Cost-effectiveness of long-chain omega-3 supplementation for the secondary prevention of cardiovascular disease in the United States
Open accessAbstract
Objectives A variety of eicosapentaenoic (EPA) and docosahexaenoic (DHA) omega-3 dietary supplements of varying dosage and pricing are available in the United States and commonly used for secondary cardiovascular prevention. Although these interventions' efficacy has been studied, their cost-effectiveness remains unknown. The goal of this article is to assess whether omega-3 dietary supplements are cost-effective for secondary cardiovascular prevention in adults in the United States. Our analysis explicitly incorporates a reported higher risk of atrial fibrillation associated with omega-3 supplementation. Methods This economic evaluation used a Markov model over a 10-year horizon with health states defined by cardiovascular disease status. Effectiveness was measured by quality-adjusted life-years (QALYs) gained, and costs were calculated from a US healthcare system perspective, estimated in 2023 US dollars. Data were obtained from the published literature. Deterministic and probabilistic sensitivity analyses were conducted to estimate the influence of parameter uncertainties on the resulting cost-effectiveness ratios. Scenarios including low (300 mg/day), medium (1000 mg/day), and high (2500 mg/day) supplementation dosages of EPA and DHA omega-3s were considered. Average and incremental cost-effectiveness ratios (ICERs) in US$/QALY are presented. Results At a willingness-to-pay threshold of $50 000/QALY, 1000 mg/day is the most cost-effective dose (ICER of $ 25 024). At a wil…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Recent cost-effectiveness analyses demonstrate that the reduction in MACE more than compensates for increased AF risk, supporting an overall favorable benefit-risk balance for high-dose omega-3 therapy.
“This interpretation aligns with recent cost-effectiveness analyses demonstrating that the reduction in MACE more than compensates for increased AF risk, supporting an overall favorable benefit-risk balance for high-dose omega-3 therapy129.”
From Effects of Omega-3 Fatty Acid Treatment on Risk for Atrial Fibrillation: An Updated Meta-Analysis of 35 Trials including 114 592 Individuals (2026) · cites this paper as [129]
Cites
Heart disease and stroke statistics-2018 update: a report from the american heart association
Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000558 · Cited by 7,146 · see citing works
How to perform a meta-analysis with R: a practical tutorial
Balduzzi, S., Rücker, G., & Schwarzer, G. (2019) · Evidence Based Mental Health · doi:10.1136/ebmental-2019-300117 · Cited by 5,827 · see citing works
Ong, K. L., Stafford, L. K., McLaughlin, S. A., Boyko, E. J., Vollset, S. E., Smith, A. E., Dalton, B. E., Duprey, J., Cruz, J. A., Hagins, H., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)01301-6 · Cited by 4,681 · see citing works
Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia
Bhatt, D. L., Steg, P. G., Miller, M., Brinton, E. A., Jacobson, T. A., Ketchum, S. B., Doyle, R. T., Juliano, R. A., Jiao, L., Granowitz, C., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1812792 · Cited by 3,317 · see citing works
Marine n−3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer
Manson, J. E., Cook, N. R., Lee, I.-M., Christen, W., Bassuk, S. S., Mora, S., Gibson, H., Albert, C. M., Gordon, D., Copeland, T., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1811403 · Cited by 979 · see citing works
Effects of n−3 Fatty Acid Supplements in Diabetes Mellitus
The ASCEND Study Collaborative Group (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1804989 · Cited by 698 · see citing works
Siscovick, D. S., Barringer, T. A., Fretts, A. M., Wu, J. H. Y., Lichtenstein, A. H., Costello, R. B., Kris-Etherton, P. M., Jacobson, T. A., Engler, M. B., Alger, H. M., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000482 · Cited by 629 · see citing works
The healthcare cost and utilization project: an overview.
Steiner, C., Elixhauser, A., & Schnaier, J. A. (2002) · PubMed · Cited by 560 · see citing works
Hu, Y., Hu, F. B., & Manson, J. E. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.013543 · Cited by 388 · see citing works
Effect of Omega-3 Dosage on Cardiovascular Outcomes
Bernasconi, A. A., Wiest, M. M., Lavie, C. J., Milani, R. V., & Laukkanen, J. A. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2020.08.034 · Cited by 237 · see citing works
Self-citationREDUCE-IT USA: Results From the 3146 Patients Randomized in the United States
Bhatt, D. L., Miller, M., Brinton, E. A., Jacobson, T. A., Steg, P. G., Ketchum, S. B., Doyle, R. T., Juliano, R. A., Jiao, L., Granowitz, C., et al. (2020) · Circulation · doi:10.1161/circulationaha.119.044440 · Cited by 136 · see citing works
Maki, K. C., Palacios, O. M., Bell, M., & Toth, P. P. (2017) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2017.07.010 · Cited by 107 · see citing works
Self-citationA contemporary and comprehensive analysis of the costs of stroke in the United States
Girotra, T., Lekoubou, A., Bishu, K. G., & Ovbiagele, B. I. (2019) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2019.116643 · Cited by 89 · see citing works
Bae, J. H., Lim, H., & Lim, S. (2023) · Advances in Nutrition · doi:10.1016/j.advnut.2023.03.014 · Cited by 78 · see citing works
Estimating the Economic Burden of Acute Myocardial Infarction in the US: 12 Year National Data
Bishu, K. G., Lekoubou, A., Kirkland, E. B., Schumann, S. O., Schreiner, A. D., Heincelman, M. E., Moran, W. P., & Mauldin, P. D. (2020) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2020.02.004 · Cited by 72 · see citing works
Landray, M., & REVEAL Collaborative Group (2017) · American Heart Journal · doi:10.1016/j.ahj.2017.02.021 · Cited by 69 · see citing works
Javaid, M., Kadhim, K., Bawamia, B., Cartlidge, T., Farag, M., & Alkhalil, M. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.032390 · Cited by 58 · see citing works
Omega-3 fatty acid biomarkers and incident atrial fibrillation
Qian, F., Tintle, N., Jensen, P. N., Lemaitre, R. N., Imamura, F., Feldreich, T. R., Nomura, S. O., Guan, W., Laguzzi, F., Kim, E., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.05.024 · Cited by 49 · see citing works
Omega-3 Benefits Remain Strong Post-STRENGTH
Bernasconi, A. A., Lavie, C. J., Milani, R. V., & Laukkanen, J. A. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.03.004 · Cited by 37 · see citing works
Self-citationLui, J. N. M., Williams, C., Keng, M. J., Hopewell, J. C., Sammons, E. L., Chen, F., Gray, A. M., Bowman, L. J., Landray, S. M. J., Mihaylova, B., et al. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.123.030766 · Cited by 31 · see citing works
Markov Models for Health Economic Evaluations: The R Package heemodPreprint
Filipović-Pierucci, A., Zarca, K., & Durand‐Zaleski, I. (2017) · arXiv (Cornell University) · doi:10.48550/arxiv.1702.03252 · Cited by 29 · see citing works
Jiang, S., Seslar, S. P., Sloan, L., & Hansen, R. N. (2022) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2022.28.11.1321 · Cited by 29 · see citing works
The Life Table Method of Half Cycle Correction
Barendregt, J. J. (2014) · Medical Decision Making · doi:10.1177/0272989x13519863 · Cited by 28 · see citing works
Zhang, X., Chen, Z., Fang, A., Kang, L., Xu, W., Xu, B., Chen, J., & Zhang, X. (2024) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2024.100634 · Cited by 18 · see citing works
Weintraub, W. S., Bhatt, D. L., Zhang, Z., Dolman, S. F., Boden, W. E., Bress, A. P., Bellows, B. K., Derington, C. G., Philip, S., Steg, P. G., et al. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.123.032413 · Cited by 7 · see citing works
Omega 3, Atrial Fibrillation, and Cardiovascular Outcomes
O’Keefe, E. L., Lavie, C. J., Elagizi, A., Milani, R. V., & Laukkanen, J. A. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.059 · Cited by 6 · see citing works
Eicosapentaenoic Acid: between Cardiovascular Benefits and the Risk of Atrial Fibrillation
Egalini, F., Rossi, M., Massussi, M., Gaggero, G., Beccuti, G., Benso, A. S., Piepoli, M. F., & Broglio, F. (2023) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/0118715303280825231122153024 · Cited by 3 · see citing works
Sadler, M. J. (2017) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2017.1365825 · Cited by 2 · see citing works
Morton, J. I., Liew, D., Nicholls, S. J., & Ademi, Z. (2022) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwac212 · Cited by 2 · see citing works
Flagged first, then by citations
2 of the 31 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Abuknesha, N. R., O’Keefe, J. H., Qian, F., Tintle, N., Lin, Y., Sun, Y., Qian, H., Aisen, P. S. S., Albert, C. M., Aronson, W. J., et al. (2026) · Proceedings of The Nutrition Society · doi:10.1017/s0029665126102493 · Cited by 5 · see citing works
Abuknesha, N. R., O’Keefe, J. H., Qian, F., Tintle, N. L., Lin, Y., Sun, Y., Qian, H.-Z., Aisen, P. S., Albert, C. M., Aronson, W. J., et al. (2026) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.125.014785 · Cited by 1 · see citing works
- Authors
- Bernasconi, A. A., Maki, K. C., & Finkelstein, E. A.
- Affiliations
- Indiana University Bloomington (US)
- National University of Singapore (SG)
- Venue
- Value in Health
- Publisher
- Elsevier BV
- Published
- 2025-10
- Volume
- 28
- Issue
- 10
- Pages
- 1481-1487
- ISSN
- 1098-3015 (ISSN-L)
- OpenAlex
- W4412529501
- Cited by
- 2
- References
- 31
- Citations by year
- 2026: 2
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Value in Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, dietary supplements, secondary prevention, cardiovascular disease, cost-effectiveness, atrial fibrillation risk, dosage, quality-adjusted life years, Markov model
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cost-Benefit Analysis, Docosahexaenoic Acids, Female, Humans, Male, Markov Chains, Middle Aged, United States, Eicosapentaenoic Acid, Fatty Acids, Omega-3, Quality-Adjusted Life Years, Dietary Supplements, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
