Markov state transition model to estimate the health impacts and related costs to the public of different trans fatty acids (TFA) intake scenarios at the EU level

The model has been developed in the specific context of preparing a policy decision at EU-level related to the presence of trans fats in foods and diets. Trans fats have been shown to increase the risk for heart disease and some countries had taken measures to reduce their presence in foods and diets at national level leading to a partly fragmented internal market. Therefore, the case to act at EU level in the field of food was based on improving the functioning of the internal market and to achieve a high level of consumer protection and promote public health.

The model took a public spending (deliberately excluding costs to the food industry) and wider social (including not only direct health care costs of heart disease but also indirect societal costs such as productivity losses and informal care) perspective. It was aimed at carrying out a public health economic evaluation to support decision making between pre-defined viable policy options against a reference situation of no EU-level action. The JRC worked closely with a SANTE-led inter-service group for producing a Commission report and an accompanying staff working document on trans fats.

Therefore, the JRC anticipated a highly likely initiative requiring an impact assessment for which the model was pro-actively designed. The JRC communicated clearly the potential to serve as decision analytical tool related to the public health objective of the policy initiative aimed at reducing trans fat intake in the EU population. It was also made clear that other aspects, such as environmental impacts, social impacts on specific population groups or economic impacts on the food industry were not within the scope of the model and would need to be done in addition for an impact assessment.

The model was built to inform the assessment of impacts in the social impact area, category on public health, safety and health systems. The main subcategory concerned is the impact on human health (CAD incidence and disability-adjusted life years) affected by the alternative policy scenarios. As trans fats intake is a dietary determinant of health, also this subcategory (lifestyle-related determinants of health) is concerned. In addition, costs to the public are assessed resulting from the health status of the population related to the policy scenarios as well as from implementing the policies. By calculating the incremental cost-effectiveness ratio (ICER) the model informs not only on the policy option that is projected to achieve the largest gain in public health but also the option that is most cost-effective from a public spending point of view.

Whilst the model was developed specifically for the Commission initiative on trans fats, the approach to assess cost-effectiveness of policy options targeting population intake of nutrients, such as salt, sugars or dietary fibre or food groups, such as fruits, vegetables, sugar-sweetened beverages, that are of public health relevance can be easily transferred from trans fats to these other nutrition and health issues. Therefore, the health economic modelling approach developed here has the potential to be used in the context of the initiatives under the Farm to Fork strategy or the prevention pillar of the Europe’s Beating Cancer Plan.