Cost-Effectiveness Analysis & Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US

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The CHOICES team partnered with the Maine-Harvard Prevention Research Center and the Maine Obesity Policy Committee to evaluate two state-level obesity prevention strategies– a sugar-sweetened beverage (SSB) excise tax and a policy removing SSBs as SNAP-eligible products. Both policies were estimated to save society more than they cost to implement. However, the SNAP restriction raised greater equity concerns among stakeholders.

Cost-Effectiveness Analysis and Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US.
Long MW, Polacsek M, Bruno P, Giles CM, Ward ZJ, Cradock AL, Gortmaker SL. Journal of Nutrition Education and Behavior. 2019 Aug [Epub ahead of print], pii: S1499-4046(19)30922-4.

Obesity prevention is a priority item for many policymakers at the state level. The goal of this study was to not only predict the health impact of two obesity prevention policies in Maine, but also to gauge stakeholder interest and level of support for these policies.

Two obesity prevention policies were focused on:

– A $0.01/ounce sugar-sweetened beverage (SSB) excise tax for the state of Maine
– A Supplemental Nutrition Assistance Program (SNAP) policy that would not allow SSBs to be bought using SNAP money (SNAP SSB restriction policy)

The stakeholder engagement process developed over more than 10 years as a result of a relationship between the Maine Obesity Policy Committee (Maine OPC) and the Maine-Harvard Prevention Research Center (MHPRC). The Maine OPC consists of individuals from the Maine Public Health Association, American Heart Association of Maine, American Cancer Society, the State Department of Health and Human Services, legislators, lobbyists, and health systems. The stakeholder interview process was conducted in two phases: Phase 1 in 2013 focused on an SSB excise tax and Phase 2 in 2016 focused on a SNAP SSB restriction policy.

The study authors also measured the health impact of these two policies on a virtual population that was developed for the state of Maine. The CHOICES model was used to project these policies’ impact on obesity prevalence and health care costs over 10 years (2017-2027).

The results from the CHOICES model showed the potential for both health improvement and cost-savings. In particular:


$0.01/ounce SSB excise tax

SNAP SSB restriction policy

Health care cost savings
$78.3 million $15.3 million
Quality-adjusted life years (QALYs) saved
3,560 749

*For metric definitions, please visit the CHOICES Modeled Outputs Glossary

Study authors noted mixed levels of support for each policy by Maine stakeholders, with less support for the SNAP SSB restriction policy. Opposition to the SNAP restriction policy was based on concern that SNAP recipients were being unfairly targeted and stigmatized. This study used strategic science thinking to inform obesity prevention policy in Maine by strengthening the capacity of existing stakeholder groups and local applied researchers to integrate advanced cost-effectiveness modeling into their already well-developed policy input process. Results of the modeling were presented to the state’s legislature, which was holding hearings on a proposed SSB tax. This study points to the need for stronger, long-term partnerships between local public health researchers, cost-effectiveness modeling groups, and local policy stakeholder groups.