Estimated health benefits, costs and cost-effectiveness of eliminating dietary industrial trans fatty acids in Kenya: cost-effectiveness analysis

Abstract

ObjectivesTo model the potential health gains and cost-effectiveness of a mandatory limit of industrial trans fatty acids (iTFA) in Kenyan foods.DesignMultiple cohort proportional multistate life table model, incorporating existing data from the Global Burden of Disease study, pooled analyses of observational studies and peer-reviewed evidence of healthcare and policy implementation costs.SettingKenya.ParticipantsAdults aged ≥20 years at baseline (n=50 million).InterventionA mandatory iTFA limit (≤2% of all fats) in the Kenyan food supply compared with a base case scenario of maintaining current trans fat intake.Main outcome measuresAverted ischaemic heart disease (IHD) events and deaths, health-adjusted life years; healthcare costs; policy implementation costs; net costs; and incremental cost-effectiveness ratio.ResultsOver the first 10 years, the intervention was estimated to prevent ~1900 (95% uncertainty interval (UI): 1714; 2148) IHD deaths and ~17 000 (95% UI: 15 475; 19 551) IHD events, and to save ~US$50 million (95% UI: 44; 56). The corresponding estimates over the lifespan of the model population were ~49 000 (95% UI: 43 775; 55 326) IHD deaths prevented, ~113 000 (95% UI: 100 104; 127 969) IHD events prevented and some ~US$300 million (256; 331) saved. Policy implementation costs were estimated as ~US$9 million over the first 10 years and ~US$20 million over the population lifetime. The intervention was estimated to be cost saving regardless of the time horizon. Findings were robust across multiple sensitivity analyses.ConclusionsFindings support policy action for a mandatory iTFA limit as a cost-saving strategy to avert IHD events and deaths in Kenya.

Estimated health benefits, costs and cost-effectiveness of eliminating industrial trans-fatty acids in Nigeria: cost-effectiveness analysis

“…This limit was expected to cover all foods and ingredients containing iTFA. The modelling framework, which has been employed to evaluate similar policies for Australia and Kenya,11 12 estimated IHD-related outcomes and total healthcare costs resulting from the intervention, where the life table method transmits changes in iTFA intake to IHD-related morbidity and mortality in the modelled population. In this study, we modelled the adult Nigerian population (≥20 years) in 5-year female and male cohorts, where each cohort was simulated until all individuals died or reached 100 years of age.…”

“…18 We used the DisMod II software19 to obtain estimates of case fatality rates for IHD, and we calculated IHD disability weights to be used for the estimation of HALYs (online supplemental appendix and tables S3-S5). 12…”

“…We estimated industry costs for reformulation as previously described,11 12 based on our recent food supply analysis, where we identified 310 packaged food products potentially containing iTFA in the Nigerian supermarkets (online supplemental appendix). 21 All costs were inflated to 2019 values using World Bank consumer price indices for Nigeria 22…”

“…To estimate the proportional change in IHD incidence due to the elimination of iTFAs, we used the reference and intervention trans -fatty acid intakes and the relative risk of IHD per %E of trans -fatty acid intake to calculate the potential impact fraction (PIF),11 12 according to Barendregt’s continuous ‘distribution shift’ PIF method (online supplemental appendix and table S7). 23 The PIF was used to calculate the effect on IHD incidence due to the reduction in trans-fatty acid intake (online supplemental appendix), and the estimated incidence rates were used in the disease Markov model to calculate reference and intervention IHD prevalence and mortality.…”

“…As previously described,11 12 we quantified the parameter uncertainty around the modelled estimates in Monte Carlo simulations (n=2000). For each iteration, a draw was made from the distributions of trans- fatty acid intake, relative risks, healthcare costs and policy implementation costs.…”