Vitamin E for Coronary Heart Disease: What is at Stake?

Two recent epidemiologic studies reported that subjects taking vitamin E (vit E) supplements had about 40% reduction in major coronary heart disease (CHD) events compared with those in the lowest quintile of Vit E intake. The Coronary Heart Disease Policy Model (CHDPM), comprehensive computer simulation of the costs and consequences of CHD in the US, was used to analyze the cost-effectiveness of vit E. The CHDPM uses age- and gender-specific distributions of CHD risk factors and age-, gender-, and risk factor-specific probabilities of disease onset to estimate CHD and non-CHD death and morbidity. The CHDPM simulation estimated the incremental cost-effectiveness (C/E) and the potential years of life saved for primary (1°) and secondary (2°) prevention over 5 and 10 years. The cost of therapy with vit E (200 IU/day) was set at $56.07/year. For 2° prevention assuming the full efficacy observed in epidemiologic studies, vit E saves both years of life and costs because of CHD averted. Even at efficacy (Men RR = 0.97, Women RR = 0.95), the incremental C/E was $9,400 per year of life saved (YOLS) for men and $2,200 for women. In contrast for 1° prevention with full efficacy over 10 years, the incremental C/E is $33,500 per YOLS for men and $35,500 for women. With the full benefit suggested by the epidemiologic studies, the potential years of life saved in the US from treatment with vit E are: This analysis suggests: 1) For 2° prevention, vit E is worthwhile even if it causes 5% or less reduction in CHD. 2) At the above cost over 10 years, widespread 1° prevention with vit E would be cost-effective only if Vit E is about as effective as suggested by the cohort studies. 3) If vit E is as effective as suggested by the above studies (or even that for 2° prevention), then the potential loss of benefit by delaying its use is sufficiently large that research into the efficacy of Vit E should be high priority.