Abstract
Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total cancer mortality associated with specific whole grain intake from meta-analysis studies; and (3) estimates of annual healthcare costs of CRC and all cancers from disease expenditure national databases. A very pessimistic (5% of population) through to universal (100% of population) adoption of the recommended DTI in Australia were shown to potentially yield savings in annual healthcare costs equal to AUD 1.9 (95% CI 1.2–2.4) to AUD 37.2 (95% CI 24.1–48.1) million for CRC and AUD 20.3 (95% CI 12.2–27.0) to AUD 405.1 (95% CI 243.1–540.1) million for total cancers. As treatment costs for CRC and other cancers are increasing, and dietary measures exchanging whole grains for refined grains are not cost preclusive nor does the approach increase energy intake, there is an opportunity to facilitate cost-savings along with reductions in disease for Australia. These results suggest specific benefits of encouraging Australians to swap refined grains for whole grains, with greater overall adherence to suggestions in dietary guidelines.
Highlights
Cancer care represents a leading burden of disease globally and accounts for 19% of the total disease burden in Australia [1]
In a conceptual framework model of input parameters derived from the relevant medical literature, a national nutrition survey, and a disease expenditure database in Australia, Nutrients 2021, 13, 2982 a three-step cost-of-illness analysis was developed based on: (1) current and targeted whole grain intake among estimates of proportions of the Australian adult population (≥20 years); (2) estimates of percent reductions in relative risk of Colorectal cancer (CRC)
Total cancers mortality associated with whole grain intake; and (3) annual healthcare costs of CRC and all cancers in Australia
Summary
Cancer care represents a leading burden of disease globally and accounts for 19% of the total disease burden in Australia [1]. There is a significant healthcare monetary burden attributable to cancer including the direct and indirect healthcare costs and income losses. Both Australia and New Zealand have CRC rates ahead of other countries [3]. Based on 2015/2016 data, cancer accounted for an estimated AUD. 9.7 billion in diagnosing and treating cancer or just over 8.6% of all direct health expenditure, including AUD 876 million in costs for CRC including AUD 56 million on the National. The mean age of diagnosis for CRC is 69 years, there is an increased risk after the age of 50 years, and more recent data suggests the incidence of an early-onset CRC under 40 years of age has emerged over the last two decades [5]
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