Study Finds Prescribing Fruits and Vegetables Could Reduce Future Healthcare Spending by $40 Billion

Dariush Mozaffarian, MD, DrPH
Credit: Friedman School at Tufts University

Implementing monthly produce prescription programs for people with diabetes could reduce healthcare spending by $40 billion, according to a new study from the Friedman School of Nutrition Science and Policy at Tufts University.

Results of the study, which used a validated microsimulation model and National Health and Nutrition Examination Survey (NHANES) data, found implementing produce prescriptions in adults with both diabetes and food insecurity could prevent nearly 300,000 cardiovascular events and generate more than 250,000 quality-adjusted life-years over a 25-year period, with the benefits in terms of health care cost and productivity savings outweighing implementation costs by an estimated $400 million.¹

“Of the strategies that can improve American’s nutrition and diet-related health outcomes, evidence continues to build that produce prescriptions are a terrific option,” said senior investigator Dariush Mozaffarian, MD, DrPH a cardiologist and Jean Mayer Professor of Nutrition at the Friedman School at Tufts University.² “These innovative treatments are exciting because they cannot only improve health and reduce healthcare spending, but also reduce disparities by reaching those patients who are most in need.”

As prevention and management strategies for diabetes have evolved in recent decades, so has the recognition and understanding of the impact of food insecurity on outcomes. Mozaffarian and a team of colleagues from Tufts University launched the current study with the intent of using the Diabetes, Obesity, Cardiovascular Disease Microsimulation model, a validated state‐transition microsimulation model, to estimate the effects of such programs among participants in NHANES cycles from 2013-2018 with effect estimates based on published literature.¹

Overall, 6.5 million US adults met investigators eligibility criteria. This cohort had a mean baseline age of 58.2 (Standard deviation [SD], 10.2) years, 43.1% were non‐Hispanic White adults, 63.0% had a high school education or less, and 56.6% had a family income to poverty ratio lower than 1.3. Further analysis of baseline clinical characteristics revealed 30.0% had baseline prevalent cardiovascular disease, the mean BMI was 33.6 (SD, 7.95) kg/m2, the mean HbA1c was 7.3% (SD, 1.95). Investigators also pointed out the baseline mean daily consumption of fruits and vegetables was 0.86 (SD, 1.08) servings of fruit and 1.30 (SD, 1.04) servings of vegetables.¹

Results of the investigators' simulation model suggest implementation of national produce prescriptions, which would provide an average monthly voucher or food boxes of $42 per month or $504 per year per patient, among this patient population could prevent 292,000 (Uncertainty interval [UI], 143,000-440,000) cardiovascular disease events and generate 260,000 (UI, 110,000-411,000) additional quality-adjusted life-years over a 25-year period. At just 5 years, such an intervention could prevent 66,900 (UI, 31,900-102,000) cardiovascular disease events and, at 10 years, could prevent 126,000 (UI, 62,300-190,000) cardiovascular disease events.¹

When assessing potential costs and cost-effectiveness, results indicated monthly produce prescriptions were estimated to cost $37.3 billion ($27.0-$47.5 billion) in food costs and $6.99 billion ($5.07-$8.19 billion) in administrative costs. In contrast, the intervention was estimated to save $39.6 billion ($20.5-$58.6 billion) in formal healthcare expenditures and $4.77 billion ($1.84 billion-$7.70 billion) in productivity costs. Investigators highlighted an analysis of the incremental cost‐effectiveness ratio (ICER), which purported an ICER of $16,900 per QALY and cost saving from societal perspectives, with net savings of $0.47 billion ($23.7 saving-$23.5 billion cost).¹

Results demonstrated this type of approach had a probability of net cost‐effectiveness of 98.4% from a healthcare perspective and 98.9% from a societal perspective. Investigators also highlighted results of subgroup analyses, which demonstrated the effects observed in the primary analysis were similar across patient subgroups.¹

“When we looked at different subgroups of Americans, we found broadly similar benefits by insurance type, race, and ethnicity,” said lead investigator Lu Wang, PhD, a postdoctoral fellow at the Friedman School.² “These results suggest that a national produce prescription initiative could benefit all Americans, highlighting the potential of Food is Medicine strategies to alleviate health inequities caused by food and nutrition insecurity and diet-related diseases.”

References:

1. Wang L, Lauren BN, Hager K, et al. Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study [published online ahead of print, 2023 Jul 7]. J Am Heart Assoc. 2023;e029215. doi:10.1161/JAHA.122.029215
2. Tufts University. Produce prescription programs for patients with diabetes could save billions in healthcare costs, study shows. Newswise. July 7, 2023. Accessed July 13, 2023. https://www.newswise.com/articles/produce-prescription-programs-for-patients-with-diabetes-could-save-billions-in-healthcare-costs-study-shows.