Cost-Effectiveness of the US Food and Drug Administration Added Sugar Labeling Policy for Improving Diet and Health
Cost-Effectiveness of the US Food and Drug Administration Added Sugar Labeling Policy for Improving Diet and Health
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DOI：
10.1161/circulationaha.118.036751
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发表时间：
2019-06-04
期刊：
影响因子：
37.8
通讯作者：
Micha, Renata
中科院分区：
文献类型：
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作者：
Huang, Yue;Kypridemos, Chris;Micha, Renata
背景技术背景：过量添加的糖，特别是来自含糖饮料的糖，是心脏代谢疾病（包括心血管疾病和2型糖尿病）的主要风险因素。2016年，美国食品和药物管理局强制要求在所有包装食品和饮料上标注添加糖含量。然而，这一政策的潜在健康影响和成本效益仍不清楚。方法：一个有效的微观模拟模型（美国IMPACT食品政策模型）被用来估计避免的心血管疾病和2型糖尿病病例、质量调整生命年、政策成本、卫生保健、非正式护理和生产力损失2种政策设想方案的（与健康有关的）节约和成本效益：（1）实施美国食品药品监督管理局添加糖标签政策（糖标签），（2）进一步核算相应的行业重新制定（糖标签+重新制定）。该模型使用了来自国家健康和营养检查调查的全国代表性人口统计和饮食摄入数据，来自疾病控制和预防中心奇迹数据库的疾病数据，来自荟萃分析的政策影响和饮食疾病影响，以及来自既定来源的政策和健康相关成本。概率敏感性分析解释了模型参数的不确定性和群体异质性。研究结果：在2018年至2037年期间，糖标签将预防354，400例心血管疾病（95%不确定区间，167 000 - 673 500）和599 300（302 400 - 957 400）糖尿病病例，增加727 000（401 3001 138 000）质量调整生命年，节省310亿美元（15.7 - 54.5）净医疗保健成本或619亿美元（33.1 - 103.3）社会成本（包括减少的生产力损失和非正式护理成本）。对于糖标签+重新配方方案，相应的收益为708800（369 2001 252 000）心血管疾病病例，120万（0.7 - 1.7）糖尿病病例，130万（0.8 - 1.9）质量调整生命年，分别为576亿美元（319 - 924）和1132亿美元（673 - 1752）。据估计，到2023年，这两种情景都有> 80%的可能性节省成本。结论：实施美国食品和药物管理局添加糖标签政策可以为美国人口带来可观的健康收益和成本节约。
BACKGROUND: Excess added sugars, particularly from sugar-sweetened beverages, are a major risk factor for cardiometabolic diseases including cardiovascular disease and type 2 diabetes mellitus. In 2016, the US Food and Drug Administration mandated the labeling of added sugar content on all packaged foods and beverages. Yet, the potential health impacts and costeffectiveness of this policy remain unclear. METHODS: A validated microsimulation model (US IMPACT Food Policy model) was used to estimate cardiovascular disease and type 2 diabetes mellitus cases averted, quality-adjusted life-years, policy costs, health care, informal care, and lost productivity (health-related) savings and costeffectiveness of 2 policy scenarios: (1) implementation of the US Food and Drug Administration added sugar labeling policy (sugar label), and (2) further accounting for corresponding industry reformulation (sugar label+ reformulation). The model used nationally representative demographic and dietary intake data from the National Health and Nutrition Examination Survey, disease data from the Centers for Disease Control and Prevention Wonder Database, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Probabilistic sensitivity analysis accounted for model parameter uncertainties and population heterogeneity. RESULTS: Between 2018 and 2037, the sugar label would prevent 354 400 cardiovascular disease (95% uncertainty interval, 167 000-673 500) and 599 300 (302 400-957 400) diabetes mellitus cases, gain 727 000 (401 3001 138 000) quality-adjusted life-years, and save $ 31 billion (15.7-54.5) in net healthcare costs or $ 61.9 billion (33.1-103.3) societal costs (incorporating reduced lost productivity and informal care costs). For the sugar label+ reformulation scenario, corresponding gains were 708 800 (369 2001 252 000) cardiovascular disease cases, 1.2 million (0.7-1.7) diabetes mellitus cases, 1.3 million (0.8-1.9) quality-adjusted life-years, and $ 57.6 billion (31.9-92.4) and $ 113.2 billion (67.3-175.2), respectively. Both scenarios were estimated with > 80% probability to be cost saving by 2023. CONCLUSIONS: Implementing the US Food and Drug Administration added sugar labeling policy could generate substantial health gains and cost savings for the US population.