Healthy food prescriptions could save lives and money

Healthy food prescriptions through Medicare and Medicaid could generate substantial health gains and be highly cost-effective, according to a study published March 19 in the open-access journal PLOS Medicine by Yujin Lee and Dariush Mozaffarian of the Friedman School of Nutrition Science and Policy at Tufts University, Massachusetts, United States and colleagues. As noted by the authors, the findings support the implementation and evaluation of such programs within private and public healthcare systems.

In nearly all nations, healthcare spending continues to increase dramatically, with diet-related diseases being a major driver. Economic incentives through health insurance may promote healthier behaviors, but little is known about the health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease, through Medicare and Medicaid. Fruit, vegetable and other produce prescriptions have just been funded in the US through the Farm Bill with pilot programs. However, the health impacts, costs, and cost-effectiveness of the programs have not been evaluated at scale.

As a part of the Food-PRICE (Policy Review and Intervention Cost-Effectiveness) Project, Lee and colleagues estimated the health and economic impacts of healthy food prescriptions for adults in Medicare and Medicaid, the two largest US federal health insurance programs, which together cover 1 in 3 Americans.

Using nationally representative data and a validated model, they evaluated two scenarios: (1) 30% incentives for the cost of purchases of fruits and vegetables (F&V incentive), and (2) 30% incentives for the cost of purchases of several healthful foods, including fruits, vegetables, whole grains, nuts/seeds, seafood, and plant oils (healthy food incentive).

Over a lifetime, the study suggests that the F&V incentive could prevent 1.93 million cardiovascular disease events, including 0.35 million cardiovascular deaths, and save about $40 billion in healthcare costs. The healthy food incentive could prevent 3.28 million cardiovascular disease events, including 0.62 million cardiovascular deaths and 0.12 million diabetes cases, and save $100 billion in healthcare costs.

Both programs would be highly cost-effective from healthcare and societal perspectives, with lifetime incremental cost-effectiveness ratios ranging from more than $9,000 to approximately $18,000 per quality-adjusted life year. Taken together, the findings suggest that implementing healthy food prescriptions within large government healthcare programs to promote healthier eating could generate substantial health gains and be highly cost-effective.

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This research was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute (R01 HL130735, PI RM; R01 HL115189, PI DM), https://www.nhlbi.nih.gov/. In addition, JL was supported by a postdoctoral fellowship award (17POST33670808) from the American Heart Association, http://www.heart.org. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I have read the journal's policy and the authors of this manuscript have the following competing interests: RM reports research funding from NIH, Bill & Melinda Gates Foundation, and Unilever and personal fees from the World Bank and Bunge. DM reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America's Test Kitchen, and Danone; scientific advisory board, Elysium Health (with stock options), Omada Health, and DayTwo; and chapter royalties from UpToDate, all outside the submitted work. TAG has also received research funds and/or consulting fees from Astra Zeneca, Novartis, United Health Group, Teva Pharmacueticals, and Takeda in the past five years, all of which were outside the submitted work.

Lee Y, Mozaffarian D, Sy S, Huang Y, Liu J, Wilde PE, et al. (2019) Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS Med 16(3): e1002761. https://doi.org/10.1371/journal.pmed.1002761

Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America

Brigham and Women's Hospital, Boston, Massachusetts, United States of America

Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002761