Introduction:
Taxes on sugar-sweetened beverage (SSB) purchases have emerged as a policy tool to lower obesity, diabetes and CVD risks. Prior cost-effectiveness analyses included SSB tax administration costs yet ignored tax payments as mere transfers from a societal perspective. Yet, tax payments could count as revenues for the government and as costs for consumers and the SSB industry. Corresponding health and economic impacts for different stakeholders, essential to guide decision-making, are not established.
Aim:
To estimate the health impact and cost-effectiveness of a national penny-per-ounce SSB tax from the healthcare perspective, societal perspective, and across 9 stakeholder groups: 6 consumer categories classified by insurance status (and reflecting varying SSB intake and risk factors), the government, the beverage industry, and other private sector.
Methods:
A validated microsimulation model (CVD PREDICT) was used to estimate CVD reductions, quality-adjusted life-years (QALYs) gained, costs, and cost-effectiveness among US adults (35+ years), evaluating both 100% and 50% price pass-through to consumers. Model inputs included dietary and demographic data from NHANES, policy effects on consumer intake and SSB-disease effects from meta-analyses, policy costs for tax administration based on the Berkeley tax, and validated healthcare costs. Findings were evaluated over a lifetime, with costs inflated to constant 2017 US dollars and outcomes discounted annually by 3%.
Results:
With 100% pass-through, the tax prevented 518,000 CVD events among US adults 35+ years over a lifetime and was cost-saving from a societal perspective. Lifetime discounted healthcare cost savings ($31.5bn) were 24 times as large as tax implementation costs ($1.3bn). Evaluating cost-effectiveness by stakeholder, for the 6 consumer categories, the tax was not cost saving, but incremental cost-effectiveness ratios (ICERs) each were <$50,000/QALY. For the government, tax revenues and healthcare savings were positive, netting $73.7bn in savings. For the beverage industry, net costs were $0.63bn (limited to tax compliance costs). With 50% pass-through, the tax would prevent 279,000 CVD events over a lifetime and remained cost-saving from a societal perspective. Government healthcare savings were approximately half as large, while consumer ICERs all remained <$50,000/QALY. For the beverage industry, tax costs were $33.64bn, much larger than with 100% pass-through, reflecting lower producer revenue per unit sold. Findings were robust to a range of sensitivity analyses.
Conclusions:
A national SSB tax would improve health and be cost-saving nationally, with varying health impacts and costs across major stakeholders. These novel findings are relevant and timely for policy decisions on continuing expansion of SSB taxes.
Health Impact and Cost-Effectiveness of Financing Fruit and Vegetable Subsidies with a Sugar-Sweetened Beverage Tax in the US: A Micro-Simulation Study