This study appraises the effectiveness and cost-effectiveness of consumption of plant sterol-enriched margarine-type spreads for the prevention of cardiovascular disease (CVD) in people with hypercholesterolemia in England, compared to a normal diet. A nested Markov model was employed using the perspective of the British National Health Service (NHS). Effectiveness outcomes were the 10-year CVD risk of individuals with mild (4–6 mmol/l) and high (above 6 mmol/l) cholesterol by gender and age groups (45–54, 55–64, 65–74, 75–85 years); CVD events avoided and QALY gains over 20 years. This study found that daily consumption of enriched spread reduces CVD risks more for men and older age groups. Assuming 50% compliance, 69 CVD events per 10,000 men and 40 CVD events per 10,000 women would be saved over 20 years. If the NHS pays the excess cost of enriched spreads, for the high-cholesterol group, the probability of enriched spreads being cost-effective is 100% for men aged over 64 years and women over 74, at £20,000/QALY threshold. Probabilities of cost-effectiveness are lower at younger ages, with mildly elevated cholesterol and over a 10-year time horizon. If consumers bear the full cost of enriched spreads, NHS savings arise from reduced CVD events.
The European Commission has acknowledged the value of sterol-enriched foods for cholesterol lowering through approval of health claims on some products. The findings from this study add weight to calls for the increased use of plant sterol-enriched functional food as a preventive strategy for people with hypercholesterolemia, and suggest that encouraging the consumption of plant sterol-enriched functional food is likely to bring cost savings to health systems, as well as improving patient outcomes.
Study findings are detailed in this paper:
Yang W, Heather Gage H, Daniel Jackson D, Raats M (in press) The effectiveness and cost-effectiveness of plant sterol or stanol-enriched functional foods as a primary prevention strategy for people with cardiovascular disease risk in England: a modelling study. European Journal of Health Economics. doi.org/10.1007/s10198-017-0934-2