Cost-effectiveness of increased healthy eating options in low-access neighborhoods

Background: Observational audits of supermarkets and fast food restaurants were conducted throughout the St. Louis area to assess access to opportunities to engage in healthy eating behaviors. The data suggest the greatest need for increased access to healthy options exists in areas of extreme poverty and African American neighborhoods. Research suggests that without access to healthy options that enable individuals to make healthy choices, some communities will continue to have disparities in critical health outcomes (e.g., obesity, heart disease). Yet there are very few cost-effectiveness studies of increasing healthy eating options.

Purpose: The purpose of this study was to assess the cost-effectiveness of increasing healthy eating options in St. Louis City, an area demonstrating greatest need for increased access.

Methods: An economic evaluation was conducted to assess two intervention options to address this disparity in access: creating subsidies for expanding options in current store locations or building a new grocery store. Outcomes were based on the prevalence and reduction of type 2 diabetes. Standard cost-effectiveness tools were used along with TreeAge software. Evidence-based literature and the BRFSS were searched for appropriate data on current levels of healthy eating and disease prevalence. In addition, a local grocery store owner was interviewed for assistance in interpreting the literature collected. Quality Adjusted Life Year (QALY) estimates were obtained from the literature. Estimates for prevalence of healthy eating were obtained from a food frequency questionnaire conducted with residents living in the St. Louis area (as part of a related study). Sensitivity analyses, varying the type of grocery store (e.g., full service or smaller, targeted stores) were conducted to verify results.

Results: The results of this economic evaluation show that increasing the availability of healthy eating options is a cost-effective way to decrease diabetes. The addition of these options is estimated to cost $292.13 per QALY gained. This result is most sensitive to the cost of the grocery store and the estimated effects of healthy eating on health.

Discussion: A number of researchers have highlighted the importance of policy and environmental interventions to improve eating patterns. However, a dearth of literature exists analyzing the cost-effectiveness of interventions to increase access to opportunities to engage in healthy eating. This economic evaluation study provides an argument for tax subsidies and abatements to entice new grocery store development in under-served markets as a way to improve the public's health.