Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study

Abstract

BackgroundEconomic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid.Methods and findingsA validated microsimulation model (CVD-PREDICT) estimated CVD and diabetes cases prevented, quality-adjusted life years (QALYs), health-related costs (formal healthcare, informal healthcare, and lost-productivity costs), and incremental cost-effectiveness ratios (ICERs) of two policy scenarios for adults within Medicare and Medicaid, compared to a base case of no new intervention: (1) 30% subsidy on fruits and vegetables (“F&V incentive”) and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils (“healthy food incentive”). Inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Overall, 82 million adults (35–80 years old) were on Medicare and/or Medicaid. The mean (SD) age was 68.1 (11.4) years, 56.2% were female, and 25.5% were non-whites. Health and cost impacts were simulated over the lifetime of current Medicare and Medicaid participants (average simulated years = 18.3 years). The F&V incentive was estimated to prevent 1.93 million CVD events, gain 4.64 million QALYs, and save $39.7 billion in formal healthcare costs. For the healthy food incentive, corresponding gains were 3.28 million CVD and 0.12 million diabetes cases prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved, respectively. From a healthcare perspective, both scenarios were cost-effective at 5 years and beyond, with lifetime ICERs of $18,184/QALY (F&V incentive) and $13,194/QALY (healthy food incentive). From a societal perspective including informal healthcare costs and lost productivity, respective ICERs were $14,576/QALY and $9,497/QALY. Results were robust in probabilistic sensitivity analyses and a range of one-way sensitivity and subgroup analyses, including by different durations of the intervention (5, 10, and 20 years and lifetime), food subsidy levels (20%, 50%), insurance groups (Medicare, Medicaid, and dual-eligible), and beneficiary characteristics within each insurance group (age, race/ethnicity, education, income, and Supplemental Nutrition Assistant Program [SNAP] status). Simulation studies such as this one provide quantitative estimates of benefits and uncertainty but cannot directly prove health and economic impacts.ConclusionsEconomic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.

Food is medicine: actions to integrate food and nutrition into healthcare

“…Research on this intervention is trending in recent years towards more robust study designs with larger sample sizes 589. Modelling studies indicate that prescriptions for an array of healthful foods can be highly cost effective or even cost saving for the healthcare system when targeting key sociodemographic subgroups at highest risk, such as elderly people, adults with disabilities, and people with low income 10. Researchers in the US found, for example, that, over a lifetime, a 30% subsidy incentive on fruits and vegetables would prevent 1.93 million cardiovascular disease events and save approximately $40bn (32bn; €36bn) in healthcare costs.…”

“…Individual interactions with the healthcare system are an important opportunity to offer evidence based food and nutrition interventions. An emerging but compelling body of research indicates that such interventions delivered in the healthcare system might be associated with improved health outcomes and reduced healthcare usage and costs 2345678910. These data point to the potential for food and nutrition interventions to play a prominent role in the prevention, management, treatment, and even in some cases reversal of disease 11.…”

Daily Almond Consumption in Cardiovascular Disease Prevention via LDL-C Change in the U.S. Population: a Cost-Effectiveness Analysis

“…A recent study assessed the effect of healthy food financial incentives from both societal and healthcare perspectives, showing that 30% subsidy on healthy food, including nuts, is a cost-effective way to prevent CVD and diabetes. [33] To our best knowledge, our study is the first cost-effectiveness research on CVD primary prevention using an almond strategy at the individual level. In this study, we conducted a base-case model and several sensitivity analyses to assess the cost-effectiveness in the short term and the long term.…”

Daily almond consumption in cardiovascular disease prevention via LDL-C change in the U.S. population: a cost-effectiveness analysis

“…Previous studies have focused on the cost-effectiveness of other foods or dietary factors on primary CVD prevention, [39][40][41][42] but little is known about the costeffectiveness of almonds or other tree nuts. A recent study assessed the effect of healthy food financial incentives from both societal and healthcare perspectives, showing that 30% subsidy on healthy food, including nuts, is a cost-effective way to prevent CVD and diabetes [43]. To our best knowledge, our study is the first costeffectiveness research on CVD primary prevention using an almond strategy at the individual level.…”