Background:
Sugar-sweetened beverages (SSB) are currently the single largest source of added sugar in the US diet, and consumption in New York City (NYC) remains high. Evidence suggests that a high sugar consumption increases the risk of coronary heart disease. To date, excise taxes on SSB have been implemented in several US jurisdictions. While reductions in SSB consumption have been reported in several places where the SSB tax was implemented, it is unclear what the long term health and economic impact an SSB tax could have within the demographically and socioeconomically diverse NYC. In addition, the impact of varying tax structures remains unknown.
Objective:
To project the cardiovascular health outcomes and cost-savings of variations on the penny-per-ounce SSB tax structure (simulating a half-penny to two-penny range) using a validated microsimulation model of cardiovascular disease.
Methods:
The Simulations for Health Improvement and Equity (SHINE) CVD Model was used to estimate the lifetime direct medical costs (2019 USD) and effectiveness of SSB tax from a healthcare sector perspective. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax was modeled to directly affect incidence rates of CVD events and was derived from variations of the penny-per-ounce tax scheme. Costs were discounted at 3%.
Results:
Compared to the non-policy situation, the SHINE CVD model projected that an SSB tax would prevent 29,341 (95% CI: 11,747-46,935) coronary heart disease (CHD) events at a half penny-per-ounce rate, 37,034 (95% CI: 19,336-54,732), at one penny-per-ounce, and 68,846 CHD events (95% CI: 51,306- 86,386) at a two-pennies-per-ounce rate over the simulated lifetimes of the NYC population. Total cost savings over this time period ranged from $662 million (95% CI $584-$741 million), $714 million (95% CI: $620-$808 million), and $1.03 billion (95% CI $0.92 - $1.16 billion), or $13.5 million/year, $14.6 million/year, $21.0 million/year for half-penny, one-penny, and two-pennies-per-ounce taxes respectively.
Conclusion:
Using a computer simulation model, we showed how different increments of the penny-per-ounce SSB tax could result in substantial benefits within the NYC population in terms of CVD outcomes and overall health care cost savings. Results from the SHINE CVD model may inform the ongoing policymaking efforts.
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