Abstract
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.
Highlights
Raised total or low-density-lipoprotein cholesterol (LDL-c) is a major risk factor predisposing an individual to cardiovascular disease (CVD), which can be modified by various prevention programs, such as changes in diet
Research has shown that adding plant sterols into the daily diet can substantially enhance the cholesterol-lowering effects of diet change [2,3,4,5]
The mean body mass index (BMI), systolic blood pressure, and total cholesterol/HDL cholesterol ratio was higher in the high-cholesterol group, which contained a larger proportion of women than the mild cholesterol group
Summary
Raised total or low-density-lipoprotein cholesterol (LDL-c) is a major risk factor predisposing an individual to cardiovascular disease (CVD), which can be modified by various prevention programs, such as changes in diet. Plant sterols and stanols (a saturated subgroup of sterols), hereafter referred to collectively as plant sterols, are plant equivalents of cholesterol with a very similar molecular structure [1]. They are found naturally in fruit, vegetables, nuts, seeds, grains, and legumes and prevent the absorption of cholesterol into the bloodstream, but are unlikely to be consumed in sufficient quantities to reduce cholesterol levels [2,3,4]. Research has shown that adding plant sterols into the daily diet can substantially enhance the cholesterol-lowering effects of diet change [2,3,4,5]. The effectiveness of plant sterols in reducing LDL-c has been verified in a number of studies [2, 3, 7,8,9,10,11,12,13], evidence on whether use of plant sterols is a cost-effective
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