The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Tufts University Boston MA USA.
Division of Clinical Decision Making Tufts Medical Center Boston MA USA.
J Am Heart Assoc. 2023 Aug;12(15):e029215. doi: 10.1161/JAHA.122.029215. Epub 2023 Jul 7.
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.
在医疗保健系统中，为饮食相关疾病的患者制定处方方案，提供免费或折扣的农产品和营养教育，已被证明可以改善饮食质量和心血管代谢风险因素。在美国，为糖尿病患者实施农产品处方方案对长期健康收益、成本和成本效益的潜在影响尚未确定。
我们使用了经过验证的状态转换微观模拟模型（糖尿病、肥胖症、心血管疾病微观模拟模型），该模型使用了来自 2013 年至 2018 年全国健康和营养调查中符合条件的个人的国家数据进行了填充，进一步纳入了荟萃分析中估计的干预效果和饮食-疾病效果，以及来自已发表文献的政策和健康相关成本。该模型估计，在一生中（平均 25 年），为 650 万患有糖尿病和粮食不安全的美国成年人实施农产品处方（终身治疗），将预防 292000 例（95%不确定区间，143000-440000）心血管疾病事件，产生 260000 个（110000-411000）质量调整生命年，实施成本为 443 亿美元，节省医疗保健成本 396 亿美元（205-586 亿美元）和生产力成本 48 亿美元（18.40-77 亿美元）。从医疗保健角度来看，该方案具有很高的成本效益（增量成本效益比：18100 美元/质量调整生命年），从社会角度来看具有成本节约效果（净储蓄：-50 亿美元）。在 5 年和 10 年的更短期时间范围内，干预措施仍然具有成本效益。按年龄、种族或民族、教育程度和基线保险状况划分的人群亚组的结果相似。
我们的模型表明，在美国患有糖尿病和粮食不安全的成年人中实施农产品处方将带来巨大的健康收益，并且具有很高的成本效益。
