A Systematic Review and Theoretical Economic Analysis of the Impacts of Providing Material  Benefits to Improve Food Access in People with Diabetes

Steer, Kieran James Daniel

A Systematic Review and Theoretical Economic Analysis of the Impacts of Providing Material Benefits to Improve Food Access in People with Diabetes

dc.contributor.advisor	Spackman, Eldon
dc.contributor.advisor	Olstad, Dana Lee
dc.contributor.author	Steer, Kieran James Daniel
dc.contributor.committeemember	Beall, Reed Francis
dc.contributor.committeemember	Campbell, David John Thomas
dc.date	2023-11
dc.date.accessioned	2023-07-24T17:46:10Z
dc.date.available	2023-07-24T17:46:10Z
dc.date.issued	2023-07-21
dc.description.abstract	Background: Providing material benefits to increase access to healthy food (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) for people with diabetes may be an effective healthcare intervention to improve food insecurity, dietary patterns, clinical parameters, and ultimately health outcomes. There are several studies that have investigated the impact of providing material benefits to improve food access among people with diabetes. There is also interest in Alberta, Canada in potentially implementing a healthy food prescription incentive for people with type 2 diabetes mellitus (T2DM) and food insecurity, which is being investigated in the “Food Rx” trial (NCT04725630). However, there has not been a systematic review or cost-effectiveness analysis on the impacts of providing material benefits to improve food access among people with diabetes. Thesis studies: a systematic review on the impacts of providing material benefits to improve food access on food insecurity, dietary patterns, and clinical parameters in people with diabetes; and a theoretical economic analysis to determine the minimum A1C improvement required for the Food Rx intervention to be cost-effective from the third-party healthcare payer perspective. Results: The systematic review showed that providing material benefits to improve food access for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality but is less likely to change clinical parameters and whole grain intake. The evidence from randomized controlled trials was limited to only six studies at high risk of bias, most commonly due to unblinded subjective outcomes measurement and high participant attrition. The economic threshold analysis showed that providing a healthy food prescription incentive to people with T2DM and food insecurity was unlikely to be cost-effective at $50,000/QALY, when projecting health outcomes from improvements in A1C and diabetes-related clinical parameters. Conclusion: The evidence of clinical effectiveness from providing material benefits to improve food access among people with T2DM is highly uncertain, and a healthy food prescription incentive for people with T2DM and food insecurity in Alberta has a low likelihood of cost-effectiveness, when measuring outcomes from improvements in diabetes-related clinical parameters
dc.identifier.citation	Steer, K. J. D. (2023). A systematic review and theoretical economic analysis of the impacts of providing material benefits to improve food access in people with diabetes (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.
dc.identifier.uri	https://hdl.handle.net/1880/116792
dc.identifier.uri	https://dx.doi.org/10.11575/PRISM/41634
dc.language.iso	en
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	diabetes
dc.subject	food insecurity
dc.subject	systematic review
dc.subject	economic evaluation
dc.subject.classification	Public Health
dc.subject.classification	Economics
dc.title	A Systematic Review and Theoretical Economic Analysis of the Impacts of Providing Material Benefits to Improve Food Access in People with Diabetes
dc.type	master thesis
thesis.degree.discipline	Medicine – Community Health Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Master of Science (MSc)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.