Economic benefits of the Mediterranean-style diet consumption in Canada and the United States

Figures & data

Fig. 1 The study's economic framework utilizing a variation of cost-of-illness analysis of three stages of estimations. Based on data from recent peer-reviewed literature and national databases, the first stage identified the proportions of individuals who are likely to adhere to a MedDiet in Canada and the United States, the second assessed the reported cardiovascular disease reduction rate following a MedDiet consumption, and the third stage imputed the potential reduction in economic costs associated with the estimated CVD incidence reduction. In covering a wide range of predictions, each stage constituted four scenarios of assumptions reflecting best- through worst-case scenarios as follows: ideal, optimistic, pessimistic, and very-pessimistic.

Table 1 Summary of the economic costs attributed to CVD in Canada (CAD $million)

Year		2008^a	2014^b
Direct costs	Hospitals	5,068.0	5,422.8
	Drugs	4,272.7	4,571.8
	Physicians	2,352.0	2,516.7
	Other directs^c	134.1	143.5
	Total direct	11,826.8	12,654.7
Indirect costs	Mortality	92.4	98.9
	Morbidity	269.6	288.5
	Total indirect	362.0	387.3
Total CVD costs		12,188.8	13,042.1

^aFrom the Economic Burden of Illness in Canada (EBIC) 2005–2008 report (42). ^bCurrent dollars based on adjustments according to Statistics Canada's Health Care Consumer Price Index. ^cComprises costs for ‘Other Professionals’ (chiropractors, physiotherapists, private duty nurses, etc.) and ‘Other Health Spending’ (home care, medical transportation, etc.) by the National Health Expenditure Trends (NHEX) 1975–2013 report (43), where the total ‘Other Direct’ costs for all diseases in 2008 equaled CAD $53,022.1 million. Percentage of CVD relative to total ‘Other Direct’ costs within the EBIC 1998 report (46) of 0.3% was used to estimate our 2008's ‘Other directs’ monetary figure of CAD $134.1 million.

Table 2 Summary of the cost reductions corresponding to 1.0% reduction in incidence of CVD within Canada and the United States

	Cost reduction (%)
	Canada		United States
Direct reduction	Hospitals	0.16	Hospital, inpatient^b	0.16
	Drugs	1.00	Hospital, emergency^c	0.16
	Physicians	1.00	Hospital, outpatient^d	0.16
	Other directs^a	0.19	Home healthcare	1.00
			Prescribed medicines	1.00
Indirect reduction	Mortality	1.00	Lost productivity/mortality	1.00
	Morbidity	1.00

All hospital figures are based on the estimation that 16% of hospitalization costs are variable (i.e. medications and supplies) and 84% are fixed (i.e. salaries, buildings, and equipments) (47). ^aBased on estimations of services by the National Health Expenditure Trends (NHEX) 1975–2013 ‘Other’ (5.4%), within the ‘Other Professionals’ category and ‘Other’ (13.8%) within the ‘Other Health Spending’ category (43). ^bRefers to room and board, and all diagnostic and laboratory costs. ^cRefers to diagnostic and laboratory costs. ^dIncludes office-based provider visits, laboratory costs, and visits to medical providers. The US categories are from Go et al. (44).

Table 3 Summary of the economic costs attributed to CVD in the United States (US $billion)

Year		2010^a	2014^b
Direct costs	Hospital, inpatient^c	98.0	107.3
	Hospital, emergency^d	8.7	9.6
	Hospital, outpatient^e	42.2	46.4
	Home healthcare	11.7	12.9
	Prescribed medicines	32.8	36.1
	Total direct	193.4	212.7
Indirect costs	Lost productivity/mortality	122.0	134.2
Total CVD costs		315.4	346.9

^aAdapted from Go et al. (44, Table 24-1). ^bCurrent dollars based on monetary adjustments according to the healthcare category of the US Department of Labor's Health Care Consumer Price Index. ^cRefers to room and board, and all diagnostic and laboratory costs. ^dRefers to diagnostic and laboratory costs. ^eIncludes office-based provider visits, laboratory costs, and visits to medical providers.

Table 4 Summary of the sensitivity analysis (%)

	Scenario
	Ideal	Optimistic	Pessimistic	Very pessimistic
Adoption rate	50.0	25.0	15.0	5.0
CVD incidence reduction	60.0	30.0	20.0	10.0

CVD, cardiovascular disease.

Table 5 Potential cost savings attributed to the reduction in CVD with varying adoption rates of MedDiet in Canada (CAD $million)

	Scenario^a
	Ideal	Optimistic	Pessimistic	Very pessimistic
Direct savings
Hospitals	260.3	65.1	26.0	4.3
Medications	1,371.5	342.9	137.2	22.9
Physicians	755.0	188.7	75.5	12.6
Other directs	8.3	2.1	0.8	0.1
Total direct	2,395.1	598.8	239.5	39.9
Indirect savings
Mortality	29.7	7.4	3.0	0.5
Morbidity	86.5	21.6	8.7	1.4
Total indirect	116.2	29.1	11.6	1.9
Total savings	2,511.3	627.8	251.1	41.9

^aThe ideal scenario represents a best-case estimate of potential economic cost savings when 50% of the population follows a MedDiet and shows 60% reduction in cardiovascular disease (CVD). The optimistic scenario is a medium- to short-term pragmatic estimate of potential cost savings when 25% of the population adopts a MedDiet and experiences 30% reduction in CVD. The pessimistic scenario is a practical short- to medium-term estimate of cost savings that could follow a MedDiet adherence among 15% of the population with 20% reduction in CVD. The very-pessimistic scenario represents a worst-case estimate with only 5% of the population making the dietary change and showing 10% reduction in CVD.

Table 6 Potential cost savings attributed to the reduction in CVD with varying adoption rates of MedDiet in the United States (US $ billion)

	Scenario^a
	Ideal	Optimistic	Pessimistic	Very pessimistic
Direct savings
Hospital, inpatient	5.2	1.3	0.5	0.1
Hospital, emergency	0.5	0.1	0.0	0.0
Hospital, outpatient	2.2	0.6	0.2	0.0
Home healthcare	3.9	1.0	0.4	0.1
Prescribed medicines	10.8	2.7	1.1	0.2
Total direct	22.5	5.6	2.3	0.4
Indirect savings
Lost productivity/mortality	40.3	10.1	4.0	0.7
Total savings	62.8	15.7	6.3	1.0

^aThe ideal scenario represents a best-case estimate of potential economic cost savings when 50% of the population follows a MedDiet and shows 60% reduction in cardiovascular disease (CVD). The optimistic scenario is a medium- to short-term pragmatic estimate of potential cost savings when 25% of the population adopts a MedDiet and experiences 30% reduction in CVD. The pessimistic scenario is a practical short- to medium-term estimate of cost savings that could follow a MedDiet adherence among 15% of the population with 20% reduction in CVD. The very-pessimistic scenario represents a worst-case estimate with only 5% of the population making the dietary change and showing 10% reduction in CVD.

Public Health Agency of Canada. Economic burden of illness in Canada, 2005–2008. 2014; Ottawa, ON: Public Health Agency of Canada.

 Google Scholar

Canadian Institute for Health Information. National Health Expenditure Trends, 1975 to 2013. 2013; Ottawa, ON: Canadian Institute for Health Information.

 Google Scholar

Public Health Agency of Canada. Economic burden of illness in Canada, 1998. 1998; Ottawa, ON: Public Health Agency of Canada.

 Google Scholar

Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, etal. Distribution of variable vs fixed costs of hospital care. JAMA. 1999; 281: 644–9. [PubMed Abstract].

 Google Scholar

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, etal. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014; 129: e28–e292. [PubMed Abstract].

 Google Scholar