Cost-Effectiveness of Health System and State-Level Strategies to Improve Diet and Reduce Cardiometabolic Diseases

项目摘要 虽然有相当多的证据支持和告知内外政策创新可能带来的好处 改善饮食和减少心脏代谢性疾病(CMD)的卫生系统及其对健康的影响， 差距、成本和成本效益并没有得到很好的确立。因为与饮食相关的主要差异 持续下去，评估这种策略在高危亚群中的效果至关重要。行政和法律挑战 会对此类战略的实施、扩大和可持续性产生重大影响，但此类考虑 还没有经过严格的评估。我们的具体目标将我们先前对国家政策的分析扩展到 解决卫生系统战略和国家具体行动的关键问题，并传播这一信息 证据。其目的是1)评估健康影响、成本、成本效益和对差异的影响 在美国改善饮食和减少CMD的具体卫生系统战略；2)评估健康 改善饮食和营养的具体州级政策的影响、成本、成本效益和对差异的影响 在美国减少CMD；3)评估特定健康的行政和法律挑战以及可行性 美国改善饮食和减少CMD的系统和国家战略；以及4)传播我们的主要发现 来自前一时期的相关赠款，以及这项新工作，向关键立法、机构和 倡导立场。根据我们以前的经验，我们将评估卫生系统干预措施，国家 干预措施和行政/法律可行性。我们将定义看似合理的政策效果大小及其 基于文献审查和专家联系的不确定性；并采用微观成本计算方法 评估政策成本的既定方法，包括按部门进行评估。我们将预测以下项目的成本和CMD收益 每项政策，使用既定的建模方法，并量化ICER衡量的相对效率 将每个干预措施与基本情况进行比较。对差异的影响将通过比较 关键人群亚组中每项行动的CMD差异(差异方法不同)。我们会 进行深入的行政和法律分析，以确定成功的可能条件和 当局和执行方面的障碍。

Project Summary While considerable evidence supports and informs the likely benefits of policy innovations within and outside health systems to improve diet and reduce cardiometabolic diseases (CMD), their impacts on health, disparities, costs, and cost-effectiveness are not well established. Because major diet-related disparities persist, assessing effects of such strategies in at-risk subgroups is crucial. Administrative and legal challenges can strongly influence implementation, scale-up, and sustainability of such strategies, but such considerations have not yet been rigorously assessed. Our specific aims extend our prior analyses of national policies to address crucial questions for health system strategies and state-specific actions and to disseminate this evidence. The aims are 1) to estimate the health impacts, costs, cost-effectiveness, and effects on disparities of specific health system strategies to improve diet and reduce CMD in the US; 2) to estimate the health impacts, costs, cost-effectiveness, and effects on disparities of specific state-level policies to improve diet and reduce CMD in the US; 3) to assess the administrative and legal challenges and feasibility of specific health system and state strategies to improve diet and reduce CMD in the US; and 4) to disseminate our top findings from the prior period, related grants, and this new work to relevant stakeholders in key legislative, agency, and advocacy positions. Building on our prior experience, we will evaluate health system interventions, state interventions, and administrative/legal feasibility. We will define plausible policy effect sizes and their uncertainty based on reviews of literature and expert contacts; and adopt a micro-costing approach using established methods to assess policy costs including by sectors. We will project costs and CMD benefits of each policy, using established modeling approaches, and quantify comparative efficiency measured by ICER comparing each intervention to a base case. Effects on disparities will be evaluated comparing differences in CMD disparities (difference in difference approach) for each action in key population subgroups. We will conduct in-depth administrative and legal analysis to identify the likely conditions for success and the authorities and obstacles for implementation.