Cost-Effectiveness of FDA Added Sugar Labeling Policy

Study Questions:

What are the potential health impacts and cost-effectiveness of implementing the added sugar label in the United States?


The investigators used a validated microsimulation model (US IMPACT Food Policy model) to estimate cardiovascular disease and type 2 diabetes mellitus cases averted, quality-adjusted life-years (QALYs), policy costs, healthcare, informal care, and lost productivity (health-related) savings and cost-effectiveness of two policy scenarios: 1) implementation of the US Food and Drug Administration (FDA) added sugar labeling policy (sugar label), and 2) further accounting for corresponding industry reformulation (sugar label + reformulation). The model used nationally representative demographic and dietary intake data from the National Health and Nutrition Examination Survey, disease data from the Centers for Disease Control and Prevention Wonder Database, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Probabilistic sensitivity analysis accounted for model parameter uncertainties and population heterogeneity.


Between 2018 and 2037, the sugar label would prevent 354,400 cardiovascular disease (95% uncertainty interval, 167,000–673,500) and 599,300 (302,400–957,400) diabetes mellitus cases, gain 727,000 (401,300–1,138,000) QALYs, and save $31 billion (15.7–54.5) in net healthcare costs or $61.9 billion (33.1–103.3) societal costs (incorporating reduced lost productivity and informal care costs). For the sugar label + reformulation scenario, corresponding gains were 708,800 (369,200–1,252,000) cardiovascular disease cases, 1.2 million (0.7–1.7) diabetes mellitus cases, 1.3 million (0.8–1.9) QALYs, and $57.6 billion (31.9–92.4) and $113.2 billion (67.3–175.2), respectively. Both scenarios were estimated with >80% probability to be cost saving by 2023.


The authors concluded that implementing the US FDA added sugar labeling policy could generate substantial health gains and cost savings for the US population.


This microsimulation study suggests that implementing the FDA added sugar labeling policy would generate substantial health gains and produce net cost savings for both the healthcare system and society. Over two decades, the model suggests that the effects of the added sugar label on consumer behaviors could gain >700,000 QALYs, whereas modest effects on industry reformulation could gain a total of 1.3 million QALYs. Thus, cost savings would be twice as large when accounting for potential modest industry reformulation, underscoring industry’s critical role in maximizing the health and economic benefits of the FDA policy. Overall, these findings highlight the need for timely and rapid implementation of the added sugar labeling to maximize health and economic gains, particularly since the compliance date for updating the Nutrition Facts label, including the added sugar provision, has been continuously delayed.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet

Keywords: Cost Savings, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Diet, Food Labeling, Health Care Costs, Metabolic Syndrome X, Nutrition Policy, Patient Care, Primary Prevention, Quality-Adjusted Life Years, Sugar Phosphates, United States Food and Drug Administration

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