Population Health Impact and Cost-Effectiveness of Community-Supported Agriculture Among Low-Income US Adults: A Microsimulation Analysis

Am J Public Health. 2020 Jan;110(1):119-126. doi: 10.2105/AJPH.2019.305364. Epub 2019 Nov 14.

Abstract

Objectives. To estimate the population-level effectiveness and cost-effectiveness of a subsidized community-supported agriculture (CSA) intervention in the United States.Methods. In 2019, we developed a microsimulation model from nationally representative demographic, biomedical, and dietary data (National Health and Nutrition Examination Survey, 2013-2016) and a community-based randomized trial (conducted in Massachusetts from 2017 to 2018). We modeled 2 interventions: unconditional cash transfer ($300/year) and subsidized CSA ($300/year subsidy).Results. The total discounted disability-adjusted life years (DALYs) accumulated over the life course to cardiovascular disease and diabetes complications would be reduced from 24 797 per 10 000 people (95% confidence interval [CI] = 24 584, 25 001) at baseline to 23 463 per 10 000 (95% CI = 23 241, 23 666) under the cash intervention and 22 304 per 10 000 (95% CI = 22 084, 22 510) under the CSA intervention. From a societal perspective and over a life-course time horizon, the interventions had negative incremental cost-effectiveness ratios, implying cost savings to society of -$191 100 per DALY averted (95% CI = -$191 767, -$188 919) for the cash intervention and -$93 182 per DALY averted (95% CI = -$93 707, -$92 503) for the CSA intervention.Conclusions. Both the cash transfer and subsidized CSA may be important public health interventions for low-income persons in the United States.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Agriculture / economics
  • Agriculture / organization & administration*
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / prevention & control
  • Community Participation / economics
  • Community Participation / methods*
  • Cost-Benefit Analysis
  • Diabetes Complications / economics
  • Diabetes Complications / prevention & control
  • Diet
  • Female
  • Food Supply / economics
  • Food Supply / methods*
  • Health Status*
  • Humans
  • Male
  • Middle Aged
  • Models, Economic
  • Nutrition Surveys
  • Poverty*
  • Public Assistance / economics
  • Public Assistance / statistics & numerical data*
  • Social Environment
  • Socioeconomic Factors