Table 2. Cost-effectiveness Analysis.
| Scenario | Total QALYs (per capita) | Total cost (USD) | Incremental QALYs gained | Incremental cost | ICER |
|---|---|---|---|---|---|
| Status quo | 22.31 (0.01) | 8,580.21 (146.65) | |||
| 30% subsidy a | 22.55 (0.01) | 7,756.47(148.20) | 0.24 (0.02) | -823.74 (1.55) | -3,432.32 (304.91) |
| Sensitivity analyses | |||||
| SNAP participation rate | |||||
| 5% b | 22.52 (0.01) | 7,943.09 (143.35) | 0.21 (0.02) | -637.12 (3.30) | -3,033.33 (302.56) |
| 25% c | 22.59 (0.01) | 7,568.07 (138.89) | 0.28 (0.02) | -1,012.14 (7.76) | -3,614.28 (248.71) |
| Duration of subsidy | |||||
| 6 years d | 22.54 (0.01) | 7,935.08 (136.11) | 0.23 (0.02) | -645.13 (10.54) | -2,804.35 (217.51) |
| 16 years e | 22.58 (0.01) | 7,700.06 (138.90) | 0.27 (0.02) | -880.15 (7.75) | -3,259.25 (230.34) |
| Additional health outcomes | |||||
| Including LC f | 22.55 (0.02) | 8,450.08 (148.99) | 0.24 (0.02) | -919.92 (2.34) | -3,898.31 (272.51) |
| Implementation cost | |||||
| 20% overhead cost g | 22.55 (0.02) | 7,665.05 (150.05) | 0.24 (0.02) | -915.16 (3.40) | -3,813.17 (331.19) |
| 40% overhead cost h | 22.55 (0.02) | 7,782.11 (142.22) | 0.24 (0.02) | -798.10 (4.43) | -3,325.42 (282.17) |
| 60% overhead cost i | 22.55 (0.02) | 7,810.07 (148.67) | 0.24 (0.02) | -770.14 (2.02) | -3,208.92 (282.54) |
| Substitution HIP trial – including changes in fruit juice j | 22.54 (0.02) | 7,782.12 (142.19) | 0.24 (0.02) | -798.00 (4.46) | -3,395.74 (211.26) |
| Subsidy level | |||||
| 10% subsidy k | 22.53 (0.02) | 7,855.14 (152.56) | 0.22 (0.02) | -725.07 (5.91) | -3,295.45 (300.35) |
| 20% subsidy l | 22.54 (0.02) | 7,815.12 (155.32) | 0.23 (0.02) | -765.09 (8.67) | -3,326.09 (275.91) |
| Habit formation | |||||
| 50% maintainm | 22.94 (0.02) | 6,687.21 (149.06) | 0.63 (0.02) | -1,893.00 (2.41) | -3,004.76 (94.57) |
Notes: The reference category for all rows is the status quo, except for the “including LC” scenario for which the reference category is the status quo with LC included.
30% subsidy: base case analysis on subsidizing 30% of FV purchases among SNAP users in the U.S.
5% enrolled: 5% of the U.S. population enrolled in SNAP.
25% enrolled: 25% of the U.S. population enrolled in SNAP
48 months SNAP: 48 months completed length of SNAP participation.
160 months SNAP: 160 months completed length of SNAP participation.
LC added: lung cancer included as one of the health outcomes.
20% overhead cost: 20% overhead expenditure rate.
40% overhead cost: 40% overhead expenditure rate.
50% overhead cost: 50% overhead expenditure rate.
Fruit juice included: 100% fruit juice included in consumption changes in addition to refined grain and targeted FV.
0% subsidy: subsidizing 10% of FV purchases.
20% subsidy: subsidizing 20% of FV purchase.
50% maintain: Habit formation and maintaining half the amount of FV increase observed during participation among individuals with a prior history of SNAP participation.
ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life years; LC, lung cancer; FV, fruits and vegetables; SNAP, Supplemental Nutrition Assistance Program; HIP, Healthy Incentive Pilot