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Costs and health effects of adding functional foods containing phytosterols/-stanols to statin therapy in the prevention of cardiovascular disease

Eussen, S. R. B. M., Feenstra, T. L., Toxopeus, I. B., Hoekstra, J., Klungel, O. H., Verhagen, H., van Kranen, H. J. & Rompelberg, C. J. M., Sep-2011, In : European Journal of Pharmacology. 668 Suppl 1, p. S91-S100 10 p.

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DOI

  • Simone R B M Eussen
  • Talitha L Feenstra
  • Ido B Toxopeus
  • Jeljer Hoekstra
  • Olaf H Klungel
  • Hans Verhagen
  • Henk J van Kranen
  • Cathy J M Rompelberg

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.

Original languageEnglish
Pages (from-to)S91-S100
Number of pages10
JournalEuropean Journal of Pharmacology
Volume668 Suppl 1
Publication statusPublished - Sep-2011

    Keywords

  • Cost-effectiveness, Cholesterol, Phytosterol, Phytostanol, Statin, DENSITY-LIPOPROTEIN CHOLESTEROL, CORONARY-HEART-DISEASE, ENRICHED MARGARINES, CONTROLLED TRIAL, ESTER MARGARINE, FUTURE COSTS, PLANT STEROL, LIFE-YEARS, HYPERCHOLESTEROLEMIA, EFFICACY

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