Choi Sung Eun, Seligman Hilary, Basu Sanjay
Department of Management Science and Engineering, Stanford University, Stanford, California.
Department of General Internal Medicine, University of California San Francisco, San Francisco, California; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California.
Am J Prev Med. 2017 May;52(5):e147-e155. doi: 10.1016/j.amepre.2016.12.013. Epub 2017 Jan 30.
A diet high in fruits and vegetables (FV) is associated with reduced risk of chronic disease. One strategy to incentivize FV consumption among low-income households is to make them more affordable through the Supplemental Nutrition Assistance Program (SNAP). This study aims to identify the cost effectiveness of subsidizing FV purchases among the one in seven Americans who participate in SNAP.
A cost-effectiveness analysis was conducted from a societal perspective to estimate lifetime costs and health gains associated with subsidizing FV purchases. A stochastic microsimulation model of obesity, type 2 diabetes, myocardial infarction, and stroke in the 2015 U.S. population was used. Model parameters were based on nationally representative SNAP participation and dietary consumption data from the National Health and Nutrition Examination Survey (2003-2012), and data from a randomized trial of FV subsidies among SNAP users.
Despite cycling of participants in and out of SNAP, expanding an FV subsidy nationwide through SNAP would be expected to reduce incidence of type 2 diabetes by 1.7% (95% CI=1.2, 2.2), myocardial infarction by 1.4% (95% CI=0.9, 1.9), stroke by 1.2% (95% CI=0.8, 1.6), and obesity by 0.2% (95% CI=0.1, 0.3), and be cost saving from a societal perspective. The saved costs would be largely attributable to long-term reductions in type 2 diabetes and cardiovascular diseases.
The model suggests nationwide SNAP FV subsidies would reduce chronic disease morbidity, mortality, and costs over long time horizons that are unlikely to be observed in short-term community-based trials.
富含水果和蔬菜（FV）的饮食与降低慢性病风险相关。激励低收入家庭食用FV的一种策略是通过补充营养援助计划（SNAP）使其价格更实惠。本研究旨在确定补贴参与SNAP的七分之一美国人购买FV的成本效益。
从社会角度进行成本效益分析，以估计补贴FV购买相关的终身成本和健康收益。使用了2015年美国人群肥胖、2型糖尿病、心肌梗死和中风的随机微观模拟模型。模型参数基于具有全国代表性的SNAP参与情况和来自国家健康与营养检查调查（2003 - 2012年）的饮食消费数据，以及SNAP用户中FV补贴随机试验的数据。
尽管参与者进出SNAP的情况有所变化，但通过SNAP在全国范围内扩大FV补贴预计将使2型糖尿病发病率降低1.7%（95%CI = 1.2, 2.2），心肌梗死发病率降低1.4%（95%CI = 0.9, 1.9），中风发病率降低1.2%（95%CI = 0.8, 1.6），肥胖率降低0.2%（95%CI = 0.1, 0.3），并且从社会角度来看具有成本节约效益。节省的成本在很大程度上归因于2型糖尿病和心血管疾病的长期减少。
该模型表明，在全国范围内实施SNAP FV补贴将在较长时间内降低慢性病的发病率、死亡率和成本，而这在短期基于社区的试验中不太可能观察到。
