Cost-Effectiveness Analysis of Adherence to Nutrition Recommendations: 2015 Health Survey of Sao Paulo

Abstract

ObjectivesTo evaluate costs and effectiveness of diets of adult individuals in the city of Sao Paulo, Brazil, in relation to the adherence to nutritional recommendations, estimating incremental cost-effectiveness ratio of diets according to nutritional quality. MethodsObservational study based on cross-sectional individual level data representative at population level in Sao Paulo, Brazil. Information on 24-hour recall of 1,188 adult individuals interviewed in the Health Survey of Sao Paulo (ISA-Capital), conducted in 2015 were assessed based on two nutritional recommendations: (1) Revised Brazilian Healthy Eating Index (BHEI-R) (0–100 points from worst to best diet quality), and (2) World Health Organization key dietary points (>400g of fruits, vegetables, and legumes/day; <5% of total energy intake from sugars; <10% of total energy intake from saturated fats; <2000 mg of sodium/day). The incremental cost-effectiveness ratio (ICER) was estimated by dividing the differences between direct costs attributable to different alternatives of diet quality by the differences between health outcomes (BHEI-R or WHO recommendation scores). ResultsThe highest diet costs were observed among female, individuals with higher income, higher social class (A) and white skin color. On the one hand, individuals who buy foods mostly in grocery stores and specialized fresh fruits and vegetables stores, and individuals with better diet quality, presented higher diet costs. On the other hand, individuals who buy food at open air fairs had lower dietary costs, and higher frequency of purchases at open air fairs resulted in lower dietary costs. There was higher adherence to nutritional recommendations represented by the BHEI-R (between 1st and 5th quintile/nptrend: P < 0.001). Adherence to the WHO recommendations represented a saving of R$ 0.26 per quality point/day in comparison with individuals with no adherence. ConclusionsThere were higher costs for diets with greater adherence to dietary recommendations, according to the analysis of dietary patterns in Sao Paulo, Brazil. However, higher adherence to WHO recommendations represented lower dietary costs, an important finding that may be important input for public policies on food and nutrition in Brazil. Funding SourcesCAPES; FAPESP; Sao Paulo Municipal Health Department; CNPq.