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Emmert-Fees, K. ; Karl, F. ; von Philipsborn, P.* ; Rehfuess, E.A.* ; Laxy, M.

Simulation modeling for the economic evaluation of population-based dietary policies: A systematic scoping review.

Adv. Nutr. 12, 1957-1995 (2021)
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Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.
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Publication type Article: Journal article
Document type Review
Corresponding Author
Keywords Dietary Policy ; Economic Evaluation ; Non-communicable Disease Prevention ; Policy Evaluation ; Public Health Nutrition ; Simulation Modeling ; Systematic Scoping Review; Cost-effectiveness Analysis; Sugar-sweetened Beverages; Coronary-heart-disease; Nutrition Assistance Program; Salt Reduction Policies; Ultra-processed Food; Cardiovascular-disease; Noncommunicable Diseases; Vegetable Purchases; Excise Tax
ISSN (print) / ISBN 2161-8313
e-ISSN 2156-5376
Journal Advances in nutrition
Quellenangaben Volume: 12, Issue: 5, Pages: 1957-1995 Article Number: , Supplement: ,
Publisher American Society for Nutrition
Publishing Place Great Clarendon St, Oxford Ox2 6dp, England
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Health Economics and Health Care Management (IGM)
Grants Poland, The National Centre for Research and Development (NCBR)
Norway, The Research Council of Norway (RCN)
New Zealand, The University of Auckland, School of Population Health
Netherlands, The Netherlands Organisation for Health Research and Development (ZonMw)
Italy, Ministry of Education, University and Research (MIUR)
Ireland, Health Research Board (HRB)
Germany, Federal Ministry of Education and Research (BMBF)
France, Institut National de la Recherche Agronomique (INRA)
Joint Programming Initiative "A Healthy Diet for a Healthy Life" (JPI HDHL)