title: Costs and health effects of adding functional foods containing phytosterols/-stanols to statin therapy in the prevention of cardiovascular disease.
abstract: The present modelling study aimed to evaluate if and by how much functional foods containing phytosterols/-stanols add to the benefits of statins in the prevention of cardiovascular disease in terms of cost-effectiveness. Long-term health effects, measured as quality-adjusted life-years gained, and costs for scenarios with additional phytosterol/-stanol use were compared to scenarios without extra use. Phytosterols/-stanols were given only to persons who were eligible for use according to their 10-year absolute risk of fatal cardiovascular disease (SCORE-risk). Intake levels and discontinuation rates as observed in daily practice were included in the model. Two situations were compared: 1) A real-life situation in which persons at high SCORE-risk were identified through clinical case-finding and, 2) A theoretical maximum situation where universal screening was implemented resulting in known SCORE-risks for the whole Dutch population aged 35-75 years (8.4 million people). Sensitivity analyses were performed for variations in the cholesterol-lowering effect and intake level of phytosterols/-stanols, indirect health care costs, time horizon and discount rates. At the model's start year, a total of 1.0 (real-life situation) to 3.3 (maximum situation) million persons qualified for phytosterol/-stanol use based on their SCORE-risk (both statin users and statin non-users). Over the model's time horizon, this resulted in a gain of 2700 to 16,300 quality-adjusted life-years, and yielded cost-effectiveness ratios that ranged between €92,000 and €203,000 per quality-adjusted life-year. This simulation study showed that the cost-effectiveness of phytosterols/-stanols as monotherapy and as add-on to statins is above thresholds for cost-effectiveness, generally ranging between €20,000 and €50,000, and is thus a non-cost-effective strategy to reduce cardiovascular disease.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands. S.Eussen@uu.nl
authors.forename: Simone R B M
authors.initials: SR
authors.lastname: Eussen
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.forename: Ido B
authors.initials: IB
authors.lastname: Toxopeus
authors.forename: Jeljer
authors.initials: J
authors.lastname: Hoekstra
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Klungel
authors.forename: Hans
authors.initials: H
authors.lastname: Verhagen
authors.forename: Henk J
authors.initials: HJ
authors.lastname: van Kranen
authors.forename: Cathy J M
authors.initials: CJ
authors.lastname: Rompelberg
mesh_terms: D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D055951:Functional Food / Q000032:analysis / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010840:Phytosterols / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010840:Phytosterols