Poor eating is a major cause of illness, especially from cardiometabolic conditions such as heart disease, type 2 diabetes, and obesity. These diseases generate large economic burdens for both government and private insurance programs. For individuals and their families, additional burdens come in the form of personal illness, out-of-pocket costs, reduced quality of life, and a shortened lifespan. These diet-related diseases and costs disproportionately affect low-income families in
A new Food-PRICE study from researchers at the
SNAP is the foremost
The study, published today in PLOS Medicine, estimated that
The three evaluated incentive/disincentive scenarios were:
* A 30 percent subsidy for fruits and vegetables (F&V), similar to the USDA FINI program currently available for some SNAP participants in certain states.
* A 30 percent F&V subsidy plus removal of sugar-sweetened beverages (SSBs) from the list of eligible purchases using SNAP funds.
* A broader incentive/disincentive program including a 30 percent subsidy for F&V, nuts, whole grains, fish, and plant-based oils and a 30 percent disincentive for SSBs, junk food, and processed meats. This program, termed "SNAP-plus" by the researchers, incentivizes healthier intakes across a broader range of foods while preserving participant choice (i.e., not restricting any items from eligibility).
The impact on health outcomes, healthcare costs, and cost-effectiveness were evaluated over different time periods: 5 years, 10 years, 20 years, and lifetime. The research team estimated that, over the cohort's lifetime, the F&V incentive could prevent 303,900 cardiovascular events, add 649,400 quality-adjusted life-years (QALYs), and save
The SNAP-plus incentive yielded the greatest corresponding gains:
- 940,000 fewer cardiovascular events;
- 2.47 million added QALYs; and
Cost-effectiveness of each scenario was evaluated from a societal perspective (accounting for costs of implementing the program and healthcare costs) and from a government affordability perspective (further adding the direct costs of the food incentives or disincentives for everyone on SNAP, including children).
From a societal perspective, all three interventions were cost-saving, leading to societal savings of
From a government affordability perspective, the incentive for fruits and vegetables showed marginal cost-effectiveness at five years but was cost-effective over a lifetime (i.e., with a cost lower than the conventional healthcare threshold of
In comparison, SNAP-plus was not only cost-effective but actually cost-saving - i.e., the government gained more dollars than it spent - with net cost-savings of
To evaluate the effects of the three incentive/disincentive protocols, the research team used a validated micro-simulation model (CVD Predict) to generate a sample representative of the
The research team constructed a data-driven simulation for the three incentive/disincentive policy interventions. Their analysis examined effects of such interventions on the number of cardiovascular events, QALYs, program costs, healthcare savings, and cost-effectiveness for the three scenarios, compared to the outcomes under the current SNAP program.
"Systems level changes are often the most efficient and cost-effective way to gain health and reduce healthcare costs. Our findings suggest that modest incentives for fruits and vegetables could dramatically reduce the burden of disease for individuals and the healthcare costs for businesses and the government," said co-senior author
"About one in seven Americans participate in SNAP, a crucial and effective program to reduce hunger. Our results suggest that SNAP can also be a powerful lever to improve nutrition, reduce major diseases, and lower healthcare spending," said corresponding and co-first author
The study is from the Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) research initiative, a collaboration of researchers identifying nutrition changes that could have the greatest impact on improving health outcomes in
This work was supported by awards from the
Mozaffarian, D., Liu, J., Sy, S., Huang, Y., Rehm, C., Lee, Y., Wilde, P., Abrahams-Gessel, S., de