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

Basu, Sanjay MD, PhD
O’Neill, Jessica
Sayer, Edward PsyD
Petrie, Maegan BA
Bellin, Rochelle BA
Berkowitz, Seth A MD, MPH

Sanjay Basu is with Research and Analytics, Collective Health, San Francisco, CA, and the Center for Primary Care, Harvard Medical School, Boston, MA. Jessica O’Neill and Rochelle Bellin are with Just Roots, Greenfield, MA. Edward Sayer and Maegan Petrie are with The Community Health Center of Franklin County, Greenfield. Seth A. Berkowitz is with the Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.

This article was accepted August 20, 2019.

Correspondence should be sent to Seth A. Berkowitz, MD, MPH, 5034 Old Clinic Bldg, CB #7110, Chapel Hill, NC 27599-7110 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

CONTRIBUTORS

S. Basu and S. A. Berkowitz originated the study, conducted analyses, and drafted the article. J. O’Neill, E. Sayer, M. Petrie, and R. Bellin made substantial contributions to the acquisition and interpretation of the data and revised the article critically for intellectual content. All authors give approval to the final version to be published.

Peer Reviewed

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.