Cost-Effectiveness of a National Sugar-Sweetened Beverage Tax to Reduce Cancer Burdens and Disparities in the United States

Abstract

Background Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. While SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States (US) are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. Methods We used the Dietary Cancer Outcome Model (DiCOM), a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults age 20+ years by income. Results A national SSB tax was estimated to prevent 22,075 (95% uncertainty interval [UI] = 16,040 to 28,577) new cancers cases and 13,524 (95% UI = 9,841 to 17,681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50 to $1.95) billion for government implementation and $1.70 (95% UI = $1.48 to $1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67 to $2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1,486, 95% UI = -$3,516 to $9,265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13,220, 95% UI = $3,453 to $28,120 per QALY). Approximately 4,800 more cancer cases and 3,100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤1.85) than higher-income individuals (FPIR >1.85). Conclusions A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the US, with the largest health gains and economic benefits among lower-income Americans.

Sugar-Sweetened Beverage Taxes Are a Sweet Deal: Improve Health, Save Money, Reduce Disparities, and Raise Revenue

“…In this issue of the Journal, Du et al ( 4 ) present a cost-effectiveness analysis (CEA) of a $0.01 per ounce sugar-sweetened beverage (SSB) excise tax on obesity-related cancer outcomes, finding that it would be a cost-effective policy to prevent obesity-related cancers and reduce disparities in cancer incidence. These findings are broadly similar to other SSB tax CEAs that find that a national SSB tax would be highly cost-effective and likely even cost-saving—that is, improving health outcomes while also saving more in healthcare spending than it would cost to implement—when broader health outcomes are taken into account ( 5–7 ).…”

“…These findings are broadly similar to other SSB tax CEAs that find that a national SSB tax would be highly cost-effective and likely even cost-saving—that is, improving health outcomes while also saving more in healthcare spending than it would cost to implement—when broader health outcomes are taken into account ( 5–7 ). The current analysis by Du et al ( 4 ) focuses only on cancer outcomes, which do not capture the full health benefits of an SSB tax. However, this more focused analysis of obesity-related cancers should be of interest to the wider cancer community —a group of stakeholders that is increasingly involved in obesity prevention efforts.…”

“…In addition to only focusing on cancer outcomes, the modeling analysis by Du et al ( 4 ) makes other assumptions that may lead to conservative estimates of the cost-effectiveness of an SSB tax. For example, as a closed cohort model, the impact on future adults (ie, current children) is not taken into account.…”

“…An authoritative review by Powell et al ( 8 ), focusing on better-designed studies (generally using demand system estimation), found an average elasticity of -1.21, and recent estimates from evaluating the impact of the SSB tax in Philadelphia, Pennsylvania, find an even larger effect of -1.7 ( 9 ). The -0.66 used in this paper [Du et al ( 4 )] thus likely underestimates the impact of an SSB excise tax. In that sense, the sensitivity analysis presented in Du et al ( 4 ) in supplementary table 8 (available online) may be a more realistic estimate.…”

“…The -0.66 used in this paper [Du et al ( 4 )] thus likely underestimates the impact of an SSB excise tax. In that sense, the sensitivity analysis presented in Du et al ( 4 ) in supplementary table 8 (available online) may be a more realistic estimate. Here, the authors assume an own-price elasticity of -1.14 and find with this assumption that “the estimated health gains doubled, and the policy became cost-saving”.…”