Whole Grain Intakes Are Associated with Healthcare Cost Savings Following Reductions in Risk of Colorectal Cancer and Total Cancer Mortality in Australia: A Cost-of-Illness Model

Abstract

Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total cancer mortality associated with specific whole grain intake from meta-analysis studies; and (3) estimates of annual healthcare costs of CRC and all cancers from disease expenditure national databases. A very pessimistic (5% of population) through to universal (100% of population) adoption of the recommended DTI in Australia were shown to potentially yield savings in annual healthcare costs equal to AUD 1.9 (95% CI 1.2–2.4) to AUD 37.2 (95% CI 24.1–48.1) million for CRC and AUD 20.3 (95% CI 12.2–27.0) to AUD 405.1 (95% CI 243.1–540.1) million for total cancers. As treatment costs for CRC and other cancers are increasing, and dietary measures exchanging whole grains for refined grains are not cost preclusive nor does the approach increase energy intake, there is an opportunity to facilitate cost-savings along with reductions in disease for Australia. These results suggest specific benefits of encouraging Australians to swap refined grains for whole grains, with greater overall adherence to suggestions in dietary guidelines.

Whole Grain Consumption and Inflammatory Markers: A Systematic Literature Review of Randomized Control Trials

“…On a population level, swapping from refined grains to whole grains has the possibility of reducing the risk of chronic disease, in turn lowering the costs related to the burden of disease. A recent nutrition economics analysis found that a swap to whole grain from refined grain foods could provide significant healthcare cost savings for cardiovascular disease, type 2 diabetes, and cancer, particularly colorectal cancer, for the Australian population [60,61].…”

Legume Intake Is Associated with Potential Savings in Coronary Heart Disease-Related Health Care Costs in Australia

“…A three-step cost-of-illness analysis was developed on the basis of (1) estimates of current per capita [ 8 ] and a targeted level of legumes intake [ 6 ] among Australian adults (age 25+ y), (2) estimates of percent reductions in relative risk (95% CI) of CHD following legumes intake [ 14 ], and (3) recent data on annual costs related to CHD management within the Australian health care system [ 15 ]. To assess the uncertainty factor, a sensitivity analysis of four scenarios (very pessimistic, pessimistic, optimistic, and universal) was conducted, as modelled previously [ 12 , 13 ]. Input parameters are summarized in Table 1 .…”

“…Based on the 2019 Global Burden of Disease data [ 8 ], in the first step of this analysis, the current estimated per capita legumes intake of 19.3 g/day for adults (age 25+ y) was compared to a targeted level of 50 g/day [ 6 ] and a calculation was built on estimates of proportions of Australian adults (age 25+ y) who are likely to increase their legumes intake by the gap amount of 30.7 g daily. As previously [ 12 , 13 ], here, the sensitivity analysis assumed very pessimistic, pessimistic, optimistic, and universal scenarios to represent 5%, 15%, 50%, and 100% (all) of prospective consumers who would reach the targeted daily level of legumes intake in the short term, short-to-medium-term, medium-to-long-term, and long-term, respectively.…”

“…The third and final step of the analysis calculated the annual savings in CHD-related costs within the Australian health care system that would potentially follow the targeted level of legumes intake (Step 1) and the estimated reduction in CHD risk (Step 2). As previously described [ 12 , 13 ], the most recent estimates of direct health expenditure (the year 2018–2019) reported by the Australian Institute of Health and Welfare (AIHW) [ 15 ] were first inflated to the year 2022 equivalent levels, based on adjustment of rates according to the Australian Bureau of Statistics (ABS) Consumer Price Index (Health group) [ 22 ] ( Table 2 ), and then utilized within arithmetic calculations where components of the cost categories were examined individually for assessment of savings, with 1% reduction in costs assumed to correspond to each 1% decrease in CHD risk. Additionally, as previously outlined [ 12 , 13 ], using the net present value equation, a 7% real discount rate was applied to the sum of savings in present day costs related to CHD management to assess the discounted value of different scenarios of legumes intake over a 20-year time frame at five-year increments after the year 2022 (year 0).…”

“…The economic benefits of pulses intake have been examined in Canada, but rather than 50 g/day, 100 g was modeled to suggest possible annual savings equal to Can$38–370 million in health care and related costs of type 2 diabetes- and cardiovascular disease combined [ 11 ]. Our previous nutrition economics research has assessed whole grains [ 12 , 13 ], but the combination with legumes is an important consideration, providing a complement of amino acids, which is important in plant-based and flexitarian dietary patterns. However, limiting the potential of legumes as a replacement for meat is also debated.…”