Modelling the effect of increased fish intake for the general population in Denmark

Presenter: Gisela Hostenkamp, Southern Denmark University

Abstract

Objectives: Considerable evidence suggests that high fish consumption can reduce the risk of developing ischemic heart disease (IHD) and stroke. This study examined the economic consequences for the healthcare sector if Danish people increased their fish intake to the recommended level.
Design: A life table was used to describe a base case population with respect to life expectancy, IHD and stroke incidence and healthcare costs. Relative risks of stroke and ischemic heart disease for a high versus a low fish intake were obtained from the literature and were used to simulate a hypothetical population with high fish intake. Data on disease-specific mortality and disease incidence were obtained from Statistics Denmark. Cost if illness was estimated using a random 20% sample of the Danish population that was followed from 1997 to 2003 using civil registration numbers to link various computerised registers.
Result: The average intake of fish and fish products in the Danish population is approximately 100g – equivalent to about one main serving per week. Simulated intakes of the recommended 250 g per week increased life expectancy for a 30-year-old by 0.28 years for men and 0.19 years for women, assuming an average risk reduction of about 16% for IHD and 7% for stroke incidence and a 5% time discount rate. The aggregate savings in the health care sector were positive for all age groups studied. Sensitivity analysis was conducted for different levels of risk reduction, time discount rate, and diseases included in the study. Only using very pessimistic assumptions and time discount rates above 10% was an increase in healthcare costs (for young women) generated.
Discussion: The study adopted a health care sector perspective. Costs from hospitalisation, primary care, medical use and sickness leave were included in the calculations. The cost of changing people’s dietary habits, i.e. by education, information and promotion and the transition from one level of fish consumption to another was not the focus of the analysis.
Conclusion: Empirical evidence suggests that a considerable fraction of IHD and stroke events could be prevented if the general public followed the guidelines on recommended fish consumption. This may result in improved public health without additional healthcare costs. In addition the study distinguishes itself by the fact that healthcare costs are calculated per patient as opposed to treatment. This is especially important for diseases with acute events, where the distribution of treatment costs is highly skewed.