The cost-effectiveness of placement restrictions of unhealthy food and drinks at end of aisles and checkouts in Australian supermarkets

Background
Obesity is a significant contributor to global morbidity and mortality, driven by rising consumption of unhealthy energy dense foods high in salt, sugar and fat (HFSS). Supermarkets, pivotal in food distribution, influence consumer choices through marketing strategies that regularly promote the purchase of unhealthy foods. Restricting the placement of unhealthy food and beverages in prominent supermarket locations is a promising intervention to reduce the purchase of unhealthy products. This study assesses the cost-effectiveness of a potential policy to restrict the placement of unhealthy foods at prominent locations in supermarkets like checkouts, end-of-aisles, and store entrances compared to the status quo (no policy).

Methods
The impact of the proposed policy to restrict the placement of unhealthy foods on the distribution of Body Mass Index (BMI) in the 2024 Australian population was estimated. A previously validated multiple cohort Markov model (Assessing Cost Effectiveness-Obesity Policy model) was used to estimate the impact of the change in BMI on the epidemiology of nine obesity related diseases resulting in changes in long-term health outcomes quantified as health-adjusted life years (HALYs), and healthcare costs. Policy implementation and monitoring costs to government and retailers were estimated. The analyses were undertaken over the lifetime of the modelled population (100 years), adopting a limited societal perspective with results presented in 2024 values. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results.

Results
The placement restriction policy was estimated to result in a mean BMI reduction of 0.26 kg/m² for males and 0.21 kg/m² for females, corresponding to 0.37 million HALYs gained and reduced healthcare costs of A$4.45 billion over the lifetime of the population. The total cost of the policy was A$20 million. Sensitivity analyses confirmed the intervention’s cost-effectiveness across various scenarios.

Conclusion
A policy to restrict retail marketing of unhealthy foods in supermarkets represents a potentially cost-effective intervention, estimated to produce long-term health gains and save costs. These findings support policy action to create healthier food retail environments.