Estimated health gains and costs of the federal menu calorie labelling policy on reducing the obesity-related cancer burdens in the USA over 10 years and a lifetime (US population=235 162 844)*
| Menu calorie labelling policy | ||||
| 10 Years | Lifetime | |||
| Consumer behaviour Median (2.5% to 97.5%) | Consumer behaviour+industry response Median (2.5% to 97.5%) | Consumer behaviour Median (2.5% to 97.5%) | Consumer behaviour+ industry response Median (2.5% to 97.5%) | |
| New cancer cases averted, N (95% UI) | ||||
| Endometrial cancer | 692 (276 to 1100) | 1130 (716 to 1550) | 5700 (2380 to 9190) | 9920 (6630 to 13 600) |
| Liver cancer | 366 (144 to 615) | 626 (386 to 887) | 5180 (2800 to 7730) | 8550 (5960 to 11 300) |
| Kidney cancer | 584 (290 to 884) | 980 (689 to 1280) | 5090 (2670 to 7470) | 8620 (6200 to 11 000) |
| Breast cancer (postmenopausal) | 670 (256 to 1110) | 1080 (658 to 1520) | 4840 (2010 to 8230) | 8520 (5610 to 12 200) |
| Pancreatic cancer | 170 (83 to 257) | 273 (183 to 367) | 1400 (756 to 2100) | 2380 (1690 to 3140) |
| Oesophageal adenocarcinoma | 179 (56 to 304) | 286 (159 to 411) | 1350 (485 to 2230) | 2330 (1440 to 3280) |
| Colorectal cancer | 189 (97 to 284) | 319 (225 to 418) | 1050 (561 to 1600) | 1780 (1230 to 2370) |
| Multiple myeloma | 75 (37 to 117) | 122 (81 to 169) | 690 (384 to 1090) | 1150 (775 to 1630) |
| Stomach cancer (cardia) | 54 (6 to 109) | 98 (51 to 165) | 647 (261 to 1140) | 1090 (644 to 1660) |
| Thyroid cancer | 105 (58 to 161) | 176 (123 to 243) | 516 (206 to 914) | 951 (576 to 1420) |
| Advanced prostate cancer | 66 (17 to 118) | 107 (57 to 162) | 339 (138 to 561) | 577 (352 to 836) |
| Gallbladder cancer | 29 (16 to 42) | 46 (34 to 60) | 314 (213 to 438) | 512 (399 to 648) |
| Ovarian cancer | 33 (15 to 56) | 53 (33 to 78) | 147 (44 to 282) | 254 (110 to 420) |
| Total | 3300 (1750 to 4720) | 5230 (3870 to 6790) | 28 000 (16 300 to 39 100) | 47 300 (35 400 to 59 100) |
| Cancer deaths prevented, N (95% UI) | ||||
| Liver cancer | 168 (59 to 287) | 287 (174 to 410) | 4530 (2410 to 6760) | 7510 (5200 to 9980) |
| Breast cancer (postmenopausal) | 68 (33 to 106) | 111 (74 to 149) | 3080 (862 to 5650) | 5590 (3230 to 8310) |
| Endometrial cancer | 52 (20 to 86) | 87 (55 to 121) | 2060 (957 to 3220) | 3520 (2390 to 4700) |
| Kidney cancer | 70 (29 to 110) | 114 (74 to 154) | 1980 (1080 to 2920) | 3320 (2430 to 4300) |
| Pancreatic cancer | 88 (38 to 138) | 143 (93 to 195) | 1230 (661 to 1830) | 2080 (1480 to 2740) |
| Oesophageal adenocarcinoma | 76 (21 to 131) | 122 (69 to 178) | 1150 (403 to 1930) | 1990 (1210 to 2820) |
| Colorectal cancer | 34 (17 to 53) | 57 (40 to 77) | 706 (369 to 1080) | 1200 (839 to 1600) |
| Stomach cancer (cardia) | 22 (2 to 48) | 40 (19 to 68) | 541 (230 to 947) | 907 (538 to 1400) |
| Multiple myeloma | 18 (8 to 30) | 29 (18 to 42) | 420 (239 to 662) | 691 (481 to 980) |
| Gallbladder cancer | 13 (7 to 20) | 21 (15 to 28) | 267 (181 to 369) | 436 (341 to 551) |
| Advanced prostate cancer | 9 (3 to 15) | 13 (7 to 19) | 163 (65 to 280) | 273 (163 to 404) |
| Ovarian cancer | 8 (3 to 15) | 13 (7 to 20) | 107 (39 to 191) | 181 (94 to 290) |
| Thyroid cancer | 1 (1 to 2) | 2 (1 to 3) | 23 (11 to 38) | 38 (24 to 58) |
| Total | 654 (320 to 970) | 1080 (746 to 1400) | 16 700 (9610 to 23 600) | 28 200 (21 100 to 35 300) |
| Life-years gained | 678 (288 to 1040) | 1120 (738 to 1490) | 76 400 (43 400 to 109 000) | 130 000 (96 900 to 162 000) |
| QALYs gained | 4280 (2170 to 6250) | 7030 (4960 to 9090) | 1 11 000 (64 800 to 158 000) | 189 000 (140 000 to 236 000) |
| Changes in health-related costs (US$, millions)ठ| ||||
| Healthcare (medical) cost | −192 (−277 to −100) | −319 (−403 to −227) | −1480 (−2080 to −884) | −2500 (−3090 to −1900) |
| Patient time cost | −7.33 (−10.9 to −3.56) | −12.2 (−15.8 to −8.39) | −102 (−144 to −62.2) | −172 (−216 to −131) |
| Productivity loss | −48.7 (−70.1 to −24.5) | −80.4 (−102 to −56.7) | −608 (−865 to −363) | −1030 (−1290 to −780) |
| Policy implementation costs (US$, millions)ठ| ||||
| Total | 518 (493 to 548) | 644 (612 to 680) | 839 (780 to 908) | 1140 (1060 to 1220) |
| Government cost | 13.2 (11.4 to 15.9) | 13.1 (11.4 to 15.7) | 18.5 (14.5 to 25.1) | 18.5 (14.4 to 25.5) |
| Administration | 9.08 (8.59 to 9.60) | 9.07 (8.64 to 9.50) | 9.07 (8.61 to 9.56) | 9.09 (8.62 to 9.55) |
| Monitoring | 4.09 (2.40 to 6.74) | 4.00 (2.35 to 6.63) | 9.40 (5.45 to 16.1) | 9.38 (5.30 to 16.3) |
| Industry cost | 505 (480 to 535) | 631 (599 to 667) | 820 (762 to 889) | 1120 (1040 to 1210) |
| Compliance | 505 (480 to 535) | 506 (480 to 533) | 820 (762 to 889) | 823 (757 to 889) |
| Reformulation | - | 124 (107 to 146) | - | 296 (249 to 353) |
| Net costs (US$, millions)द | ||||
| Societal perspective | 270 (156 to 389) | 233 (119 to 356) | −1350 (−2260 to −486) | −2570 (−3460 to −1650) |
| Healthcare perspective | −179 (−263 to −86.3) | −305 (−390 to−-214) | −1460 (−2060 to −864) | −2480 (−3070 to −1880) |
| ICER (US$/QALY)† | ||||
| Societal perspective | 64 500 (26 100 to 187 000) | 33 600 (13 300 to 72 400) | Dominant | Dominant |
| Healthcare perspective | Dominant | Dominant | Dominant | Dominant |
*Values are the median estimates (95% uncertainty intervals) of each distribution of 1000 simulations.
†ICER threshold was evaluated at US$150 000/QALY. Dominant represents less costly and more effective than the ”no-policy” intervention.
‡Health-related costs were inflated to 2015 US$ using the Personal Healthcare (PHC) Index. Policy intervention costs were inflated to 2015 US dollars using the Consumer Price Index. Negative costs represent savings.
§Costs are medians from 1000 simulations so may not add up to totals.
¶Net costs were calculated as policy costs minus health-related costs from reduced cancer burden. The societal perspective includes healthcare costs, patient time costs, productivity costs and policy implementation costs; the healthcare perspective included policy costs relevant to policy implementation and programme monitoring and evaluation and medical costs.
ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-years; UI, uncertainty interval.