Background:
Both high sugar intake and low fruit and vegetable (FV) consumption increase the risk of coronary heart disease (CHD). Sugar-sweetened beverage (SSB) taxes can reduce sugar intake, whereas FV subsidies increase FV consumption. Several cities in the US have proposed an innovative policy that used the SSB tax revenue towards FV subsidies. It is unclear what the long-term health and economic impact this innovative policy could have in large cities such as New York City (NYC).
Objective:
To project lifetime CHDs averted and costs if a penny-per-ounce SSB tax were used to subsidize FV incentives in NYC using a validated microsimulation model of cardiovascular disease.
Methods:
We used the SHINE CVD model to compare the cost and CHD outcomes of a combination of SSB tax and FV subsidy policy with only SSB tax, only FV subsidy, and no policy from a healthcare sector perspective, respectively. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. We simulated 10,000 adults starting at age 40. CHD risk factor trajectories and risk of incident CHD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax (penny-per-ounce) and FV subsidy were modeled to directly affect incidence rates of CHD events. Medical costs were included and discounted at 3%.
Results:
Compared to the non-policy scenario over the simulated lifetime, the SHINE CVD model projected that the policy intervention with SSB taxes only would prevent 62 per 10,000 (95% CI: 57 - 67) CHD events at a penny-per-ounce rate, the intervention with FV subsidies only would prevent 28 per 10,000 (95% CI: 24-34), and the combined policy would prevent 91 CHD events (95% CI: 87 - 96). Total medical cost savings over the simulation period ranged from $22.5 million (95% CI: $21.5 - $23.6 million), $13.1 million (95% CI: $12.3 - $13.8million), and $37.9 million (95% CI: $36.5 - $39.4million), or $0.45 million/year, $0.27 million/year, $0.75 million/year for SSB taxes only, FV subsidies only, and the combined policy, respectively.
Conclusion:
Using a computer simulation model, we showed how converting SSB tax revenues into FV subsidies could result in substantial benefits within the NYC population in terms of CHD outcomes and overall healthcare cost savings. Results from the SHINE CVD model may inform the ongoing policy-making efforts.
News Media Framing of New York City’s Sugar-Sweetened Beverage Portion-Size Cap
