Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study
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 prescr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.029215 |
| _version_ | 1797738428500017152 |
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| author | Lu Wang Brianna N. Lauren Kurt Hager Fang Fang Zhang John B. Wong David D. Kim Dariush Mozaffarian |
| author_facet | Lu Wang Brianna N. Lauren Kurt Hager Fang Fang Zhang John B. Wong David D. Kim Dariush Mozaffarian |
| author_sort | Lu Wang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T13:43:39Z |
| format | Article |
| id | doaj.art-f691111784c14caaa6eab809e76641b6 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T13:43:39Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f691111784c14caaa6eab809e76641b62023-08-23T10:41:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-08-01121510.1161/JAHA.122.029215Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation StudyLu Wang0Brianna N. Lauren1Kurt Hager2Fang Fang Zhang3John B. Wong4David D. Kim5Dariush Mozaffarian6The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University Boston MA USAThe Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University Boston MA USAThe Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University Boston MA USAThe Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University Boston MA USADivision of Clinical Decision Making Tufts Medical Center Boston MA USADivision of Hospital Medicine, Department of Medicine University of Chicago IL USAThe Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University Boston MA USABackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.122.029215cost‐effectivenessfood is medicinemicro‐simulationproduce prescription |
| spellingShingle | Lu Wang Brianna N. Lauren Kurt Hager Fang Fang Zhang John B. Wong David D. Kim Dariush Mozaffarian Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cost‐effectiveness food is medicine micro‐simulation produce prescription |
| title | Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study |
| title_full | Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study |
| title_fullStr | Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study |
| title_full_unstemmed | Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study |
| title_short | Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study |
| title_sort | health and economic impacts of implementing produce prescription programs for diabetes in the united states a microsimulation study |
| topic | cost‐effectiveness food is medicine micro‐simulation produce prescription |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.029215 |
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