Background:High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative proposed government-supported voluntary national sugar reduction targets. This intervention’s potential effects and cost-effectiveness are unclear.Methods:A validated microsimulation model, CVD-PREDICT (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends), coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs, and cost-effectiveness of the US National Salt and Sugar Reduction Initiative policy. The model was run at the individual level, incorporating the annual probability of each person’s transition between health statuses on the basis of risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011 through 2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from health care and societal perspectives. Uncertainty was evaluated in a 1-way analysis by assuming 50% industry compliance and probabilistic sensitivity analyses through a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal health care cost savings, stratified by age, race, income, and education.Results:Achieving the US National Salt and Sugar Reduction Initiative sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150 000/QALYs) at 6 years, highly cost-effective (<50 000/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a health care perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black or Hispanic individuals, lower income, and less educated Americans.Conclusions:Implementing and achieving the US National Salt and Sugar Reduction Initiative sugar reformation targets could generate substantial health gains, equity gains, and cost savings.

中文翻译：

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在美国实现国家减盐减糖倡议自愿减糖目标的健康影响和成本效益：微观模拟研究


背景：大量摄入添加糖与体重增加和心脏代谢风险有关。 2018年，美国国家减盐减糖倡议提出了政府支持的自愿国家减糖目标。这种干预措施的潜在效果和成本效益尚不清楚。方法：使用经过验证的微观模拟模型 CVD-PREDICT（心血管疾病风险、事件、检测、干预、成本和趋势的政策模型），用 C++ 编码，用于估计增量美国国家减盐减糖倡议政策在 2 型糖尿病、心血管疾病 (CVD)、质量调整生命年 (QALY)、成本和成本效益方面的变化。该模型在个人层面上运行，根据风险因素纳入每个人健康状态之间转变的年度概率。该模型纳入了 3 个周期（2011 年至 2016 年）国家健康和营养检查调查的国家人口和饮食数据，通过荟萃分析添加了与糖相关的疾病，以及来自既定来源的政策成本和健康相关成本。创建了具有全国代表性的模拟美国人口，并对其进行跟踪直至 100 岁或死亡，并以 2019 年为干预开始年。从医疗保健和社会角度对十年和一生的研究结果进行了评估。通过假设 50% 的行业合规性，通过单向分析评估不确定性，并通过二阶蒙特卡罗方法进行概率敏感性分析。模型输出包括避免的糖尿病病例、CVD 事件和 CVD 死亡、获得的 QALY 以及按年龄、种族、收入和教育程度分层的正式医疗保健成本节省。结果：实现美国国家减盐减糖倡议的减糖目标可预防 248 万例 CVD 事件、49 万例 CVD 死亡和 75 万例糖尿病病例；获得 667 万 QALY；从社会角度来看，一生可节省 1608.8 亿美元的净成本。该政策在 6 年时变得具有成本效益（<150 000/QALY），在 7 年时变得具有高成本效益（<50 000/QALY），并在 9 年时节省成本。从医疗保健的角度来看，结果是稳健的，行业合规性较低（50%），并且在概率敏感性分析中。该政策还可以减少差距，估计每百万成年人的健康收益最大的是黑人或西班牙裔、收入较低和受教育程度较低的美国人。结论：实施和实现美国国家减盐和减糖倡议糖改革目标可以带来可观的健康收益、股权收益和成本节约。