Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study

Abstract

Background Produce prescription programs, providing free or discounted produce and nutrition education to patients with diet‐related conditions within health care systems, have been shown to improve dietary quality and cardiometabolic risk factors. The potential impact of implementing produce prescription programs for patients with diabetes on long‐term health gains, costs, and cost‐effectiveness in the United States has not been established. Methods and Results We used a validated state‐transition microsimulation model (Diabetes, Obesity, Cardiovascular Disease Microsimulation model), populated with national data of eligible individuals from the National Health and Nutrition Examination Survey 2013 to 2018, further incorporating estimated intervention effects and diet‐disease effects from meta‐analyses, and policy‐ and health‐related costs from published literature. The model estimated that over a lifetime (mean=25 years), implementing produce prescriptions in 6.5 million US adults with both diabetes and food insecurity (lifetime treatment) would prevent 292 000 (95% uncertainty interval, 143 000–440 000) cardiovascular disease events, generate 260 000 (110000–411 000) quality‐adjusted life‐years, cost $44.3 billion in implementation costs, and save $39.6 billion ($20.5–58.6 billion) in health care costs and $4.8 billion ($1.84–$7.70 billion) in productivity costs. The program was highly cost effective from a health care perspective (incremental cost‐effectiveness ratio: $18 100/quality‐adjusted life‐years) and cost saving from a societal perspective (net savings: $−0.05 billion). The intervention remained cost effective at shorter time horizons of 5 and 10 years. Results were similar in population subgroups by age, race or ethnicity, education, and baseline insurance status. Conclusions Our model suggests that implementing produce prescriptions among US adults with diabetes and food insecurity would generate substantial health gains and be highly cost effective.

Development and Validation of the US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) Model: Health Disparity and Economic Impact Model

“…The program was highly cost-effective from a health care perspective (incremental cost-effectiveness ratio: $18,100/QALY) and health-improving and cost-saving from a societal perspective (net savings of $ 0.1 billion; Table 6). Importantly, the programs would provide greater health benefits and result in more favorable cost-effectiveness ratios among non-Hispanic Black and Hispanic patients than non-Hispanic White patients, primarily due to higher baseline cardiometabolic and mortality risk among non-Hispanic Black and Hispanic patients (data are not shown, and the complete analyses are available elsewhere 64 ).…”

“…Our publication details our approach with additional subgroup analyses by age, race/ethnicity, educational attainment, and insurance status. 64…”

“…To illustrate the application of the DOC-M model, we evaluated the long-term cost-effectiveness of a national produce prescription program. While the full study is published elsewhere, 64 we briefly explain our case study. Produce prescription is a nutrition intervention strategy that prescribes free or discounted fresh produce to patients with diet-related chronic diseases identified in the health system.…”

Addressing Social Determinants of Health via Food as Medicine Interventions to Improve Cardiometabolic Health

“…11 These types of research efforts are especially important for health disparate populations that suffer disproportionate risk due to sex, race/ethnicity, or socioeconomic status. 12 This article itself is evidence of the need for and benefit of collaborative research to address social determinants of health. Hager et al partnered with Wholesome Wave-the organization that designed and operated the produce prescription programs-to formally test hypotheses and effectively evaluate the health impact of the produce prescription programs via statistical analyses and testing that otherwise may have been unattainable without this partnership.…”

“…11 These types of research efforts are especially important for health disparate populations that suffer disproportionate risk due to sex, race/ethnicity, or socioeconomic status. 12…”