Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review

Emmert-Fees, Karl; Karl, Florian; Philipsborn, Peter von; Rehfuess, Eva; Laxy, Michael

doi:10.1093/advances/nmab028

Cited by 13 publications

(22 citation statements)

References 116 publications

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“…Most models we reviewed used either cohort or microsimulation modeling methods, simulated a population defined by age and gender or sex, and projected changes in weight, diabetes, or cardiovascular disease. These results are in line with findings from other reviews of food policies [ 8 , 9 ]. Our results point to norms in the literature and highlight areas for future work to build on this strong foundation.…”

Section: Discussionsupporting

confidence: 93%

“…Use of simulation models to evaluate SSB policies has grown over time; all studies were published after 2011, and over half were published within the past four years (2017–2021). Consistent with prior literature, we find that the most commonly evaluated SSB policy is a tax, with the tax literature dominated by ad valorem and volumetric tax policies [ 8 , 9 ]. We also document an emerging literature that includes other policy options such as purchasing bans, warning labels, and portion size restrictions.…”

Section: Discussionsupporting

confidence: 84%

“…Very few articles we reviewed provided code or data to replicate their work, and supplementary material often focused more on supplementary results rather than providing additional methodological details that would support replication. We advocate for increased transparency and code sharing of simulation models, as other reviews have called for [ 8 , 9 ]. For example, researchers should consider the framework set out by Alarid-Escudero and colleagues [ 123 ] and utilize platforms such as GitHub or the Open Science Framework.…”

Section: Discussionmentioning

confidence: 99%

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Simulation models of sugary drink policies: A scoping review

Smith

Grummon

et al. 2022

PLoS ONE

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Introduction Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. Methods We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021–22. Results Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). Discussion Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Simulation models of sugary drink policies: A scoping review

Smith

Grummon

et al. 2022

PLoS ONE

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“…Furthermore, this country has relatively high quality epidemiological and health economic modeling data with BODE 3 models using consistent approaches. These BODE 3 model publications have also met the quality inclusion criteria in various systematic reviews (e.g., on sodium [49] [50]; dietary policies [51] and equity [52]). BODE 3 modeling has also been ranked highest quality out of 25 tobacco control models in a systematic review [53].…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Prioritization of Intervention Domains to Prevent Cardiovascular Disease: A Country-Level Case Study using Global Burden of Disease and Local Data

Wilson

Cleghorn

Nghiem

et al. 2022

Preprint

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Aim: We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ). Methods: Risk factor data for CVD in NZ was extracted from the GBD using the “GBD Results Tool”. We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by two alternative ways: (i) strength of the evidence-base for domain-specific interventions being cost-saving (based on number of NZ publications); and (ii) the domain-specific interventions that delivered the highest health gains and cost-savings. Results: Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). When considering strength of evidence-base around health economic benefits, we found that tobacco control could be considered to be the highest priority risk factor domain to intervene in (nine NZ publications showing cost-savings). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion). Other potential considerations for prioritization are: (i) the potential for total health gain that includes non-CVD health loss (i.e., again favoring tobacco control); (ii) potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities; and (iii) consideration of co-benefits such as greenhouse gas reductions from dietary interventions. Conclusions: We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Tobacco control could be top ranked if policy-makers focused on the strength of evidence for health economic benefits. But if policy-makers wished to maximize health gain and cost-savings from any specific intervention/s, then they may favor dietary interventions e.g., food taxes and subsidies.

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“…Many different public health interventions have been proposed to tackle rising obesity rates and their consequences, ranging from weight loss interventions targeted specifically at individuals with obesity, to dietary policies that aim to reduce consumption of calories, fat, sugar and/or salt at the population level either through taxation, reformulation or labelling [ 7 ]. Another population level approach is to restrict advertising for particular products.…”

Section: Introductionmentioning

confidence: 99%

The health, cost and equity impacts of restrictions on the advertisement of high fat, salt and sugar products across the transport for London network: a health economic modelling study

Thomas

Breeze

Cummins

et al. 2022

Int J Behav Nutr Phys Act

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Background Policies aimed at restricting the marketing of high fat, salt and sugar products have been proposed as one way of improving population diet and reducing obesity. In 2019, Transport for London implemented advertising restrictions on high fat, salt and sugar products. A controlled interrupted time-series analysis comparing London with a north of England control, suggested that the advertising restrictions had resulted in a reduction in household energy purchases. The aim of the study presented here was to estimate the health benefits, cost savings and equity impacts of the Transport for London policy using a health economic modelling approach, from an English National Health Service and personal social services perspective. Methods A diabetes prevention microsimulation model was modified to incorporate the London population and Transport for London advertising intervention. Conversion of calorie to body mass index reduction was mediated through an approximation of a mathematical model estimating weight loss. Outcomes gathered included incremental obesity, long-term diabetes and cardiovascular disease events, quality-adjusted life years, healthcare costs saved and net monetary benefit. Slope index of inequality was calculated for proportion of people with obesity across socioeconomic groups to assess equity impacts. Results The results show that the Transport for London policy was estimated to have resulted in 94,867 (4.8%) fewer individuals with obesity, and to reduce incidence of diabetes and cardiovascular disease by 2,857 and 1,915 cases respectively within three years post intervention. The policy would produce an estimated 16,394 additional quality-adjusted life-years and save £218 m in NHS and social care costs over the lifetime of the current population. Greater benefits (e.g. a 37% higher gain in quality-adjusted life-years) were expected to accrue to individuals from the most socioeconomically deprived groups compared to the least deprived. Conclusions This analysis suggests that there are considerable potential health and economic gains from restricting the advertisement of high fat, salt and sugar products. The population health and economic impacts of the Transport for London advertising restrictions are likely to have reduced health inequalities in London.

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Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review

Cited by 13 publications

References 116 publications

Simulation models of sugary drink policies: A scoping review

Simulation models of sugary drink policies: A scoping review

Prioritization of Intervention Domains to Prevent Cardiovascular Disease: A Country-Level Case Study using Global Burden of Disease and Local Data

The health, cost and equity impacts of restrictions on the advertisement of high fat, salt and sugar products across the transport for London network: a health economic modelling study

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