Original paper

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 modeling study

  • This new publication evaluates the cost-effectiveness of consuming margarine-type spreads with added plant sterols or stanols for the prevention of cardiovascular disease (CVD) in people with hypercholesterolemia in England as compared to a normal diet.
  • This study therefore adds to available evidence from previous studies on whether the use of plant sterols/stanols is a cost-effective preventive strategy for reducing CVD risk, especially from an United Kingdom (UK) context.
  • It was found that daily intake of spreads with added plant sterols or stanols could reduce CVD risk, esp. in men and older age groups. Assuming a 50% compliance rate, over a period of 20 years 69 CVD events per 10,000 men and 40 CVD events per 10,000 women aged 45-85 years could be saved.
  • If the costs to the consumers between a typical spread and a plant sterol- or stanol-added spread is subsidized, the intake of plant sterols or stanols from spread is likely to be cost-effective over 20 years for hypercholesterolaemic men aged over 64 years and for hypercholesterolaemic women aged over 74 years with a compliance level of either 10 or 50% and assuming a cost-effectiveness threshold of £30,000 per QALY gained.
  • The findings from this assessment suggests that encouraging consumers to use foods with added plant sterols or stanols is likely to bring cost savings to national health systems next to improving health outcomes.

This new analysis by Yang et al. assessed the cost-effectiveness of plant sterol- or stanol-added foods took for the prevention of CVD in an English population with elevated total cholesterol (TC). The analysis took the perspective of the British National Health Service (NHS). The population cohort used for the analysis was from the 2011 Health Survey for England including 2238 individuals with elevated TC (1598 with TC of 4-6 mmol/L and 640 with TC above 6 mmol/L). Reported health outcomes included CVD events, mortality, and quality-adjusted life years (QALYs). Cost-effectiveness was defined based on available UK criteria with a threshold of between £20,000 and £30,000 per QALY gained. Effectiveness outcomes were assessed for 10-year CVD risk of individuals with either mild (4-6 mmol/L) or high (above 6 mmol/L) TC and by gender and age groups (45–54, 55–64, 65–74, 75–85 years) and for CVD events avoided and QALY gains over 20 years.

Regarding the effect size, a 12% reduction in TC or LDLC with an intake of 3 g/d of plant sterols or stanols was assumed.

The analyses were based on plant sterol- or stanol-added spreads and not on other food formats because the required intake of 3 g/d can be best achieved with spreads, they are commonly consumed in the English diet and are the least expensive means of providing the required daily intake.

Regarding cost-effectiveness and if the NHS would pay the costs for the plant sterol- or stanol-added spreads, the probability that these foods are cost-effective was seen as 100% for men over 64 years and for women over 74 years in the high cholesterol group (total cholesterol above 6 mmol/L) and at £20,000 per quality-adjusted life years QALYs).  It is also below the £30,000 threshold for men over 54 women over 64 years of age.

Subsidizing plant sterol or stanols added spreads was found to be more cost-effective in individuals with higher TC levels; QALY gains increased with the level of compliance (10 vs. 50%) and with older age of men and women.

Shifting the cost burden of paying for the plant sterol- or stanol-added spread to the consumers, increases the cost-effectiveness and the NHS will benefit from reduced CVD treatment costs.

Overall, this new cost-effectiveness assessment focusing on the UK perspective adds to previous analyses from e.g. Germany, Finland and Canada showing that significant cost savings in health care costs could be achieved with the regular consumption of foods with added plant sterols or stanols next to a potential reduction in CVD cases.