621 - Cost-effectiveness analysis of pediatric food security interventions

Publication Number: 3602.621

Melinda Xu, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Victoria Clemons, Northwestern University, Chicago, IL, United States; Lindsay Allen, Northwestern University Feinberg School of Medicine - McGaw - Chicago, IL, Chicago, IL, United States; Lindsey Arenberg, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Pediatric food insecurity (FI) is a growing problem in the US and IL that disproportionately impacts Black, Hispanic and single-mother households. Now that federal SNAP cuts are occurring-acutely with the ongoing government shutdown and more broadly through reductions under HR1-food will play an increasingly critical role for both patients requiring medically tailored diets and the general food-insecure population.

Objective: The purpose of this study was to conduct a cost-effectiveness analysis across Lurie Children's diverse landscape of food assistance programs to better inform future strategy.

Design/Methods: We employed a mixed-methods approach combining micro-costing cost-effectiveness analysis (CEA) with qualitative insights from program stakeholders. Cost-effectiveness ratios (CERs) were calculated for available process and outcome measures for each program with a time horizon of 6 months from the payer's perspective. A one-way deterministic sensitivity analysis (DSA) approach was applied by systematically varying one cost input at a time while holding all others constant.

Results: Eight food security interventions were included in the final analysis. We found great variation in patient population, clinic modality and program implementation. Food content was dependent on delivery model, with in-clinic pantry programs relying on canned goods and shelf-stable grains while delivery programs were able to provide fresh produce, meat and dairy products. One consistent trend was a strong reliance on social workers across programs. Six-month estimates spanned from $9000-$60,000 for total costs, $77-$217 per parcel of food distributed and $4-$30 per pound. Using survey data from a delivery program for ambulatory patients, CERs estimate a 6-month cost of $372-$427 per family to meet food needs, $431-$507 per family to increase healthy habits, and $389-$402 per family to help stretch their budget. DSA found high sensitivity to implementation costs across the board. We also found a transition in sensitivity from nonphysician to physician labor as program medical complexity grew.

Conclusion(s): Programs provide vital support to FI families. Key characteristics such as the community partner or patient dietary needs dictate cost differences between programs. More medically complex programs were costlier. Delivery programs saved costs on labor, storage and other logistics, but cost more for food content and delivery. For future cost savings, experienced program implementation is vital. Our findings highlight core characteristics of food security interventions that drive program cost and impact.

Figure 1. Program overview of Lurie Children's pediatric food security interventions
Programs were categorized by medical complexity and resource intensity. Programs that focused on a specific chronic condition, i.e. kidney dialysis, were deemed as more medically complex than programs that targeted the general pediatric population. Delivery programs were deemed as more resource intensive than in-clinic pantry programs due to added logistics and management of delivery.

Figure 2. Cost-effectiveness ratios per pediatric food security program
Calculated cost-effectiveness ratios for cost per parcel of food distributed and for cost per pound of food distributed across programs

Figure 3. Tornado diagrams for cost per food parcel distributed for selected programs
Selected programs represent each quadrant from Figure 1. Light purple bars represent lower bounds and dark purple bars represent higher bounds for cost per food parcel.