부산대학교 도서관

Background: Taxes on sugar-sweetened beverages (SSBs) have been implemented globally to reduce the burden of cardiometabolic diseases by disincentivizing consumption through increased prices (e.g., 1 peso/litre tax in Mexico) or incentivizing industry reformulation to reduce SSB sugar content (e.g., tiered structure of the United Kingdom [UK] Soft Drinks Industry Levy [SDIL]). In Germany, where no tax on SSBs is enacted, the health and economic impact of SSB taxation using the experience from internationally implemented tax designs has not been evaluated. The objective of this study was to estimate the health and economic impact of national SSBs taxation scenarios in Germany. Methods and findings: In this modelling study, we evaluated a 20% ad valorem SSB tax with/without taxation of fruit juice (based on implemented SSB taxes and recommendations) and a tiered tax (based on the UK SDIL) in the German adult population aged 30 to 90 years from 2023 to 2043. We developed a microsimulation model (IMPACTNCD Germany) that captures the demographics, risk factor profile and epidemiology of type 2 diabetes, coronary heart disease (CHD) and stroke in the German population using the best available evidence and national data. For each scenario, we estimated changes in sugar consumption and associated weight change. Resulting cases of cardiometabolic disease prevented/postponed and related quality-adjusted life years (QALYs) and economic impacts from healthcare (medical costs) and societal (medical, patient time, and productivity costs) perspectives were estimated using national cost and health utility data. Additionally, we assessed structural uncertainty regarding direct, body mass index (BMI)-independent cardiometabolic effects of SSBs and cross-validated results with an independently developed cohort model (PRIMEtime). We found that SSB taxation could reduce sugar intake in the German adult population by 1 g/day (95%-uncertainty interval [0.05, 1.65]) for a 20% ad valorem tax on SSBs leading to reduced consumption through increased prices (pass-through of 82%) and 2.34 g/day (95%-UI [2.32, 2.36]) for a tiered tax on SSBs leading to 30% reduction in SSB sugar content via reformulation. Through reductions in obesity, type 2 diabetes, and cardiovascular disease (CVD), 106,000 (95%-UI [57,200, 153,200]) QALYs could be gained with a 20% ad valorem tax and 192,300 (95%-UI [130,100, 254,200]) QALYs with a tiered tax. Respectively, €9.6 billion (95%-UI [4.7, 15.3]) and €16.0 billion (95%-UI [8.1, 25.5]) costs could be saved from a societal perspective over 20 years. Impacts of the 20% ad valorem tax were larger when additionally taxing fruit juice (252,400 QALYs gained, 95%-UI [176,700, 325,800]; €11.8 billion costs saved, 95%-UI [€6.7, €17.9]), but impacts of all scenarios were reduced when excluding direct health effects of SSBs. Cross-validation with PRIMEtime showed similar results. Limitations include remaining uncertainties in the economic and epidemiological evidence and a lack of product-level data. Conclusions: In this study, we found that SSB taxation in Germany could help to reduce the national burden of noncommunicable diseases and save a substantial amount of societal costs. A tiered tax designed to incentivize reformulation of SSBs towards less sugar might have a larger population-level health and economic impact than an ad valorem tax that incentivizes consumer behaviour change only through increased prices. In a modeling study, Karl MF Emmert-Fees and team estimate the health and economic impact of national sugar-sweetened beverages taxation scenarios in Germany. Author summary: Why was this study done?: Taxation of sugar-sweetened beverages (SSBs), recommended by the World Health Organization (WHO) and implemented in many jurisdictions globally, aims to reduce the noncommunicable disease burden by disincentivizing consumption through increased consumer prices or incentivizing industry reformulation to reduce SSB sugar content. No tax on SSBs is currently enacted in Germany and the national government is preparing a new national strategy on food seeking evidence-based recommendations to establish policy priorities until 2050. In Germany, the potential long-term health and economic impacts of SSB taxation have not been evaluated. What did the researchers do and find?: We developed and validated a microsimulation model based on national data and international evidence to model the impact of SSB taxation on dietary exposure of added sugar from beverages, body mass index (BMI), cardiometabolic diseases, and related economic costs. We evaluated 3 SSB taxation scenarios in Germany with the simulation model: (1) 20% ad valorem tax on SSBs; (2) extended 20% ad valorem tax on SSBs and fruit juice; (3) tiered tax leading to reformulation of SSBs towards 30% lower sugar content. Taxation of SSBs in Germany could prevent or postpone 132,100 to 244,100 cases of type 2 diabetes, gain 106,000 to 192,300 quality-adjusted life years (QALYs) and save €10.8 to €16.0 billion in societal cost from 2023 to 2043 with the highest impacts estimated for tiered taxation. The absolute long-term health impacts are largely dependent on the relevance of direct, BMI-independent cardiometabolic effects of SSBs. What do these findings mean?: All modelled SSB taxation scenarios are likely to improve population health and reduce societal costs in Germany by preventing cardiometabolic disease. Considering all sources of uncertainty, we find that modelled SSB taxation scenarios that lead to reformulation towards less sugar might have a larger population-level health and economic impact than those that incentivize consumer behaviour change only through increased prices. From a public health perspective, taxation of SSBs should be considered as a policy option for German decision-makers to reduce consumption of added sugar and improve population health. [ABSTRACT FROM AUTHOR]