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LaRiccia PJ, Cafaro T, John D, van Helmond N, Mitrev LV, Bandomer B, Brobyn TL, Hunter K, Roy S, Ng KQ, Goldstein H, Tsai A, Thwing D, Maag MA, Chung MK. Healthcare Costs and Healthcare Utilization Outcomes of Vitamin D3 Supplementation at 5000 IU Daily during a 10.9 Month Observation Period within a Pragmatic Randomized Clinical Trial. Nutrients 2023; 15:4435. [PMID: 37892510 PMCID: PMC10609978 DOI: 10.3390/nu15204435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization. Comparisons were made between the vitamin D3 at 5000 IU supplementation group and a non-supplemented control group. Costs of care between the groups differed but were not statistically significant. Vitamin D3 supplementation reduced healthcare utilization in four major categories: hospitalizations for any reason (rate difference: -0.19 per 1000 person-days, 95%-CI: -0.21 to -0.17 per 1000 person-days, p < 0.0001); ICU admissions for any reason (rate difference: -0.06 per 1000 person-days, 95%-CI: -0.08 to -0.04 per 1000 person-days, p < 0.0001); emergency room visits for any reason (rate difference: -0.26 per 1000 person-days, 95%-CI: -0.46 to -0.05 per 1000 person-days, p = 0.0131; and hospitalizations due to COVID-19 (rate difference: -8.47 × 10-3 per 1000 person-days, 95%-CI: -0.02 to -1.05 × 10-3 per 1000 person-days, p = 0.0253). Appropriately powered studies of longer duration are recommended for replication of these utilization findings and analysis of cost differences.
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Affiliation(s)
- Patrick J. LaRiccia
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Teresa Cafaro
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ 08103, USA;
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, USA; (D.J.); (K.H.)
| | - Dibato John
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, USA; (D.J.); (K.H.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Noud van Helmond
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ 08103, USA;
| | - Ludmil V. Mitrev
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ 08103, USA;
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Brigid Bandomer
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Tracy L. Brobyn
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
- The Chung Institute of Integrative Medicine, Moorestown, NJ 08057, USA
- Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, USA; (D.J.); (K.H.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
- Division of General Internal Medicine, Cooper University Health Care, Camden, NJ 08103, USA
| | - Kevin Q. Ng
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- The Chung Institute of Integrative Medicine, Moorestown, NJ 08057, USA
- Division of Infectious Disease, Cooper University Health Care, Camden, NJ 08103, USA
| | - Helen Goldstein
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Alan Tsai
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Denise Thwing
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Mary Ann Maag
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Myung K. Chung
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
- The Chung Institute of Integrative Medicine, Moorestown, NJ 08057, USA
- Department of Family Medicine, Cooper University Health Care, Camden, NJ 08103, USA
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Cafaro T, LaRiccia PJ, Bandomer B, Goldstein H, Brobyn TL, Hunter K, Roy S, Ng KQ, Mitrev LV, Tsai A, Thwing D, Maag MA, Chung MK, van Helmond N. Remote and semi-automated methods to conduct a decentralized randomized clinical trial. J Clin Transl Sci 2023; 7:e153. [PMID: 37528946 PMCID: PMC10388435 DOI: 10.1017/cts.2023.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Designing and conducting clinical trials is challenging for some institutions and researchers due to associated time and personnel requirements. We conducted recruitment, screening, informed consent, study product distribution, and data collection remotely. Our objective is to describe how to conduct a randomized clinical trial using remote and automated methods. Methods A randomized clinical trial in healthcare workers is used as a model. A random group of workers were invited to participate in the study through email. Following an automated process, interested individuals scheduled consent/screening interviews. Enrollees received study product by mail and surveys via email. Adherence to study product and safety were monitored with survey data review and via real-time safety alerts to study staff. Results A staff of 10 remotely screened 406 subjects and enrolled 299 over a 3-month period. Adherence to study product was 87%, and survey data completeness was 98.5% over 9 months. Participants and study staff scored the System Usability Scale 93.8% and 90%, respectively. The automated and remote methods allowed the study maintenance period to be managed by a small study team of two members, while safety monitoring was conducted by three to four team members. Conception of the trial to study completion was 21 months. Conclusions The remote and automated methods produced efficient subject recruitment with excellent study product adherence and data completeness. These methods can improve efficiency without sacrificing safety or quality. We share our XML file for researchers to use as a template for learning purposes or designing their own clinical trials.
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Affiliation(s)
- Teresa Cafaro
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ, USA
- Cooper Research Institute, Cooper University Health Care, Camden, NJ, USA
- Won Sook Chung Foundation, Moorestown, NJ, USA
| | - Patrick J. LaRiccia
- Won Sook Chung Foundation, Moorestown, NJ, USA
- Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Tracy L. Brobyn
- Won Sook Chung Foundation, Moorestown, NJ, USA
- The Chung Institute of Integrative Medicine, Moorestown, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Division of General Internal Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Kevin Q. Ng
- Won Sook Chung Foundation, Moorestown, NJ, USA
- The Chung Institute of Integrative Medicine, Moorestown, NJ, USA
- Division of Infectious Disease, Cooper University Health Care, Camden, NJ, USA
| | - Ludmil V. Mitrev
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Alan Tsai
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | - Myung K. Chung
- Won Sook Chung Foundation, Moorestown, NJ, USA
- The Chung Institute of Integrative Medicine, Moorestown, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Department of Family Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Noud van Helmond
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ, USA
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