TY - JOUR
T1 - Addressing the low consumption of fruit and vegetables in England
T2 - A cost-effectiveness analysis of public policies
AU - Pinho-Gomes, Ana Catarina
AU - Knight, Alec
AU - Critchley, Julia
AU - Pennington, Mark
PY - 2020
Y1 - 2020
N2 - Background: Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F and V) in England, but economic analyses of structural policies to change diet are sparse. Methods: Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL) and the healthcare costs attributable to consumption of F and V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies: A universal 10% subsidy on F and V, a targeted 30% subsidy for low-income households and a social marketing campaign (SMC). Findings: Consumption of F and V below the recommended five portions a day accounted for 16 321 [10 091-23 516] deaths and 238 767 [170 350-311 651] YLL in England in 2017, alongside £705 951 [398 761-1 061 559] million in healthcare costs. All policies would increase consumption and reduce the disease burden attributable to low intake of F and V. From a societal perspective, the incremental cost-effectiveness ratios were £22 891 [22 300-25 079], £16 860 [15 589-19 763] and £25 683 [25 237-28 671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20 000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy would additionally reduce inequalities. Conclusions: Low intake of F and V represents a heavy health and care burden in England. All dietary policies can improve consumption of F and V, but only a targeted subsidy to low-income households would most likely be cost-effective.
AB - Background: Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F and V) in England, but economic analyses of structural policies to change diet are sparse. Methods: Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL) and the healthcare costs attributable to consumption of F and V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies: A universal 10% subsidy on F and V, a targeted 30% subsidy for low-income households and a social marketing campaign (SMC). Findings: Consumption of F and V below the recommended five portions a day accounted for 16 321 [10 091-23 516] deaths and 238 767 [170 350-311 651] YLL in England in 2017, alongside £705 951 [398 761-1 061 559] million in healthcare costs. All policies would increase consumption and reduce the disease burden attributable to low intake of F and V. From a societal perspective, the incremental cost-effectiveness ratios were £22 891 [22 300-25 079], £16 860 [15 589-19 763] and £25 683 [25 237-28 671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20 000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy would additionally reduce inequalities. Conclusions: Low intake of F and V represents a heavy health and care burden in England. All dietary policies can improve consumption of F and V, but only a targeted subsidy to low-income households would most likely be cost-effective.
KW - Diet
KW - Economic evaluation
KW - Public health policy
UR - http://www.scopus.com/inward/record.url?scp=85094142696&partnerID=8YFLogxK
U2 - 10.1136/jech-2020-214081
DO - 10.1136/jech-2020-214081
M3 - Article
AN - SCOPUS:85094142696
SN - 0143-005X
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
M1 - jech-2020-214081
ER -