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

项目摘要 虽然有大量证据支持并说明了内外部政策创新可能带来的好处， 卫生系统改善饮食和减少心脏代谢疾病（CMD）及其对健康的影响， 差异、成本和成本效益没有得到很好的确定。因为与饮食有关的主要差异 然而，如果这些战略持续存在，评估这些战略在高危亚组中的效果至关重要。行政和法律的挑战 可以强烈影响这些战略的实施，扩大规模和可持续性，但这些考虑因素 尚未得到严格评估。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，并传播这一点; 证据其目的是1）估计健康影响，成本，成本效益和对差距的影响 具体的卫生系统战略，以改善饮食和减少CMD在美国; 2）估计健康 影响，成本，成本效益，以及对具体的州一级政策，以改善饮食和 减少美国的CMD; 3）评估特定健康的行政和法律的挑战和可行性 系统和国家的战略，以改善饮食和减少CMD在美国;和4）传播我们的主要发现 从前期，相关赠款，这项新的工作，以相关利益攸关方在关键的立法，机构， 宣传阵地。根据我们以前的经验，我们将评估卫生系统干预措施， 干预和行政/法律的可行性。我们将定义合理的政策效应大小及其 根据对文献和专家联系的审查， 制定了评估政策成本的方法，包括按部门评估。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，并量化比较效率衡量ICER 将每个干预与基本情况进行比较。对差异的影响将通过比较以下方面的差异来评估： 关键人群亚组中每项行动的CMD差异（差异方法差异）。我们将 进行深入的行政和法律的分析，以确定成功的可能条件和 执行的障碍和障碍。

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.