What if it is B12 deficiency? How much would it cost to treat?

Firstly there’s a cost of diagnosis. 

Using the <Chandy diagnostic criteria> takes 2-3minutes which fits easily within a 10 minute consultation.

Blood serum B₁₂ assay for £3.37 (NHS price –  this would be approx £10 through a private laboratory).  The assay may not be definitive (it’s debatable where the threshold point for treatment should be) but blood B₁₂ below 350ng/L should certainly be cause for concern. For 2million people this adds up to less than £7million, and they don’t need testing every year.

Treatment:

Individual vials (1ml of 1mg/ml) of hydroxyl-cobalamin cost £1.50. Depending on the frequency of injection a pack of 5 (£7.50) can last 15 months (over a year) at BNF recommended injections every 3 months – in practice we find people need injections more often (hydroxyl-cobalamin and methyl-cobalamin can be obtained more cost-effectively in bulk).  Even allowing for nurse time to perform the injection the cost of treatment at a GP surgery is unlikely to exceed £10 (simple intramuscular or sub-dermal injection).

For many people, oral B₁₂ in the form of tablets or sub-lingual lozenges are perfectly adequate. We recommend 1mg (1,000µg) per day, which can be purchased from <a health food store> for perhaps £7.99 per 100 tablet dose

Cost of treatment

Injections: assume 1 per month = 12 per year.  Assume 33% of the 2 million need this = 660,000.  Cost £10 per injection = £79.2million.

Oral supplement: assume 1 per day = 365 per year.  Assume remainder = 1,340,000 population.  Cost 8p per dose (no administration cost) = £39.1 million

This total of £125.3million is substantially different from the conservative estimate of £844million above.

(F YOU LIVE IN A COUNTRY WITHOUT GOOD STATE-FUNDED HEALTHCARE, YOUR COSTS ARE LIKELY TO BE BETWEEN 1 ½ AND 2 TIMES THESE)