectional study.
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Singh Amit, Huiskes Victor J B, van den Bemt Bart J F, van Ameijden Hedye, Nurmohamed Michael T, Spijkers Karin M, Vervloet Marcia, Brabers Anne E M
Аннотация
OBJECTIVE: To assess the impact of the non-reimbursement policy on vitamin D therapy discontinuation in patients from the general and rheumatic populations.
DESIGN: A cross-sectional study.
SETTING: Research institute specialised in health research and two outpatient pharmacies in the Netherlands.
PARTICIPANTS: Patients from the general and rheumatic population with an active prescription for vitamin D supplementation therapy were included.
DATA COLLECTION AND ANALYSIS: Data were collected between April and May 2023 through self-reported questionnaires. Descriptive statistics and logistic regression were performed using STATA V. 17. P value <0.05 was considered statistically significant.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the proportion of patients who discontinued vitamin D supplementation therapy following the implementation of the non-reimbursement policy. Secondary outcomes included patient-reported reasons for therapy discontinuation and the association between patient-related characteristics and the risk of therapy discontinuation. In addition, the proportion of patients who switched to an alternative supplement and whether this switch had been made in consultation with a healthcare provider was examined.
RESULTS: Of the 4800 patients, 302 (6.4%) patients discontinued their vitamin D therapy. The three most frequently reported reasons for therapy discontinuation were the inability to afford supplements without reimbursement, not willing to pay for supplements without reimbursement and being unaware of the alternative vitamin D supplements to switch to. Younger age, financial constraints and limited health literacy were significantly associated with vitamin D therapy discontinuation (p<0.05). Among the 1478 patients that switched to an alternative supplement, 706 (17.9%) patients indicated that they made the switch in consultation with a healthcare provider.
CONCLUSION: The implementation of the non-reimbursement policy resulted in a small proportion of patients discontinuing their vitamin D therapy. Elevated discontinuation rates were associated with specific patient-related characteristics including patients aged <50 years, those experiencing financial constraints and those with limited health literacy, suggesting the need for developing interventions and preventive strategies to support patients at risk of therapy discontinuation.
DESIGN: A cross-sectional study.
SETTING: Research institute specialised in health research and two outpatient pharmacies in the Netherlands.
PARTICIPANTS: Patients from the general and rheumatic population with an active prescription for vitamin D supplementation therapy were included.
DATA COLLECTION AND ANALYSIS: Data were collected between April and May 2023 through self-reported questionnaires. Descriptive statistics and logistic regression were performed using STATA V. 17. P value <0.05 was considered statistically significant.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the proportion of patients who discontinued vitamin D supplementation therapy following the implementation of the non-reimbursement policy. Secondary outcomes included patient-reported reasons for therapy discontinuation and the association between patient-related characteristics and the risk of therapy discontinuation. In addition, the proportion of patients who switched to an alternative supplement and whether this switch had been made in consultation with a healthcare provider was examined.
RESULTS: Of the 4800 patients, 302 (6.4%) patients discontinued their vitamin D therapy. The three most frequently reported reasons for therapy discontinuation were the inability to afford supplements without reimbursement, not willing to pay for supplements without reimbursement and being unaware of the alternative vitamin D supplements to switch to. Younger age, financial constraints and limited health literacy were significantly associated with vitamin D therapy discontinuation (p<0.05). Among the 1478 patients that switched to an alternative supplement, 706 (17.9%) patients indicated that they made the switch in consultation with a healthcare provider.
CONCLUSION: The implementation of the non-reimbursement policy resulted in a small proportion of patients discontinuing their vitamin D therapy. Elevated discontinuation rates were associated with specific patient-related characteristics including patients aged <50 years, those experiencing financial constraints and those with limited health literacy, suggesting the need for developing interventions and preventive strategies to support patients at risk of therapy discontinuation.