Healthcare economics and health-related spending in the United States has been a significant topic of debate for years, and concerns for solutions are only increasing. In the vast array of analysis over costs, there appears to be an infinite number of proposed strategies towards reducing categorical spending on healthcare. One area which has been closely analyzed more recently has been shown to have important implications in healthcare spending—our diets.
The estimated spending on yearly treatment of cardiometabolic disease in the U.S. is a whopping $276.3 billion, and $50.4 billion of that is related to having a suboptimal diet, according to a new study [1]. Researchers at Brigham and Women’s Hospital in Boston, Massachusetts conducted a study which was published last month in PLOS Medicine. The study utilized a microsimulation model to estimate the associated costs of treatment of various cardiometabolic diseases including ischemic heart disease, type 2 diabetes, and stroke. This analysis revealed that 18.2% of those total costs were applied towards care related to poor dietary intake of 10 dietary factors associated with cardiovascular health status. The head physician on the study, Thomas A. Gaziano, MD, and his colleagues predicted that if the adult population between the ages of 35 and 85 in the U.S. were to adjust their dietary consumption into the “ideal diet,” this change would save upwards of $50 billion in healthcare spending, where all savings could be actualized from reduction in cardiovascular and diabetic care [1].
The microsimulation ultimately determined that about 80% of savings, when adjusted to their “ideal diet” would come from reductions in cost of hospitalization for acute care after a heart attack or stroke, according to Gaziano. The remaining costs reductions would come from other factors including drug costs. Various health economists have demonstrated interest in studying the remaining 82% of costs related to cardiometabolic disease not associated with diet according to this study. Some analysts remain cautious in interpreting these results and have a heavy suspicion that an even larger percentage could be attributed to dietary factors [2].
In further breakdown of this study, it was found that the annual diet-related costs of cardiometabolic disease were approximately $301 per person on a per capita basis. The largest costs were related to underconsumption of what the study categorized as, “good and healthy foods,” such as nuts and seeds and other omega-3 fats from sources like seafood. More so, it was determined that the average American only consumes 19.5% of the ideal amount of healthy fats from nuts and seeds—20 grams per day. On the contrary, other food groups negatively associated with cardiometabolic condition were assessed. To some surprise, the costs of consuming too much red meat and sodium only amounted to a spending breakdown of $3 per person in treatment. It was noted that 37.5% of individuals were at or below the level of consumption of red meat and sodium considered to contribute to detrimental health effects. For other cost-contributing “bad foods,” it was found that 52% of the population consumes sugar-sweetened beverages and 68% eat processed meats on a regular basis, where the ideal consumption was zero.
Another study conducted in 2018 suggested similar results after analyzing the cost implications of improving the American diet. The study was a meta-analysis examining health outcomes associated with increased levels of adherence to diets measured by either the Healthy Eating Index (HEI) or the Mediterranean style diet (MED) scores. The HEI score is typically used to evaluate a US-style diet and reflects adherence with the 2015-2020 Dietary Guidelines for Americans. The MED score, on the other hand, was used to evaluate dietary metrics alongside the diet of countries in the Mediterranean region with a heavy emphasis on fish, nuts, fruits, and healthy fats such as olive oil [3].
Researchers determined that increasing adherence to dietary patterns along the HEI parameters, even by a relative 20% (conservative model), would result in an estimated reduction of $30-47 billion in healthcare costs. The team conducting the study also estimated cost-savings with respect to a more ambitious model, assuming 80% adherence to the HEI. This resulted in a projected annual savings of about $52-82 billion. Half of these savings came from a reduction in costs associated with solely cardiovascular disease reduction. Additional savings were noted to be associated with costs in the management of cancer and type 2 diabetes.
Under the MED score guidelines, a 20% increase in adherence would project a savings of about $21-26 billion. This estimate was associated with breast, colorectal, and prostate cancer in addition to coronary heart disease, stroke, type 2 diabetes, hip fractures, and Alzheimer’s Disease. The more ambitious model under this guideline, 80% adherence elicited savings related to all types of cancer along with the same health outcomes (coronary heart disease, stroke, type 2 diabetes, hip fractures, and Alzheimer’s Disease) as the more conservative model at 20% increase in adherence. The 80% increase in MED score guideline dietary adherence demonstrated a projected annual savings that could reach upwards of $112-125 billion [4].
All in all, numerous recent studies have increased the understanding and significance of dietary patterns and their role in driving healthcare costs. While this may be a well-known fact already, the induction of concrete, sustained change in the American diet is unlikely to occur anytime soon. The new rise in evidence rather provides a promising reference and potential for the benefits of improving our diets, for the sake of our personal health and our spending as a nation.
[1] Beck DL. Suboptimal Diet May Drive $50 Billion in Cardiometabolic Costs. Medscape. https://www.medscape.com/viewarticle/923257. Published December 31, 2019. Accessed January 6, 2020.
[2] Jardim TV, Mozaffarian D, Abrahams-Gessel S, et al. Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model. PLOS Medicine. 2019;16(12). doi:10.1371/journal.pmed.1002981
[3] Lagasse J. To save billions in health-related costs, it’s worth looking at Americans’ diets. Healthcare Finance News. https://www.healthcarefinancenews.com/news/save-billions-health-related-costs-its-worth-looking-americans-diets. Accessed January 6, 2020.
[4] Scrafford CG, Bi X, Multani JK, Murphy MM, Schmier JK, Barraj LM. Health Economic Evaluation Modeling Shows Potential Health Care Cost Savings with Increased Conformance with Healthy Dietary Patterns among Adults in the United States. Journal of the Academy of Nutrition and Dietetics. 2019;119(4):599-616. doi:10.1016/j.jand.2018.10.002.
Aaron Tran is a member of The University of Arizona College of Medicine – Phoenix Class of 2023. He graduated from Arizona State University in 2018 with a degree in Kinesiology. In his spare time, he enjoys training Brazilian Jiu-jitsu, bodybuilding, playing guitar and piano, and hanging out with his labrador retriever, Rex, outdoors.
For questions, concerns, or discussion: atran13@email.arizona.edu