Gerber A, Evers T, Haverkamp H, Lauterbach K W
Institute of Health Economics and Clinical Epidemiology, University of Cologne, Germany.
Eur J Health Econ. 2006 Dec;7(4):247-54. doi: 10.1007/s10198-006-0363-0.
For decreasing the risk of coronary heart disease (CHD) it has been proposed to enrich food such as margarine with plant sterol esters which have been shown to reduce total and LDL cholesterol concentrations, two of the major risk factors. A Markov model was developed to assess the costs and benefits of consuming a low-fat plant sterol containing margarine (PS margarine). A health insurer's perspective was taken with a time frame of 10 years. Transition probabilities for CHD and CHD-related death were calculated on the basis of the Framingham risk equations. These were applied to a representative sample of the German population. The alteration in cholesterol levels after intake of PS margarine was estimated based on a meta-analysis of ten randomized controlled trials with parallel or crossover design that found a reduction of 5.7% in total cholesterol. Average annual costs of CHD were assumed to be at 3,000 euro. Costs for "no CHD" and "CHD-related death" were set to 0 euro since the intervention would solely be paid by the consumers. Sensitivity analyses were performed with regard to annual costs, risk estimation, PS margarine reduction in total cholesterol, discount factor, and risk of CHD-related death. The 10-year CHD risks are 6.1% (PS margarine) vs. 6.5% (control). Thus expected 10-year CHD costs are 696 euro (PS margarine) vs. 748 euro (control). The cost savings of 52 euro varied between 32 euro and 74 euro in the sensitivity analysis. A projection at the level of the population for which evidence (randomized controlled trials) exists that plant sterols lower cholesterol (25.35 million) leads to a reduction of 117,000 CHD cases over 10 years and a cost reduction of 1.3 billion euro for this time period (sensitivity analysis 0.8-1.9 billion euro).
为降低冠心病（CHD）风险，有人提议在人造黄油等食品中添加植物甾醇酯，研究表明这些物质可降低总胆固醇和低密度脂蛋白胆固醇浓度，而这两种胆固醇是主要风险因素。开发了一个马尔可夫模型来评估食用含低脂肪植物甾醇的人造黄油（PS人造黄油）的成本和效益。从健康保险公司的角度出发，时间跨度为10年。基于弗雷明汉风险方程计算冠心病和冠心病相关死亡的转移概率。这些概率应用于德国人口的代表性样本。基于对十项平行或交叉设计的随机对照试验的荟萃分析估计了摄入PS人造黄油后胆固醇水平的变化，该分析发现总胆固醇降低了5.7%。假设冠心病的年均成本为3000欧元。“无冠心病”和“冠心病相关死亡”的成本设定为0欧元，因为干预措施仅由消费者支付。针对年均成本、风险估计、PS人造黄油降低总胆固醇的效果、贴现因子以及冠心病相关死亡风险进行了敏感性分析。10年冠心病风险分别为6.1%（PS人造黄油）和6.5%（对照组）。因此，预期10年冠心病成本分别为696欧元（PS人造黄油）和748欧元（对照组）。敏感性分析中，52欧元的成本节约在32欧元至74欧元之间变化。对于有证据（随机对照试验）表明植物甾醇可降低胆固醇的人群（2535万）进行预测，结果显示10年内冠心病病例减少11.7万例，该时间段成本降低13亿欧元（敏感性分析为0.8 - 19亿欧元）。
