Addressing the low consumption of fruit and vegetables in England: a cost-effectiveness analysis of public policies

Background Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F&V) in England, but economic analyses of structural policies to change diet are sparse. Methods Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL) and the healthcare costs attributable to consumption of F&V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies: a universal 10% subsidy on F&V, a targeted 30% subsidy for low-income households and a social marketing campaign (SMC). Findings Consumption of F&V below the recommended five portions a day accounted for 16 321 [10 091-23 516] deaths and 238 767 [170 350-311 651] YLL in England in 2017, alongside 705 pound 951 [398 761-1 061 559] million in healthcare costs. All policies would increase consumption and reduce the disease burden attributable to low intake of F&V. From a societal perspective, the incremental cost-effectiveness ratios were 22 pound 891 [22 300-25 079], 16 pound 860 [15 589-19 763] and 25 pound 683 [25 237-28 671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of 20 pound 000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy would additionally reduce inequalities. Conclusions Low intake of F&V represents a heavy health and care burden in England. All dietary policies can improve consumption of F&V, but only a targeted subsidy to low-income households would most likely be cost-effective.

Automated summary

Most adults in England do not consume the recommended five portions of fruit and vegetables per day, leading to a significant number of deaths and healthcare costs. Subsidizing fruit and vegetable consumption through various policies can increase intake and reduce disease burden, with targeted subsidies for low-income households being the most likely cost-effective option.