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Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study

Citation: Lee Y, Mozaffarian D, Sy S, Huang Y, Liu J, Wilde PE, et al. (2019) Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS Med 16(3):

Academic Editor: Ed Gregg, Centers for Disease Control and Prevention, UNITED STATES

Received: August 16, 2018; Accepted: February 11, 2019; Published: March 19, 2019

Copyright: © 2019 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data from the National Health and Nutrition Examination Survey(NHANES) are publicly available at; other data inputs are from published papers or published in the manuscript.

Funding: This research was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute (R01 HL130735, PI RM; R01 HL115189, PI DM), In addition, JL was supported by a postdoctoral fellowship award (17POST33670808) from the American Heart Association, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: RM reports research funding from NIH, Bill Melinda Gates Foundation, and Unilever and personal fees from the World Bank and Bunge. DM reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board, Elysium Health (with stock options), Omada Health, and DayTwo; and chapter royalties from UpToDate, all outside the submitted work. TAG has also received research funds and/or consulting fees from Astra Zeneca, Novartis, United Health Group, Teva Pharmacueticals, and Takeda in the past five years, all of which were outside the submitted work.

American College of Cardiology and American Heart Association; ADA,
American Diabetes Association; CHD,
coronary heart disease; CMS,
Centers for Medicare and Medicaid Service; CVA,
cerebrovascular accident; CVD,
cardiovascular disease; EBT,
electronic benefits transfer; FV,
fruits and vegetables; Food-PRICE,
Food Policy Review and Intervention Cost-Effectiveness; FVRx,
Fruit and Vegetable Prescription Program; HDL,
high-density lipoprotein; HIP,
Healthy Incentives Pilot; ICER,
incremental cost-effectiveness ratio; LDL,
low-density lipoprotein; NHANES,
National Health and Nutrition Examination Survey; oz,
ounce; PCSK9,
proprotein convertase subtilisin/kexin type 9; PIR,
poverty–income ratio; PUFA,
polyunsaturated fatty acids; QALY,
quality-adjusted life year; SNAP,
Supplemental Nutrition Assistant Program; USDA,
United States Department of Agriculture

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