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7.17 Evidence on cost-effectiveness of diet-related interventions
TABLE 7.17 Evidence on cost-effectiveness of diet-related interventions
INTERVENTION
Excise taxes on unhealthy foods and beverages
RESEARCH FINDINGS
Modeling studies find excise taxes on unhealthy foods and beverages to be cost-saving.
FOP warning labels FOP warning labels are both effective and cost-saving. FOP traffic light labeling appears to be cost saving. Menu warning labels Warning labels on restaurant menus are more effective than calorie labels.
Ban on child-targeted advertising of unhealthy foods and beverages
Nutrition standards and bans on unhealthy foods and beverages in schools, hospitals, and public health facilities
Limits on industrial trans fats
Salt and sodium reformulation interventions Child-targeted television advertising of unhealthy foods and beverages appear to be cost-effective or cost-saving. Though the studies of effectiveness are based on low-quality data, there is little doubt that child-centered advertising affects food preferences. Indirect evidence suggests that such effects eventually lead to increases in obesity and obesity-related NCDs. One modeling study concludes that nutrition standards in schools are either cost-effective or cost-saving, but the underlying evidence of effectiveness is weak.
A modeling study finds that limits on industrial trans fats in England and Wales are cost-saving. Mandated and voluntary reductions of sodium or salt are cost-effective or cost-saving.
Mass media campaigns to reduce salt consumption Effects are modest, but two modeling studies conclude that they are cost-saving.
Mandated limits on portions in packaged goods An Australian modeling study finds that a 375-milliliter limit on the size of packaged SSBs is cost-saving.
Source: Original compilation for this publication. Note: FOP = front-of-package. SSB = sugar-sweetened beverage. REFERENCES
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Musicus et al. 2019
Brown et al. 2018; Cecchini et al. 2010; Magnus et al. 2009
Gortmaker et al. 2015
Pearson-Stuttard et al. 2017
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Collins et al. 2014; Nghiem et al. 2015
Crino et al. 2017
There is evidence that other diet-related interventions are cost-effective (table 7.17). A large number of modeling studies have found excise taxes on unhealthy foods and beverages to be cost-saving. The economic benefits of such taxes are even stronger if worker productivity gains are taken into consideration (carter et al. 2019). Taxes on salt also have been found to be cost-saving (Nghiem et al. 2015; Smith-Spangler et al. 2010). indirect evidence suggests that FoP warning labels are cost-saving. Since warning labels are at least as effective as traffic light labels in encouraging healthy purchasing decisions (if not more so) (Arrúa et al. 2017a; Temple 2020), it is reasonable to infer that FoP warning labels are also likely to be cost-saving. indirect evidence suggests that menu warning labels are more cost-effective than menu calorie labels (musicus et al 2019). Assuming that these two types of labels have the same costs, menu warning labels appear to be more cost-effective than menu calorie labels. The latter
are already mandated in Saudi Arabia. restrictions on child-targeted television advertising of unhealthy foods and beverages appear to be either cost-effective or cost-saving. eliminating the tax deductibility of child-targeted television advertising for unhealthy foods also would likely be cost-saving (Sonneville et al. 2015). mandated limits on trans fatty acids and beverage packaging may be cost-saving (crino et al. 2017; Pearson-Stuttard et al. 2017). cost-effectiveness evaluations of interventions that ban unhealthy foods and beverages from schools, hospitals, and public health facilities are almost nonexistent.
Some evidence exists on the cost-effectiveness of workplace interventions to promote weight loss, although the results are mixed. Fitzgerald et al. (2018) calculate that a workplace dietary modification program was highly costeffective—€101 per QAlY gained—but caution that their estimate of effectiveness is uncertain. corso et al. (2018) report that an adapted version of the Diabetes Prevention Program is a cost-effective weight management intervention if implemented via self-study (uS$10,600 per QAlY gained) or in small study groups (uS$22,400 per QAlY gained). A cost-effectiveness analysis by robroek et al. (2012) finds that an internet-delivered worksite health promotion program had no effect on physical activity, fruit and vegetable consumption, obesity, blood pressure, or self-perceived health.
There is a discrepancy between the effectiveness literature and the cost-effectiveness literature with regard to physical activity interventions. As noted earlier, the evidence regarding the effectiveness of community-wide interventions is weak. However, a systematic review of cost-effectiveness studies concludes, “Available evidence for the cost-effectiveness of physical activity interventions is scattered, but points towards the cost-effectiveness of certain interventions” (Abu-omar et al. 2017, 72). Among the most cost-effective interventions listed are many of the same interventions that lack strong evidence of effectiveness, such as the construction of community rail trails (multiuse trails built on top of abandoned railroad tracks) (Stokes, macDonald, and ridgeway 2008). if the underlying evidence of effectiveness is weak, mixed, inconsistent, or inconclusive, then a modeling study that assumes effectiveness should be viewed with skepticism.
School-based programs are an exception, as they appear to be both effective and cost-effective. As discussed earlier, evidence consistently shows such programs to be effective at increasing in-school physical activity, according to multiple systematic reviews. Wu et al. (2011) review the literature to assess the cost of these programs per metabolic equivalent of task hours gained per child per day. These cost-effectiveness ratios, however, are not easily interpreted for policy purposes. moreover, spending more time on physical activity in schools has opportunity costs for other subjects unless the length of the school day is extended. Finally, it is not clear whether such programs would be cost-effective in schools that already offer physical education classes.
The most cost-effective school-based intervention in both reviews is a health and nutrition program for first-grade schoolchildren in crete, Greece. The intervention, known as the cretan Health and Nutrition education Program, was based on the Know Your Body health promotion program of the American Health Foundation. it was effective in increasing moderate-to-vigorous physical activity during classes that used noncompetitive and cooperative activities.
