Nutritional Policy Changes in the Supplemental Nutrition Assistance Program: A Microsimulation and Cost-Effectiveness Analysis
Nutritional Policy Changes in the Supplemental Nutrition Assistance Program: A Microsimulation and Cost-Effectiveness Analysis
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DOI：
10.1177/0272989x13493971
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发表时间：
2013-10-01
影响因子：
3.6
通讯作者：
Bhattacharya, Jay
中科院分区：
文献类型：
--
作者：
Basu, Sanjay;Seligman, Hilary;Bhattacharya, Jay
背景。一些专家建议限制补充营养援助计划 (SNAP) 福利的使用，用于高热量食品或补贴 SNAP 购买更健康的食品。客观的。评估禁止含糖饮料 (SSB) 或对其征税或补贴通过 SNAP 购买的水果和蔬菜对健康的影响和成本效益。设计。微观模拟。数据源。国家健康和营养检查调查、美国农业部季度家庭食品价格数据库和 SNAP 计划数据。目标人群：25 至 64 岁的美国成年人。时间范围。 10岁。看法。政府的。结果措施。增量成本、质量调整生命年 (QALY)、体重指数、替代健康饮食指数、食品安全评分、糖尿病人年以及心肌梗死 (MI) 和中风死亡人数。基本案例分析的结果。禁止使用 SNAP 福利购买 SSB 预计将在未来十年内避免 510,000 名糖尿病人年以及 52,000 人死于心梗和中风，每节省 QALY 即可节省 2900 美元。对用 SNAP 美元购买的 SSB 按每盎司征税，可以通过税收收入节省更多成本，但可以避免慢性病死亡人数减少。然而，一些 SNAP 参与者可能会通过可支配收入优先购买 SSB，从而间接降低了他们的粮食安全。 30% 的农产品补贴预计将在 10 年内避免 39,000 人每年患糖尿病和 4600 人因心血管疾病死亡，而且不会影响粮食安全。敏感性分析的结果。结果对 SSB 和农产品的摄入弹性敏感。局限性。输入数据没有提供有关 SNAP 使用人群中价格变化的异质性信息。结论。 SNAP 对 SSB 的限制可能会降低慢性病死亡率，但进一步的测试应检查对可支配收入和粮食安全的间接影响。对农产品进行补贴可能带来更少的好处或风险，但成本更高。
Background. Some experts have proposed limiting the use of Supplemental Nutrition Assistance Program (SNAP) benefits, for calorie-dense foods or subsidizing SNAP purchases of healthier foods. Objective. To estimate health effects and cost-effectiveness of banning or taxing sugar-sweetened beverages (SSBs) or subsidizing fruits and vegetables purchased with SNAP. Design. Microsimulation. Data Sources. National Health and Nutrition Examination Survey, US Department of Agriculture Quarterly Food-at-Home Price Database, and SNAP program data. Target Population: US adults aged 25 to 64 y. Time Horizon. 10 y. Perspective. Governmental. Outcome Measures. Incremental costs, quality-adjusted life-years (QALYs), body mass index, Alternative Healthy Eating Index, Food Security Score, diabetes person-years, and deaths from myocardial infarctions (MIs) and strokes. Results of Base-Case Analysis. Banning SSB purchases using SNAP benefits would be expected to avert 510,000 diabetes person-years and 52,000 deaths from MIs and strokes over the next decade, with a savings of $2900 per QALY saved. A penny-per-ounce tax on SSBs purchased with SNAP dollars would produce higher cost savings due to tax revenues but avert fewer chronic disease deaths. However, some SNAP participants are likely to preferentially purchase SSBs through their disposable income, indirectly reducing their food security. A 30% produce subsidy would be expected to avert 39,000 diabetes person-years and 4600 cardiovascular deaths over 10 y without effects on food security. Results of Sensitivity Analysis. Results are sensitive to the intake elasticities of SSBs and produce. Limitations. Input data did not provide information on heterogeneity in response to price changes within the SNAP-using population. Conclusions. SNAP restrictions on SSBs could lower chronic disease mortality, but further testing should examine indirect effects on disposable income and food security. Subsidizing produce could confer fewer benefits or risks but at higher cost.