Economic modeling for improved prediction of saving estimates in healthcare costs from consumption of healthy foods: the Mediterranean-style diet case study

  • Jason P. H. Jones
  • Mohammad M. H. Abdullah
  • Dallas Wood
  • Peter J. H. Jones
Keywords: nutrition economics, Mediterranean-style diet, economic modeling, Monte Carlo simulation, healthcare cost savings


Background: By design, existing scenario-based nutrition economics studies on the financial benefits of healthy dietary behaviors generally report uncertainty in inputs and wide ranges of outcome estimates.

Objectives: This modeling exercise aimed to establish precision in prediction of the potential healthcare cost savings that would follow a reduction in the incidence of cardiovascular disease (CVD) consistent with an increase in adherence to a Mediterranean-style diet (MedDiet).

Design: Using a Monte Carlo simulation model on a cost-of-illness analysis assessing MedDiet adherence, CVD incidence reduction, and healthcare cost savings in the United States and Canada, short- and long-term cost savings that are likely to accrue to the American and Canadian healthcare systems were estimated using 20 and 80% increases in MedDiet adherence scenarios.

Results: Increasing percentage of population adhering to a MedDiet by 20% beyond the current adherence level produced annual savings in CVD-related costs of US$8.2 billion (95% confidence interval [CI], $7.5–$8.8 billion) in the United States and Can$0.32 billion (95% CI, $0.29–$0.34 billion) in Canada. An 80% increase in adherence resulted in savings equal to US$31 billion (95% CI, $28.6–$33.3 billion) and Can$1.2 billion (95% CI, $1.11–$1.30 billion) in each respective country.

Conclusion: Computational techniques with stochastic parameter inputs, such as the Monte Carlo simulation, could be an effective way of incorporating variability of modeling parameters in nutrition economics studies for improved precision in estimating the monetary value of healthy eating habits.


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  1. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al. The global economic burden of noncommunicable diseases. Geneva: World Economic Forum; 2011.

  2. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation 2018; 137(12): e67–e492. doi: 10.1161/CIR.0000000000000573

  3. Public Health Agency of Canada. Economic burden of illness in Canada, 2005–2008. Ottawa, ON: Public Health Agency of Canada; 2014.

  4. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, et al. European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network. 2017. Available from: [cited 4 May 2018].

  5. Gyles CL, Lenoir-Wijnkoop I, Carlberg JG, Senanayake V, Gutierrez-Ibarluzea I, Poley MJ, et al. Health economics and nutrition: a review of published evidence. Nutr Rev 2012; 70(12): 693–708. doi: 10.1111/j.1753-4887.2012.00514.x

  6. Dall TM, Fulgoni VL, 3rd, Zhang Y, Reimers KJ, Packard PT, Astwood JD. Potential health benefits and medical cost savings from calorie, sodium, and saturated fat reductions in the American diet. Am J Health Promot 2009; 23(6): 412–22. doi: 10.4278/ajhp.080930-QUAN-226

  7. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010; 362(7): 590–9. doi: 10.1056/NEJMoa0907355

  8. Gyles CL, Carlberg JG, Gustafson J, Davlut DA, Jones PJ. Economic valuation of the potential health benefits from foods enriched with plant sterols in Canada. Food Nutr Res 2010; 54. doi: 10.3402/fnr.v54i0.5113.

  9. Schmier JK, Miller PE, Levine JA, Perez V, Maki KC, Rains TM, et al. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model. BMC Public Health 2014; 14: 374-2458-14-374. doi: 10.1186/1471-2458-14-374

  10. Abdullah MM, Jones JP, Jones PJ. Economic benefits of the Mediterranean-style diet consumption in Canada and the United States. Food Nutr Res 2015; 59: 27541. doi: 10.3402/fnr.v59.27541

  11. Abdullah MM, Gyles CL, Marinangeli CP, Carlberg JG, Jones PJ. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada. Front Pharmacol 2015; 6: 167. doi: 10.3389/fphar.2015.00167

  12. Abdullah MM, Gyles CL, Marinangeli CP, Carlberg JG, Jones PJ. Dietary fibre intakes and reduction in functional constipation rates among Canadian adults: a cost-of-illness analysis. Food Nutr Res 2015; 59: 28646. doi: 10.3402/fnr.v59.28646.

  13. Abdullah MM, Jew S, Jones PJ. Health benefits and evaluation of healthcare cost savings if oils rich in monounsaturated fatty acids were substituted for conventional dietary oils in the United States. Nutr Rev 2017; 75(3): 163–74. doi: 10.1093/nutrit/nuw062.

  14. Abdullah MMH, Marinangeli CPF, Jones PJH, Carlberg JG. Canadian potential healthcare and societal cost savings from consumption of pulses: a cost-of-illness analysis. Nutrients 2017; 9(7). doi: 10.3390/nu9070793.

  15. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33(13): 1635–701. doi: 10.1093/eurheartj/ehs092.

  16. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63(25 Pt B): 2960–84. doi: 10.1016/j.jacc.2013.11.003.

  17. Liyanage T, Ninomiya T, Wang A, Neal B, Jun M, Wong MG, et al. Effects of the Mediterranean diet on cardiovascular outcomes – a systematic review and meta-analysis. PLoS One 2016; 11(8): e0159252. doi: 10.1371/journal.pone.0159252.

  18. Rosato V, Temple NJ, La Vecchia C, Castellan G, Tavani A, Guercio V. Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr 2019; 58(1): 173–91. doi: 10.1007/s00394-017-1582-0.

  19. Arenas DJ, Lett LA, Klusaritz H, Teitelman AM. A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic. PLoS One 2017; 12(12): e0189718. doi: 10.1371/journal.pone.0189718.

  20. Hammersley JM, Handscomb DC. Monte Carlo methods. London: Methuen; 1964.

  21. Ahmad S, Moorthy MV, Demler OV, Hu FB, Ridker PM, Chasman DI, et al. Assessment of risk factors and biomarkers associated with risk of cardiovascular disease among women consuming a Mediterranean diet. JAMA Netw Open 2018; 1(8): e185708. doi: 10.1001/jamanetworkopen.2018.5708.

  22. Park YM, Zhang J, Steck SE, Fung TT, Hazlett LJ, Han K, et al. Obesity mediates the association between Mediterranean diet consumption and insulin resistance and inflammation in US adults. J Nutr 2017; 147(4): 563–71. doi: 10.3945/jn.116.243543.

  23. Tsivgoulis G, Psaltopoulou T, Wadley VG, Alexandrov AV, Howard G, Unverzagt FW, et al. Adherence to a Mediterranean diet and prediction of incident stroke. Stroke 2015; 46(3): 780–5. doi: 10.1161/STROKEAHA.114.007894.

  24. Zaragoza-Marti A, Cabanero-Martinez MJ, Hurtado-Sanchez JA, Laguna-Perez A, Ferrer-Cascales R. Evaluation of Mediterranean diet adherence scores: a systematic review. BMJ Open 2018; 8(2): e019033-2017-019033. doi: 10.1136/bmjopen-2017-019033.

  25. Scrafford CG, Bi X, Multani JK, Murphy MM, Schmier JK, Barraj LM. Health Economic evaluation modeling shows potential health care cost savings with increased conformance with healthy dietary patterns among adults in the United States. J Acad Nutr Diet 2019; 119(4): 599–616. doi: 10.1016/j.jand.2018.10.002.

  26. Shikany JM, Safford MM, Bryan J, Newby PK, Richman JS, Durant RW, et al. Dietary patterns and Mediterranean diet score and hazard of recurrent coronary heart disease events and all-cause mortality in the REGARDS study. J Am Heart Assoc 2018; 7(14). doi: 10.1161/JAHA.117.008078.

  27. George SM, Ballard-Barbash R, Manson JE, Reedy J, Shikany JM, Subar AF, et al. Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women’s Health Initiative Observational Study: evidence to inform national dietary guidance. Am J Epidemiol 2014; 180(6): 616–25. doi: 10.1093/aje/kwu173.

  28. Gardener H, Wright CB, Gu Y, Demmer RT, Boden-Albala B, Elkind MS, et al. Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study. Am J Clin Nutr 2011; 94(6): 1458–64. doi: 10.3945/ajcn.111.012799.

  29. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 2009; 119(8): 1093–100. doi: 10.1161/CIRCULATIONAHA.108.816736.

  30. Bureau of Labor Statistics. Measuring price change in the CPI: Medical care. United States Department of Labor. Available from: [cited 4 May 2018].

  31. Statistics Canada Health Care Consumer Price Index Available from: [cited 4 May 2018].

  32. Public Health Agency of Canada. Economic burden of illness in Canada, 2010. Ottawa, ON: Public Health Agency of Canada; 2018.

  33. Global nutrition policy review 2016–2017: country progress in creating enabling policy environments for promoting healthy diets and nutrition. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

  34. Lenoir-Wijnkoop I, Dapoigny M, Dubois D, van Ganse E, Gutierrez-Ibarluzea I, Hutton J, et al. Nutrition economics – characterising the economic and health impact of nutrition. Br J Nutr 2011; 105(1): 157–66. doi: 10.1017/S0007114510003041.

  35. Kuczera G, Parent E. Monte Carlo assessment of parameter uncertainty in conceptual catchment models: the Metropolis algorithm. J Hydro 1998; 211(1–4): 69–85.

  36. Lewis A, Bridle S. Cosmological parameters from CMB and other data: a Monte Carlo approach. Phys Rev D 2002; 66(10): 103511. doi: 10.1016/S0022-1694(98)00198-X.

  37. Wintle BA, McCarthy MA, Volinsky CT, Kavanagh RP. The use of Bayesian model averaging to better represent uncertainty in ecological models. Conserv Biol Ser 2003; 17(6): 1579–90. doi: 10.1111/j.1523-1739.2003.00614.x.

  38. Wang ZH, Bou-Zeid E, Au SK, Smith JA. Analyzing the sensitivity of WRF’s single-layer urban canopy model to parameter uncertainty using advanced Monte Carlo simulation. J Appl Meteorol Climatol 2011; 50(9): 1795–814. doi: 10.1175/2011JAMC2685.1.

How to Cite
Jones J. P. H., Abdullah M. M. H., Wood D., & Jones P. J. H. (2019). Economic modeling for improved prediction of saving estimates in healthcare costs from consumption of healthy foods: the Mediterranean-style diet case study. Food & Nutrition Research, 63.
Original Articles