Restricting price promotions on unhealthy foods and beverages has been identified by governments as a promising approach for improving population diets. Using a limited societal perspective, this study assessed the potential cost-effectiveness of mandatory restrictions on price promotions for sugar-sweetened beverages (SSBs) in Australia.
Australian dietary consumption data, together with UK data on the SSB sales uplift associated with price promotions, were used to estimate reductions in SSB purchases and consequent changes in body mass index following the intervention. A multi-state, multiple-cohort Markov model was used to estimate the obesity-related health and cost impacts over the lifetime of the 2010 Australian population. Costs included passing legislation, assisting retailer implementation, and compliance monitoring.
The intervention was estimated to result in a mean change in daily energy intake of −12.52 kJ (95% Uncertainty Interval, UI: −15.91 to −9.58) per person, which translated to a mean body weight change of −0.11 kg (95%UI: −0.14 to −0.08) per person. Total Health Adjusted Life Years gained were estimated at 34,260 (95%UI: 24,922–45,504). Estimated costs were AUD17.0 million, with estimated healthcare cost savings of AUD376.0 million. The intervention was considered dominant (cost-saving and health promoting). The intervention remained cost-effective if retailers reduced average non-discounted SSB prices in response to the intervention by less than 5.36%.
Restricting price promotions on SSBs is likely to be highly cost-effective, although its impact would depend on how industry and shoppers respond. Although Australian data are used, these results are likely to be transferable and highly relevant to the UK context. Policies for restricting price promotions should be considered as part of a comprehensive obesity prevention strategy.
Subscribe to Journal
Get full journal access for 1 year
only $64.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97:667–75.
Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. New Engl J Med. 2011;364:2392–404.
Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100:216–22.
Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, et al. The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Health Nutrition. 2016;19:3070–84.
Chandon P, Wansink B. When are stockpiled products consumed faster? A convenience–salience framework of postpurchase consumption incidence and quantity. J Mark Res. 2002;39:321–35.
Zeviani R. Are we really getting value from our promotions? Nielsen. 2018. http://www.nielsen.com/au/en/insights/news/2018/are-we-really-getting-value-from-our-promotions.html
Gilham B, Zorbas C, Boelsen-Robinson T, Blake MR, Peeters A, Cameron AJ, et al. The frequency and magnitude of beverage price promotions available for sale in Australian supermarkets. Aust N Z J Public Health. 2019;43:346–51.
Riesenberg D, Backholer K, Zorbas C, Sacks G, Paix A, Marshall J, et al. Frequency and magnitude of price promotions on Australian supermarket food according to food category and product healthiness. 2019;109:1434–9.
Nakamura R, Suhrcke M, Jebb SA, Pechey R, Almiron-Roig E, Marteau TM. Price promotions on healthier compared with less healthy foods: a hierarchical regression analysis of the impact on sales and social patterning of responses to promotions in Great Britain. Am J Clin Nutrition. 2015;101:808–16.
Public Health England. Sugar reduction: the evidence for action. Annexe 4: an analysis of the role of price promotions on the household purchases of food and drinks high in sugar. London: Public Health England; 2016.
Taillie LS, Ng SW, Xue Y, Harding M. Deal or no deal? The prevalence and nutritional quality of price promotions among U.S. food and beverage purchases. Appetite. 2017;117:365–72.
Backholer K, Vandevijvere S, Blake M, Tseng M. Sugar sweetened beverage taxes in 2018: a year of reflections and consolidation. Public Health Nutrition. 2019;21:3291–5.
Health and Social Care Committee. Childhood obesity: time for action. London: Health and Social Care Committee; 2018.
Pomeranz JL. Sugary beverage tax policy: Lessons learned from tobacco. Am J Public Health. 2014;104:13–5.
Obesity Action Scotland. Obesity and price promotions. Glasgow: Obesity Action Scotland; 2016.
Pomeranz JL. Advanced policy options to regulate sugar-sweetened beverages to support public health. J Public Health Policy. 2012;33:75–88.
Department of Health and Social Care: Global Public Health Directorate: Obesity Food and Nutrition. Childhood obesity: a plan for action, Chapter 2 London: Department of Health and Social Care: Global Public Health Directorate: Obesity Food and Nutrition; 2018.
APS Group Scotland. A healthier future–Scotland’s diet & healthy weight delivery plan. Edinburgh: APS Group Scotland; 2018.
Childhood Obesity Team. Restricting volume promotions for high fat, sugar, and salt (HFSS) products. London, England: Childhood Obesity Team; 2018.
Backholer K, Blake M, Vandevijvere S. Sugar-sweetened beverage taxation: an update on the year that was 2017. Public Health Nutrition. 2017;20:3219–24.
Australian Bureau of Statistics. Australian health survey 2011–12. Canberra: Australian Bureau of Statistics; 2015.
Bates B, Lennox A, Prentice A, Bates C, Page P, Nicholson S, et al. NDNS: results from Years 1 to 4 (combined). London, UK: Public Health England. 2014.
Euromonitor International. Soft drinks: euromonitor from trade sources/national statistics. London, UK: Euromonitor International. 2018.
Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, et al. Quantification of the effect of energy imbalance on bodyweight. The Lancet. 2011;378:826–37.
Hall KD, Butte NF, Swinburn BA, Chow CC. Dynamics of childhood growth and obesity: development and validation of a quantitative mathematical model. Lancet Diabetes Endocrinol. 2013;1:97–105.
Ananthapavan J, Nguyen PK, Bowe SJ, Sacks G, Mantilla Herrera AM, Swinburn B, et al. Cost-effectiveness of community-based childhood obesity prevention interventions in Australia. Int J Obesity. 2019;43:1102–12.
Australian Bureau of Statistics. 3101.0 - Australian demographic statistics, Dec 2010. Canberra, Australia: Australian Bureau of Statistics; 2011.
Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A. The burden of disease and injury in Australia 2003. Canberra, Australia: Australian Institute of Health and Welfare. 2007.
Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380:2129–43.
Gold MR, Stevenson D, Fryback DG. HALYs and QALYs and DALYs, Oh my: similarities and differences in summary measures of population health. Annual Rev Public Health. 2002;23:115–34.
Chen G, Ratcliffe J, Olds T, Magarey A, Jones M, Leslie E. BMI, health behaviors, and quality of life in children and adolescents: a school-based study. Pediatrics. 2014;133:868.
Australian Institute of Health and Welfare. Health and welfare expenditure series, disease costs and impacts studies. Canberra, Australia: Australian Institute of Health and Welfare; 2001.
Australian Institute of Health and Welfare. Health expenditure Australia 2014–15. Canberra: Australian Institute of Health and Welfare; 2016. Report No.: HWE 67.
George B, Harris A, Mitchell A. Cost-effectiveness analysis and the consistency of decision making. PharmacoEconomics. 2001;19:1103–9.
Gold M, Siegel J, Russell L, Weinstein MC. Cost-effectiveness in health and medicine. New York, USA: Oxford University Press. 1996.
Barendregt JJ. Ersatz user guide. Sunrise Beach, Queensland, Australia: EpiGear International Pty Ltd. 2017.
Sharma A, Hauck K, Hollingsworth B, Siciliani L. The effects of taxing sugar-sweetened beverages across different income groups. Health Econ. 2014;23:1159–84.
Bradshaw P, Bromley C, Corbett J, Day J, Doig M, Dowling S, et al. The Scottish health Survey 2011, volume 1: Main report. Edinburgh, Scotland: The Scottish Government. 2012.
Nielsen. Promotions not so special anymore. Ney York, USA: The Nielsen Company; 2014.
Lal A, Mantilla-Herrera AM, Veerman L, Backholer K, Sacks G, Moodie M, et al. Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: a cost-effectiveness and equity analysis. PLOS Med. 2017;14:e1002326.
Crino M, Herrera AMM, Ananthapavan J, Wu JHY, Neal B, Lee YY, et al. Modelled cost-effectiveness of a package size cap and a kilojoule reduction intervention to reduce energy intake from sugar-sweetened beverages in Australia. Nutrients. 2017;9:983.
Sacks G, Swinburn B, Lawrence M. Obesity policy action framework and analysis grids for a comprehensive policy approach to reducing obesity. Obes Rev. 2009;10:76–86.
Schoeller DA. How accurate is self-reported dietary energy intake? Nutrition Reviews. 1990;48:373–9.
Smithson M, Kirk J, Capelin C. Sugar reduction: the evidence for action Annexe 4: an analysis of the role of price promotions on the household purchases of food and drinks high in sugar. London, UK: Public Health England. 2015.
Heng Y, House LA, Kim H. The competition of beverage products in current market: a composite demand analysis. Agric Resour Econ Rev. 2018;47:118–31.
Backholer K, Martin J. Sugar-sweetened beverage tax: the inconvenient truths. Public Health Nutrition. 2017;20:3225–7.
APS Group Scotland. A healthier future – action and ambitions on diet, activity and healthy weight. Consultation document. Edinburgh: APS Group Scotland; 2017.
Griesbach D, Griesbach JW, Associates. A healthier future – action and ambitions on diet, activity and healthy weight. Analysis of consultation responses. Edinburgh, Scotland: The Scottish Government. 2017.
Nakamura R, Suhrcke M, Pechey R, Morciano M, Roland M, Marteau TM. Impact on alcohol purchasing of a ban on multi-buy promotions: a quasi-experimental evaluation comparing Scotland with England and Wales. Addiction. 2014;109:558–67.
All authors contributed to the development of the research question, design of the methods, provided critical feedback on draft versions of this manuscript and have provided final approval for publishing. OH and KB sourced and interpreted the data for this work. OH and JA analysed this data and interpreted the results. All authors agree to be held accountable for all aspects of this research.
Conflict of interest
All authors have completed the ICMJE uniform disclosure form and declare no support from any organisation for the submitted work. GS, AJC and MM are the academic partners on a healthy supermarket intervention trial that includes Australian local government and supermarket retail (IGA) collaborators. JA, GS, MM, JM, AP, and AJC are part of a NHMRC Centre of Research Excellence in Obesity Policy and Food Systems #1041020. AJC and GS are the recipients of Australian Research Council Discovery Early Career Researcher Awards (project numbers DE160100141 and DE160100307). All other authors have no conflict of interests or funding to declare.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Huse, O., Ananthapavan, J., Sacks, G. et al. The potential cost-effectiveness of mandatory restrictions on price promotions for sugar-sweetened beverages in Australia. Int J Obes (2019). https://doi.org/10.1038/s41366-019-0495-9