Journal Article

Population Health Impact and Cost-Effectiveness of Community-Supported Agriculture Among Low-Income US Adults: A Microsimulation Analysis

Bellin, Rochelle, Petrie, Maegan, O’Neill, Jessica, Berkowitz, Seth A., Basu, Sanjay, Sayer, Edward

2020

Overview

Objectives. To estimate the population-level effectiveness and cost-effectiveness of a subsidized community-supported agriculture (CSA) intervention in the United States. Methods. In 2019, we developed a microsimulation model from nationally representative demographic, biomedical, and dietary data (National Health and Nutrition Examination Survey, 2013–2016) and a community-based randomized trial (conducted in Massachusetts from 2017 to 2018). We modeled 2 interventions: unconditional cash transfer ( $300/year) and subsidized CSA ($ 300/year subsidy). Results. The total discounted disability-adjusted life years (DALYs) accumulated over the life course to cardiovascular disease and diabetes complications would be reduced from 24 797 per 10 000 people (95% confidence interval [CI] = 24 584, 25 001) at baseline to 23 463 per 10 000 (95% CI = 23 241, 23 666) under the cash intervention and 22 304 per 10 000 (95% CI = 22 084, 22 510) under the CSA intervention. From a societal perspective and over a life-course time horizon, the interventions had negative incremental cost-effectiveness ratios, implying cost savings to society of – $191 100 per DALY averted (95% CI = –$ 191 767, – $188 919) for the cash intervention and –$ 93 182 per DALY averted (95% CI = – $93 707, –$ 92 503) for the CSA intervention. Conclusions. Both the cash transfer and subsidized CSA may be important public health interventions for low-income persons in the United States.

• Publisher: American Public Health Association
• Subject: Adult / Adults / Aged / Agricultural economics / Agriculture / Agriculture - economics / Agriculture - organization & administration / AJPH Open-Themed Research / Atherosclerosis / Biomedicine / Body mass index / Cardiovascular Disease / Cardiovascular diseases / Cardiovascular Diseases - economics / Cardiovascular Diseases - prevention & control / Community / Community Participation - economics / Community Participation - methods / Community supported agriculture / Computer simulation / Confidence intervals / Consumption / Cost analysis / Cost control / Cost-Benefit Analysis / Costs / Demographics / Diabetes / Diabetes Complications - economics / Diabetes Complications - prevention & control / Diet / Disability adjusted life years / Effectiveness / Ethnicity / Female / Food Supply - economics / Food Supply - methods / Health care / Health care expenditures / Health education / Health promotion / Health Status / Heart attacks / Hispanic Americans / Humans / Intervention / Life course / Life events / Low income areas / Low income groups / Male / Medicaid / Metabolic disorders / Middle Aged / Models, Economic / Monetary incentives / Mortality / Nutrition / Nutrition research / Nutrition Surveys / Nutrition/Food / Parameter estimation / Population / Poverty / Prevention / Public Assistance - economics / Public Assistance - statistics & numerical data / Public health / Quality / Risk perception / Sensitivity analysis / Simulation / Social Environment / Socioeconomic Factors / Socioeconomic status / Subsidies / Supplemental Nutrition Assistance Program / Vegetables