Health and economic impact and cost-effectiveness of produce prescriptions for diabetes in 50 U.S. States: A microsimulation study

OBJECTIVE: Produce prescription (PRx) programs have been shown to result in improved dietary quality, diabetes control, and cardiometabolic outcomes. However, their potential health and economic impacts across 50 U.S. states, where Medicaid and commercial plans determine coverage, are unclear. 

RESEARCH DESIGN AND METHODS: Using a validated microsimulation model, we projected the health and economic outcomes of implementing PRx for adults aged 40-79 years with both diabetes and food insecurity in each U.S. state, over 5- and 10-year horizons. The model incorporated state-specific data, pooled intervention effects and costs from 20 PRx programs, diet-disease associations, and payer-specific health care expenditures. Outcomes and costs were discounted at 3% annually. Probabilistic sensitivity analyses accounted for uncertainty. 

RESULTS: An estimated 693,000 adults in California to 7,000 in Wyoming were eligible for PRx. Over 10 years, PRx was projected to avert between 9,240 cardiovascular disease (CVD) events (95% uncertainty interval [UI] 4,710-14,500) in Texas and 94 (95% UI 48-147) in Alaska and gain 9,990 (95% UI 4,810-15,500) to 92.2 (95% UI -30.8 to 159) quality-adjusted life-years (QALYs) across states. From a health care perspective, PRx was projected to be net cost-saving in 43 of 50 states and was cost-effective (incremental cost-effectiveness ratio <$150,000/QALY) in all, with New York having the largest net saving ($345 million) and California the largest net costs ($155 million). By insurance type, PRx was most likely to be cost-saving for Medicare beneficiaries, followed by Medicaid and private payers. Similar patterns were observed over 5 years. 

CONCLUSIONS: PRx for patients with diabetes and food insecurity could substantially improve health and be cost saving or cost-effective in all U.S. states.