Abstract
Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.
Highlights
Cardiovascular disease (CVD) is a significant health burden globally and while the age-standardized prevalence of CVD has declined in the US and other high-income countries over the last decades, it remains a leading cause of morbidity and mortality [1]
A spreadsheet model was developed to quantify potential reductions in healthcare costs using inputs derived from (1) relative risk (RR) estimates from meta-analyses quantifying the association between whole grains consumption and cardiovascular health outcomes (incidence and incidence or mortality of CVD, and coronary heart disease (CHD)); (2) estimates of total grains and whole grains consumption among US adults; and (3) published data on annual direct medical and indirect costs associated with CVD and risk factors
Lower cost savings were estimated in models assuming smaller increases in whole grains consumption, with increased intake of 0.25 oz-eq/day estimated to save US$2.4B annually (US$0.6B to US$4.3B) from reduced risk of CVD
Summary
Cardiovascular disease (CVD) is a significant health burden globally and while the age-standardized prevalence of CVD has declined in the US and other high-income countries over the last decades, it remains a leading cause of morbidity and mortality [1]. In 2016, prevalence of CVD, excluding hypertension, in the US population 20 years and older was 9.0%, representing 24.3 million adults; including hypertension, prevalence of CVD increases to 121.5 million adults [2]. The economic burden associated with CVD is sizeable and medical costs alone are expected to exceed US$750 billion by 2035 [2]. Epidemiological and clinical evidence provide support for the importance of diet in maintaining health and reducing risk for chronic disease. Consumption of whole grains is associated with several health benefits, including reduced risk for CVD [3,4]. The 2015–2020 Dietary Guidelines for Americans (DGA) recommends consumption of at least half of total grains as whole grains [5]
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