B-vitamins are potentially a cost-effective population health strategy to tackle dementia: Too good to be true?

•We need to prioritize resources on strategies to prevent dementia.•Treatment with B-vitamins at an early stage appears to be highly cost-effective.•This provocative finding should be debated and tested.

IntroductionTo respond to the threat of dementia to public health and the economy, we need to prioritize research resources on strategies that would be the most effective. In relation to the prevention of dementia, this article considers whether lowering plasma homocysteine by B-vitamin supplementation is one of the top priority and cost-effective treatments.MethodA decision model was constructed to calculate the lifetime costs and quality-adjusted life years (QALYs) of providing B-vitamin treatment to people in the United Kingdom over 60 years with high levels (>13 μmol/L) of plasma homocysteine, which was compared to the lifetime costs and outcomes of not providing them with the treatment.ResultsTreatment with B-vitamins will save £60,021 per QALY gained and so is highly cost-effective.DiscussionWe anticipate that this provocative finding will be debated by scientists, clinicians, and policy makers and eventually be tested in future clinical trials.