Abstract
The Health Star Rating (HSR) system is a voluntary front-of-pack labelling (FoPL) initiative endorsed by the Australian government in 2014. This study examines the impact of the HSR system on pre-packaged food reformulation measured by changes in energy density between products with and without HSR. The cost-effectiveness of the HSR system was modelled using a proportional multi-state life table Markov model for the 2010 Australian population. We evaluated scenarios in which the HSR system was implemented on a voluntary and mandatory basis (i.e., HSR uptake across 6.7% and 100% of applicable products, respectively). The main outcomes were health-adjusted life years (HALYs), net costs, and incremental cost-effectiveness ratios (ICERs). These were calculated with accompanying 95% uncertainty intervals (95% UI). The model predicted that HSR-attributable reformulation leads to small reductions in mean population energy intake (voluntary: 0.98 kJ/day [95% UI: −1.08 to 2.86]; mandatory: 11.81 kJ/day [95% UI: −11.24 to 36.13]). These are likely to result in reductions in mean body weight (voluntary: 0.01 kg [95% UI: −0.01 to 0.03]; mandatory: 0.11 kg [95% UI: −0.12 to 0.32], and HALYs (voluntary: 4207 HALYs [95% UI: 2438 to 6081]; mandatory: 49,949 HALYs [95% UI: 29,291 to 72,153]). The HSR system evaluated via changes in reformulation could be considered cost-effective relative to a willingness-to-pay threshold of A$50,000 per HALY (voluntary: A$1728 per HALY [95% UI: dominant to 10,445] and mandatory: A$4752 per HALY [95% UI: dominant to 16,236]).
Highlights
Obesity represents a burden to health and the economy by increasing the risk of non-communicable diseases [1], decreasing health-related quality of life [2], increasing healthcare costs, and decreasingNutrients 2018, 10, 614; doi:10.3390/nu10050614 www.mdpi.com/journal/nutrientsNutrients 2018, 10, 614 productivity [3,4,5]
When comparing pre-packaged food products across both years, we found that those with a Health Star Rating (HSR) label led to greater reductions in energy density than food products without a HSR label
We found that the mandatory implementation of the HSR system was cost-effective (A$4752 per health-adjusted life years (HALY), 95% uncertainty intervals (UI): dominant to 16,236)
Summary
Obesity represents a burden to health and the economy by increasing the risk of non-communicable diseases [1], decreasing health-related quality of life [2], increasing healthcare costs, and decreasingNutrients 2018, 10, 614; doi:10.3390/nu10050614 www.mdpi.com/journal/nutrientsNutrients 2018, 10, 614 productivity [3,4,5]. Obesity represents a burden to health and the economy by increasing the risk of non-communicable diseases [1], decreasing health-related quality of life [2], increasing healthcare costs, and decreasing. Recent research has noted the need for initiatives that both improve the energy density of food and help consumers make healthier choices [9,10,11,12]. Front-of-pack labelling (FoPL) is one such initiative that provides consumers with immediate, summary information regarding the nutritional value of a food product at the point of purchase [11,13,14,15,16,17,18]. FoPL involves displaying nutritional information on the front of pre-packaged foods in a clear and uniform manner [17].
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