Table 2.
Estimated health gains, costs, and cost-effectiveness of the U.S. Federal Menu Calorie labeling law over 5 y (2018–2023) and lifetime. *
| 5 year | Lifetime | |
|---|---|---|
| Simulated years | 4.86 | 28.40 |
| Average change in calories (kcal) | −15.60 | −15.60 |
| Average change in BMI (kg/m2) | −0.04 | −0.04 |
| Cases averted | ||
| CVD cases | 14,698 | 135,781 |
| Diabetes cases | 21,522 | 99,736 |
| CVD deaths | 1,575 | 27,646 |
| QALYs gained | 8,749 | 367,450 |
| Change in health-related costs ($billion) † | ||
| Formal healthcare costs | −0.90 | −11.87 |
| Informal healthcare costs | −0.001 | −0.009 |
| Productivity costs | −0.17 | −2.27 |
| Change in policy-related costs ($billion) ‡ | ||
| Government administrative costs | 0.01 | 0.02 |
| Industry compliance costs | 0.63 | 1.43 |
| Industry reformulation costs | 0 | 0 |
| Total net costs ($billion), by perspective§ | ||
| Healthcare | −0.26 | −10.42 |
| Societal | −0.43 | −12.71 |
| Incremental cost-effective ratio ($/QALY), by perspective || | ||
| Healthcare | Cost-saving | Cost-saving |
| Societal | Cost-saving | Cost-saving |
Health outcomes and costs were evaluated among US adults aged 35–80 years at baseline (n=175 million) and followed until death or age 100, whichever first. All costs were inflated to constant 2018 US dollars using the Bureau of Labor Statistics’ Consumer Price Index. Costs and quality-adjusted life years (QALYs) were discounted at 3% annually. Menu calorie labeling was estimated to reduce average calories consumed by consumers in restaurant meals by 7.3%, based on a meta-analysis of menu labeling interventions. Our model further conservatively assumed that 50% of this reduction in calories from restaurant meals would be compensated by an increase in calories consumed outside of restaurants (i.e. diminishing the policy effect size by half).
Formal healthcare costs for acute and chronic CVD states included costs of surgical procedures, screening costs, and drug costs; and for diabetes cases, costs of institutional care, outpatient care, outpatient medications and supplies. Informal healthcare costs included patient travel and waiting time costs. We conservatively excluded other informal healthcare cost such as unpaid caregiving costs. Productivity costs included costs resulting from loss in productivity
Detailed policy-related costs available in the Appendix (Table S3).
The healthcare perspective included policy costs and medical costs; the societal perspective further incorporated informal healthcare costs and productivity costs. Net costs were calculated as policy costs minus health-related costs reduced from CVD events and diabetes cases.
Incremental cost-effectiveness ratios (ICERs) were calculated as the net change in costs divided by the net change in QALYs. ICERs thresholds were evaluated at $150,000/QALY and $50,000/QALY according to ACC/AHA guidelines.