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The following criteria were considered: Full economic evaluations: cost-utility analysis, cost-effectiveness analysis, cost-benefit analysis Economic evaluations reporting incremental cost-effectiveness ratios (i.e., cost per quality-adjusted life year/life years gained or cost per event avoided) Studies in patients with confirmed vitamin B12 deficiency Studies in English Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained

Clinical indications include deficiency due to inadequate diet or malabsorption, drug-induced deficiency (for example, from long-term isoniazid or oral contraceptives), and certain inborn errors of metabolism (such as pyridoxine-dependent seizures or sideroblastic anemia)

These may be due to defective DNA synthesis inhibiting replication in a site with a high turnover of cells

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