Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States

Abstract

Aims: Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats.

Materials and methods: A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000–2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS.

Results: Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ∼ $25.7 billion (95% CI = $6.0–$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI = $1.8–$14.0 billion), Medicare saving $9.4 billion (95% CI = $2.1–$16.7 billion), Medicaid saving $1.4 billion (95% CI = $0.2–$2.5 billion), and patients saving $2.2 billion (95% CI = $0.5–$3.8 billion). The annual savings in terms of reduced job absenteeism ranges from a lower bound of $600 million (95% CI = $100 million to $1.0 billion) to an upper bound of $1.2 billion (95% CI = $0.2–$2.1 billion) for 2010.

Limitations: The data cover only the non-institutionalized population. Decreased costs due to any decreases in the severity of heart disease are not included. Cost savings do not include any reduction in informal care at home.

Conclusions: Diets high in saturated fat impose substantial medical care costs and job absenteeism costs, and substantial savings could be achieved by substituting MUFA for saturated fat.

Keywords:

• Diet
• heart disease
• saturated fat
• unsaturated fat
• MUFA
• PUFA
• medical care costs
• absenteeism costs

Notes

Transparency

Declaration of funding

This research was supported by Dow AgroSciences. The study design, conduct and analysis, and manuscript development were conducted by the authors independent of the funding source.

Declaration of financial/other interests

JC, CM, LGG, PKE, and PJHJ report no conflicts of interest. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We thank Steve Walker, Kristie Sigler, Tiffany Howe, Andy Gard, and Lisa Brooks for editorial assistance.

Notes

1 Hourly wage information was not collected for self-employed respondents, so we imputed their wages as well as the wages of those with missing wage information using a standard two part model or 2PM⁴⁴. The first part of the 2PM is a Probit model of employment (including having a job to return to) using the full sample of individuals aged 18–64. The second part of the 2PM is an OLS model of log wages for those with reported wages. We also used Duan et al.’s³⁹ non-parametric smearing factor estimate, adjusted for age-induced heteroscedasticity, to retransform the log wage estimates back to the raw scale of dollars. The regressors in both parts of the 2PM include age, age squared, gender, race, years of education, household composition, Census region, the log of family income per capita excluding the respondent’s wage income, and the spouse’s wage (if applicable). From the 2PM we calculate E(wage|X) and use this conditional mean function to impute wages for the self-employed and those employed by businesses, but with missing wage information.

2 For example, a pooled analysis of 11 cohort studies¹⁷ failed to detect any reduction in heart disease associated with a substitution of MUFA for SFA, but this is due, at least in part, to: the MUFA studied originated from animal sources rather than plant sources, and trans-fatty acids (TFA) were included with the MUFA. The editorial that accompanied the Jakobsen¹⁷ article stated that, as a result of incomplete controls for confounders in the Jakobsen study, “monounsaturated fatty acids may have acted as a surrogate for other risk factors” (p. 1283).