Suchergebnisse

OBJECTIVES: Meta-analyses have identified obesity as an independent risk factor for 13 cancers and added sugars as a contributor to obesity. In 2016, the new Nutrition Facts label on US packaged foods mandated the inclusion of added sugar content. We assessed the health outcomes, costs, and cost-effectiveness of this policy on obesity-related cancer burdens among 250 million US adults over their lifetime. METHODS: We populated the Diet Cancer Outcome Model (DiCOM), a probabilistic cohort-state transitional model, to evaluate two effects of the policy on (a) consumer behavior alone; and (b) consumer behavior plus industry reformulation. Policy effect on consumer behavior was derived from a meta-analysis of calorie labeling; and on industry reformulation, from the FDA's regulatory impact analysis and the UK sugar reformulation strategy. Effects of added sugar on obesity and obesity on cancer incidence were derived from meta-analyses and published literature. Cost-effectiveness was evaluated as net costs with 3% annual discounting, under both government affordability and societal perspectives. RESULTS: We estimated that, based on consumer responses alone, the added sugar labeling would prevent 35,500 new cancer cases (95% uncertainty interval [UI]: 12,300 to 65,800) and 16,700 cancer deaths (95% UI: 5720 to 31,400) and gain 113,000 quality-adjusted life years (QALYs) (95% UI: 38,800 to 210,000) over a lifetime. Adding potential additional effects on industry reformulation, corresponding values were 79,700 new cancer cases (95% UI: 28,100 to 140,000), 37,500 cancer deaths (95% UI: 13,200 to 66,000), and 253,000 QALYs (95% UI: 89,600 to 444,000). Policy would result in estimated net cost savings of $8600 M (95% UI: $6900 M to $11,000 M) from governmental affordability and $7500 M ($5400 M to $9900 M) from societal perspectives based on consumer responses alone. With industry reformulation, net savings were $19,000 (95% UI: $15,000 M to $23,000 M) and $16,000 M (95% UI: $12,000 M to $20,000 M), respectively. ...

OBJECTIVES: Sugar sweetened beverage (SSB) intake is pervasive in the U.S. and a critical risk factor for weight gain and obesity. Obesity is a preventable factor associated with 13 types of cancers. While SSB taxes can lower SSB intake, the potential impact on cancer outcomes, health costs, and cost-effectiveness in the U.S. is lacking. We aimed to evaluate the health outcomes, costs, and cost-effectiveness of a national SSB tax policy for reducing obesity-related cancer in the U.S. METHODS: We used the Diet Cancer Outcome Model (DiCOM), a probabilistic cohort state-transition model, to project the effect of a national $0.01 per oz SSB excise tax on 13 obesity-associated cancers among U.S. adults age 20+ years over their lifetime. Model inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2013–2016, policy effects, diet-BMI effects, and BMI-cancer effects from meta-analyses, and policy and cancer costs from established sources. Cost-effectiveness was evaluated as net costs with 3% annual discounting, under both government affordability and societal perspectives. Probabilistic sensitivity analyses jointly incorporated uncertainty in model inputs using 1000 simulations. RESULTS: The SSB tax policy was estimated to prevent 20,545 (95% uncertainty interval [UI]: 12,586 to 32,000) new cancers cases and 10,181 (6362 to 16,000) cancer deaths and add 67,100 (41,100 to 104,505) quality-adjusted life years (QALYs) over lifetime. Largest health benefits were seen for endometrial, kidney, and liver cancer. The SSB tax was estimated to generate $1.17 billion industry compliance costs, $1.20 billion in government implementation costs, and $5.4 billion in lifetime medical savings for the 13 types of cancer. The SSB tax was net cost saving from a societal perspective and government affordability perspective, at $3.2 billion (95% UI: $2.4 to $4.1) and $4.1 billion (95% UI: $3.4 to $4.9), respectively, not including the $6.6 billion generated from tax revenues. ...

BACKGROUND: Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. Although SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. METHODS: We used the Diet and Cancer Outcome Model, a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults aged 20 years and older by income. RESULTS: A national SSB tax was estimated to prevent 22 075 (95% uncertainty interval [UI] = 16 040-28 577) new cancer cases and 13 524 (95% UI = 9841-17 681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50-$1.95) billion for government implementation and $1.70 (95% UI = $1.48-$1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67-$2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1486, 95% UI = -$3516-$9265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13 220, 95% UI = $3453-$28 120 per QALY). Approximately 4800 more cancer cases and 3100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤ 1.85) than higher-income individuals (FPIR > 1.85). CONCLUSIONS: A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the United States, with the largest health gains and economic benefits among low-income Americans.