Public health economic evaluation of different European Union–level policy options aimed at reducing population dietary trans fat intake

Abstract

Background: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations.Objective: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or self-regulatory measures).Design: We developed a mathematical model to compare different policy options at the EU level: 1) to do nothing beyond the current state (reference situation), 2) to impose mandatory TFA labeling of prepackaged foods, 3) to seek voluntary agreements toward further reducing industrially produced TFA (iTFA) content in foods, and 4) to impose a legislative limit for iTFA content in foods.Results: The model indicated that to impose an EU-level legal limit or to make voluntary agreements may, over the course of a lifetime (85 y), avoid the loss of 3.73 and 2.19 million disability-adjusted life-years (DALYs), respectively, and save >51 and 23 billion euros when compared with the reference situation. Implementing mandatory TFA labeling can also avoid the loss of 0.98 million DALYs, but this option incurs more costs than it saves compared with the reference option.Conclusions: The model indicates that there is added value of an EU-level action, either via a legal limit or through voluntary agreements, with the legal limit option producing the highest additional health benefits. Introducing mandatory TFA labeling for the EU common market may provide some additional health benefits; however, this would likely not be a cost-effective strategy.

Systematic review of dietary trans-fat reduction interventions

“…We found no empirical studies investigating the sole effect of labels showing the TFA content of food products, but we included five modelling studies (two of good quality, 32 , 33 two fair 34 , 35 and one of poor quality 36 ). In the Netherlands a healthier choices logo for food packages was implemented in 2006.…”

“…However, compared with taking no action, this option incurred greater costs than it saved, in terms of health-care costs, lost productivity and implementation costs. 33 In a similar approach to the Dutch study, researchers in Brazil investigated replacing products with ones that complied with a healthy choices logo. 36 Estimated TFA intakes were 0.8 g/day (standard deviation, SD: 1.0) for typical menus, 0.1 g/day (SD: 0.2) for the choices menus and 0.2 g/day (SD: 0.3) for energy-adjusted choices menus, i.e.…”

Trans Fat Intake and Its Dietary Sources in General Populations Worldwide: A Systematic Review

“…In 2010, estimated intakes varied from 0.2 to 6.5 En% worldwide [ 10 ]. At present, many countries actively work on measures to further lower industrial trans fat levels in foods [ 7 , 14 , 15 ].…”

<b><i>Trans</i></b>-Fatty Acids and Cardiovascular Disease: Urgent Need for Legislation

“…This was very clearly demonstrated by Martin-Saborido et al [35] in an economic simulation of the effects of different anti-iTFA strategies using the example of the EU. They predicted that an EU-level legal limit on iTFA would be the optimal action, considering both the number of averted CVD-related disease-adjusted life years (DALYs) and associated cost savings in public healthcare.…”

“…Fortunately, this problem is fairly easy to solve via proper legislation. The experience of multiple countries has shown that banning iTFA use is an effective and feasible approach, leading to lower CVD morbidity and mortality [7,22,26,35]. Thus, it appears reasonable that cardiology societies around the world, both national and international, should strive to raise public awareness about the issue and lobby for implementing anti-iTFA laws either on the level of individual countries or, if possible, on the level of international entities like the EU.…”