Policy R01:

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

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. 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 also project costs and CMD benefits of each policy using established modeling approaches and quantify comparative efficiency of each intervention.

This project is also part of the Friedman School’s larger collection of Food-PRICE projects.

Aim One

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;

Aim Two

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;

Aim Three

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

Aim Four

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.

Kim DD, Wang L, Lauren BN, Liu J, Marklund M, Lee Y, Micha R, Mozaffarian D, Wong JB. Development and Validation of the US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) Model: Health Disparity and Economic Impact Model. Med Decis Making. 2023 Oct 16:272989X231196916. doi: 10.1177/0272989X231196916. Epub ahead of print. PMID: 37842820.

Hager K, Du M, Li Z, Mozaffarian D, Chui K, Shi P, Ling B, Cash SB, Folta SC, Zhang FF. Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States. Circ Cardiovasc Qual Outcomes. 2023 Aug 29:e009520. doi: 10.1161/CIRCOUTCOMES.122.009520. Epub ahead of print. PMID: 37641928.

Mozaffarian D. Identifying nutritional priorities for global health: time for a more PURE focus on protective foods. Eur Heart J. 2023 Jul 21;44(28):2580-2582. doi: 10.1093/eurheartj/ehad325. PMID: 37414412; PMCID: PMC10361008.

Wang L, Lauren BN, Hager K, Zhang FF, Wong JB, Kim DD, Mozaffarian D. Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study. J Am Heart Assoc. 2023 Jul 7:e029215. doi: 10.1161/JAHA.122.029215.

Hager K, Shi P, Li Z, Chui K, Berkowitz SA, Mozaffarian D, Chhabra J, Wilken J, Vergara C, Becker E, Small S, Ling B, Cash SB, Folta SC, Zhang FF. Evaluation of a Produce Prescription Program for Patients With Diabetes: A Longitudinal Analysis of Glycemic Control. Diabetes Care. 2023 Jun 1;46(6):1169-1176. doi: 10.2337/dc22-1645. PMID: 36812470; PMCID: PMC10234740.

Pomeranz JL, Cash SB, Mozaffarian D. US Policies That Define Foods for Junk Food Taxes, 1991-2021. Milbank Q. 2023 Jun;101(2):560-600. doi: 10.1111/1468-0009.12652. Epub 2023 Apr 26. PMID: 37101340; PMCID: PMC10262384.

Menichetti G, Ravandi B, Mozaffarian D, Barabási AL. Machine learning prediction of the degree of food processing. Nat Commun. 2023 Apr 21;14(1):2312. doi: 10.1038/s41467-023-37457-1. PMID: 37085506; PMCID: PMC10121643.

Mozaffarian, D., Blanck, H.M., Garfield, K.M. et al. A Food is Medicine approach to achieve nutrition security and improve health. Nat Med. 2022 Oct 6. doi: org/10.1038/s41591-022-02027-3.

Liu J, Steele EM, Li Y, Karageorgou D, Micha R, Monteiro CA, Mozaffarian D. Consumption of Ultraprocessed Foods and Diet Quality Among U.S. Children and Adults. Am J Prev Med. 2022 Feb;62(2):252-264. doi: 10.1016/j.amepre.2021.08.014. Epub 2021 Nov 6. PMID: 34753645.

Pomeranz JL, Cash SB, Springer M, Del Giudice IM, Mozaffarian D. Opportunities to address the failure of online food retailers to ensure access to required food labelling information in the USA. Public Health Nutr. 2022 Jan 24:1-9. doi: 10.1017/S1368980021004638. Epub ahead of print. PMID: 35067257.

O'Hearn M, Gerber S, Cruz SM, Mozaffarian D. The time is ripe for ESG + Nutrition: evidence-based nutrition metrics for Environmental, Social, and Governance (ESG) investing. Eur J Clin Nutr. 2022 Jan 24. doi: 10.1038/s41430-022-01075-9. Epub ahead of print. PMID: 35075230.

Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis. Adv Nutr. 2021 Oct 1;12(5):1944-1956. doi: 10.1093/advances/nmab039. PMID: 33999108; PMCID: PMC8483962.

Peñalvo JL, Sagastume D, Mertens E, Uzhova I, Smith J, Wu JHY, Bishop E, Onopa J, Shi P, Micha R, Mozaffarian D. Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis. Lancet Public Health. 2021 Sep;6(9):e648-e660. doi: 10.1016/S2468-2667(21)00140-7. PMID: 34454642; PMCID: PMC8627548.

Liu J, Lee Y, Micha R, Li Y, Mozaffarian D. Trends in junk food consumption among US children and adults, 2001-2018. Am J Clin Nutr. 2021 May 21:nqab129. doi: 10.1093/ajcn/nqab129. Epub ahead of print. PMID: 34020459.

Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis. Adv Nutr. 2021 May 17:nmab039. doi: 10.1093/advances/nmab039. Epub ahead of print. PMID: 33999108.

Du M, Griecci CF, Cudhea FF, Eom H, Kim DD, Wilde P, Wong JB, Wang YC, Michaud DS, Mozaffarian D, Zhang F; Food-PRICE Project. Cost-effectiveness Analysis of Nutrition Facts Added-Sugar Labeling and Obesity-Associated Cancer Rates in the US. JAMA Netw Open. 2021 Apr 1;4(4):e217501. doi: 10.1001/jamanetworkopen.2021.7501. PMID: 33904914; PMCID: PMC8080223.

Liu J, Micha R, Li Y, Mozaffarian D. Trends in Food Sources and Diet Quality Among US Children and Adults, 2003-2018. JAMA Netw Open. 2021 Apr 1;4(4):e215262. doi: 10.1001/jamanetworkopen.2021.5262. PMID: 33844000; PMCID: PMC8042524.

Mozaffarian D, Fleischhacker S, Andrés JR. Prioritizing Nutrition Security in the US. JAMA. 2021 Apr 27;325(16):1605-1606. doi: 10.1001/jama.2021.1915. PMID: 33792612.

O'Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. J Am Heart Assoc. 2021 Feb;10(5):e019259. doi: 10.1161/JAHA.120.019259. Epub 2021 Feb 25. PMID: 33629868.

Du M, Griecci CF, Kim DD, Cudhea F, Ruan M, Eom H, Wong JB, Wilde PE, Michaud DS, Lee Y, Micha R, Mozaffarian D, Zhang FF. Cost-Effectiveness of a National Sugar-Sweetened Beverage Tax to Reduce Cancer Burdens and Disparities in the United States. JNCI Cancer Spectr. 2020 Aug 25;4(6):pkaa073. doi: 10.1093/jncics/pkaa073. PMID: 33409452; PMCID: PMC7771430.

Hager K, Mozaffarian D. The Promise and Uncertainty of Fruit and Vegetable Prescriptions in Health Care. J Nutr. 2020 Nov 19;150(11):2846-2848. doi: 10.1093/jn/nxaa283. PMID: 33021312; PMCID: PMC7675025.