Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study.
Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study.
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DOI：
10.1161/jaha.122.029215
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发表时间：
2023-08
影响因子：
5.4
通讯作者：
Mozaffarian, Dariush
中科院分区：
文献类型：
--
作者：
Wang, Lu;Lauren, Brianna N.;Hager, Kurt;Zhang, Fang Fang;Wong, John B.;Kim, David D.;Mozaffarian, Dariush
生产处方计划，提供免费或打折的产品和营养教育的患者与饮食相关的条件在卫生保健系统内，已被证明可以改善饮食质量和心脏代谢风险因素。在美国，为糖尿病患者实施生产处方计划对长期健康收益、成本和成本效益的潜在影响尚未确定。我们使用了一个经过验证的状态转换微观模拟模型（糖尿病、肥胖、心血管疾病微观模拟模型），该模型使用了2013年至2018年国家健康和营养检查调查中合格个体的国家数据，进一步纳入了Meta分析中估计的干预效果和饮食疾病影响，以及已发表文献中的政策和健康相关成本。该模型估计，在一生中，（平均=25年），在650万患有糖尿病和粮食不安全的美国成年人中实施农产品处方（终身治疗）将防止292 000人（95%不确定区间，143 000-440 000）心血管疾病事件，产生260 000例（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（18.4 - 77亿美元）。从医疗保健的角度来看，该计划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，节省了成本（净节省：-0.5亿美元）。在5年和10年的较短时间内，干预措施仍然具有成本效益。按年龄、人种或种族、教育程度和基线保险状态划分的人群亚组的结果相似。我们的模型表明，在患有糖尿病和粮食不安全的美国成年人中实施生产处方将产生巨大的健康收益，并且具有很高的成本效益。
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. 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. 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.