Riviste scientifiche

Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study

PLoS Medicine - Ma, 19/03/2019 - 22:00

by Yujin Lee, Dariush Mozaffarian, Stephen Sy, Yue Huang, Junxiu Liu, Parke E. Wilde, Shafika Abrahams-Gessel, Thiago de Souza Veiga Jardim, Thomas A. Gaziano, Renata Micha

Background

Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid.

Methods and findings

A validated microsimulation model (CVD-PREDICT) estimated CVD and diabetes cases prevented, quality-adjusted life years (QALYs), health-related costs (formal healthcare, informal healthcare, and lost-productivity costs), and incremental cost-effectiveness ratios (ICERs) of two policy scenarios for adults within Medicare and Medicaid, compared to a base case of no new intervention: (1) 30% subsidy on fruits and vegetables (“F&V incentive”) and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils (“healthy food incentive”). Inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Overall, 82 million adults (35–80 years old) were on Medicare and/or Medicaid. The mean (SD) age was 68.1 (11.4) years, 56.2% were female, and 25.5% were non-whites. Health and cost impacts were simulated over the lifetime of current Medicare and Medicaid participants (average simulated years = 18.3 years). The F&V incentive was estimated to prevent 1.93 million CVD events, gain 4.64 million QALYs, and save $39.7 billion in formal healthcare costs. For the healthy food incentive, corresponding gains were 3.28 million CVD and 0.12 million diabetes cases prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved, respectively. From a healthcare perspective, both scenarios were cost-effective at 5 years and beyond, with lifetime ICERs of $18,184/QALY (F&V incentive) and $13,194/QALY (healthy food incentive). From a societal perspective including informal healthcare costs and lost productivity, respective ICERs were $14,576/QALY and $9,497/QALY. Results were robust in probabilistic sensitivity analyses and a range of one-way sensitivity and subgroup analyses, including by different durations of the intervention (5, 10, and 20 years and lifetime), food subsidy levels (20%, 50%), insurance groups (Medicare, Medicaid, and dual-eligible), and beneficiary characteristics within each insurance group (age, race/ethnicity, education, income, and Supplemental Nutrition Assistant Program [SNAP] status). Simulation studies such as this one provide quantitative estimates of benefits and uncertainty but cannot directly prove health and economic impacts.

Conclusions

Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.

Google announces video game streaming service to let you play anywhere

New Scientist - Ma, 19/03/2019 - 19:12
Google announces a streaming service that will allow people to play video games in 4K in their browser — provided they have a good internet connection

Asteroid Bennu is spewing out dust and rocks to create its own moons

New Scientist - Ma, 19/03/2019 - 18:30
NASA’s OSIRIS-REx has found that Bennu is an active asteroid and is also covered in large rocks that will make grabbing a sample more difficult

Asteroid Ryugu is so dry we may have to rethink how Earth got water

New Scientist - Ma, 19/03/2019 - 17:45
The first results from Japan’s Hayabusa-2 mission show that the asteroid Ryugu is surprisingly dry, which may have implications for how life began on Earth

Protected hen harriers are vanishing under suspicious circumstances

New Scientist - Ma, 19/03/2019 - 17:00
A study that tracked 58 hen harriers over a decade found that most of the birds disappeared without a trace – and this was more likely to happen on grouse moors

Cheer the first women-only spacewalk, but equality is still far away

New Scientist - Ma, 19/03/2019 - 13:30
The first women-only spacewalk is a cause for celebration, but we are still a long way from achieving equality in our space programmes

Spread of cancers halted by smart bacteria that trigger immune attack

New Scientist - Ma, 19/03/2019 - 12:34
In tests in animals, injecting genetically modified bacteria shrank tumours and triggered a strong immune response that prevented cancers spreading

James Bond is making the switch to an electric car, so when will you?

New Scientist - Ma, 19/03/2019 - 12:18
You don’t need to be green to embrace an electric car – their design and performance now rivals their gas-guzzling equivalents, says Jason Barlow

Karen Uhlenbeck is first woman to win prestigious maths Abel prize

New Scientist - Ma, 19/03/2019 - 12:10
Karen Uhlenbeck has won the Abel prize, often called the Nobel prize of mathematics, for work that laid the foundations for major breakthroughs in theoretical physics

Toilet on International Space Station gets a bacteria-killing upgrade

New Scientist - Ma, 19/03/2019 - 05:00
Killing bacteria in space is hard – but an experimental silver-ruthenium surface that was added to the ISS toilet door seems to be up to the job

Distant space rock Ultima Thule formed in a slow and gentle collision

New Scientist - Lu, 18/03/2019 - 20:24
New images of the most distant space rock we have ever visited show that it has mysterious bright spots and stripes, and that it probably formed in a slow-motion collision

Boys and girls may have differing attitudes to risk thanks to society

New Scientist - Lu, 18/03/2019 - 20:00
Risk taking levels between boys are girls are far from written in stone, but are shaped by society, according to a new study

Women with a twin brother are more likely to drop out of school

New Scientist - Lu, 18/03/2019 - 20:00
Decades of data from Norway show that girls with a twin brother are less likely to finish school or university, which may be due to testosterone exposure in the womb

Our brains might sense Earth's magnetic field just like birds do

New Scientist - Lu, 18/03/2019 - 18:00
Some magnetic field alterations cause changes in our brain activity, suggesting a magnetic sense could have played a role in the nomadic lives of our hunter-gatherer ancestors

How to make your brain adaptive enough to cope with anything

New Scientist - Lu, 18/03/2019 - 17:30
Physicist, neuroscience author and Star Trek script writer Leonard Mlodinow shares the secrets to the kind of elastic thinking that has fuelled his diverse career

Dead whale found with 40 kilograms of plastic in its stomach

New Scientist - Lu, 18/03/2019 - 16:33
A dead whale found in the Philippines with 40 kilograms of plastic inside its body is the latest example of the problem of plastic pollution

Dead whale found with 40kg of plastic in its stomach

New Scientist - Lu, 18/03/2019 - 16:33
A dead whale found in the Philippines with 40kg of plastic inside its body is the latest example of the problem of plastic pollution

A third of fish sold is mislabelled — here’s how to avoid being duped

New Scientist - Lu, 18/03/2019 - 16:32
Working out if you’re eating wild cod or farmed catfish is hard as mislabelling is rampant, but there are ways to make sure you're not swindled

Revealed: First image of huge meteor explosion over Earth last year

New Scientist - Lu, 18/03/2019 - 13:21
The huge meteor explosion which hit Earth in December was caught on camera by the Japanese Himawari-8 weather satellite

Thousands of unknown underwater mountains found in Earth’s oceans

New Scientist - Sa, 16/03/2019 - 09:00
Between 5000 and 10,000 underwater mountains have been discovered by measuring their gravitational effects on the sea
Condividi contenuti