Increasing access to fruit and vegetables could save US$40B in US healthcare costs, experts flag

11 Jul 2023 --- Using a simulation model, researchers predict that a US national produce prescription program could prevent 296,000 cases of cardiovascular disease. The program, which would offer free or discounted fruits or vegetables, could also add 260,000 quality-adjusted life years – years lived with good health – in people (aged 40-79) with diabetes and food insecurity.

With these health gains, the authors estimate that the country could save around US$39.6 billion in healthcare spending and US$4.8 billion in lost productivity costs over a lifetime – using a mean of 25 years. 

Implementation costs are estimated at US$44.3 billion, resulting in net savings of around US$500 million. 

“Of the strategies that can improve Americans’ nutrition and diet-related health outcomes, evidence continues to build that produce prescriptions is a terrific option,” says senior author Dariush Mozaffarian, professor of Nutrition at the Friedman School of Nutrition Science and Policy, Tufts University, US. 

“These innovative treatments are exciting because they cannot only improve health and reduce healthcare spending but also reduce disparities by reaching patients most in need.”

Aside from expanding citizens’ access to fruits and vegetables to patients with diet-related conditions within health care systems, prescription programs also offer valuable nutrition education. 

Produce prescription programs provide free or discounted fruits and vegetables and nutrition education.US$18,100 per year  
The study, published in the Journal of the American Heart Association, found that a produce prescription program was cost-effective from a healthcare perspective “over a lifetime” and at shorter timelines (five or ten years). 

A lifetime program had an estimated incremental cost-effectiveness ratio of US$18,100 per quality-adjusted life-year. This statistic is calculated by dividing the mean net change in health care costs saved by the mean net change in quality-adjusted life-years. 

The researchers note this is similar to other prevention strategies, such as drug treatments for hypertension (US$20,000 per quality-adjusted life-year) and statins that help lower total cholesterol (US$37,000 per quality-adjusted life-year). 

“When we looked at different subgroups of Americans, we found broadly similar benefits by insurance type, race and ethnicity,” says first author Lu Wang, a postdoctoral fellow at the Friedman School. 

“These results suggest that a national produce prescription initiative could benefit all Americans, highlighting the potential of Food is Medicine strategies to alleviate health inequities caused by food and nutrition insecurity and diet-related diseases.”

Policy implications 
The researchers note there is a growing interest in produce prescription programs. The US Department of Agriculture announced a US$59.4 million investment in such programs in November 2022. 

However, they caution that produce prescriptions only reach a minority of Americans with limited access by most healthcare providers or eligible patients. 

“Our new findings help inform implementation to scale and evaluate these programs across the US,” says Mozaffarian. 

“A national program could be enacted through the inclusion of produce prescriptions as a covered healthcare benefit, already being piloted by several states under Medicaid section 1,115 waivers as well as by private healthcare payers.” 

Although the model used the best available data, the authors note that a simulation cannot prove such a program’s health and cost effects but provide the “most likely health benefits and cost effects.” 

They note that existing literature on similar programs is limited and based on up to 18 months of interventions, while cost savings of sustained programs could be over- or under-estimated. The authors caution “the healthcare cost savings estimates from our model should be considered conservative estimates.” 

A review of used programs found participants increased fruit and vegetable consumption, reducing BMI and diabetic risk.Microsimulation model  
The researchers used a diabetes, obesity and cardiovascular disease microsimulation model, a validated health state-transition model. This model predicts the annual probability of transitions among different health states for each person based on individual-level risk factors, population trends and potential impact of interventions. 

The model tracks changes in body mass index (BMI), cases of diabetes and cardiovascular disease, all-cause mortality, quality-adjusted life years and health care costs and an individual level. The authors used national data from eligible individuals from the National Health and Nutrition Examination Survey (2013-2018). 

Moreover, the research team analyzed 20 produce prescription interventions to estimate the intervention effect size of these programs on dietary habits and cardiometabolic risk factors. 

The authors used outcomes of a recent review of US-based produce prescription programs in their model. This evaluation found participants increased fruit and vegetable consumption by 0.80 servings/day, reduced BMI by 0.6 kg/m2 per day and reduced hemoglobin A1c in blood by 0.8 points – a commonly used test to diagnose prediabetes and diabetes. 

By Jolanda van Hal