title: Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial.
abstract: Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention.
  
  
  
  Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week.
  
  
  
  At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group.
  
  
  
  A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901.
authors.affiliation: Deakin Health Economics, Population Health SRC, Deakin University, Locked Bag 20000, Geelong, Victoria, 3220, Australia; Centre of Community and Child Health, Murdoch Childrens Research Institute, 50 Flemington road, Parville, Victoria, 3052, Australia. Electronic address: ha.le@deakin.edu.au.
authors.forename: Ha N D
authors.initials: HN
authors.lastname: Le
authors.affiliation: Deakin Health Economics, Population Health SRC, Deakin University, Locked Bag 20000, Geelong, Victoria, 3220, Australia; Centre of Community and Child Health, Murdoch Childrens Research Institute, 50 Flemington road, Parville, Victoria, 3052, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gold
authors.affiliation: Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Abbott
authors.affiliation: Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Crawford
authors.affiliation: Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McNaughton
authors.affiliation: National Institute for Health Innovation, University of Auckland, Victoria street west, Auckland, 1142, New Zealand.
authors.forename: Cliona Ni
authors.initials: CN
authors.lastname: Mhurchu
authors.affiliation: School of Public Health, Curtin University, Kent street, Bentley, Perth, Western Australia, 6102, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Pollard
authors.affiliation: Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Ball
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D001628:Beverages / Q000191:economics; D003362:Cost-Benefit Analysis; D000072001:Diet, Healthy / Q000191:economics*; D005247:Feeding Behavior; D005260:Female; D005502:Food / Q000191:economics; D005518:Food Preferences; D063427:Food Quality; D006801:Humans; D008875:Middle Aged
keywords: Australia; Cost; Cost-effectiveness; Economic evaluation; Fruit and vegetables; Price discounts; Skill-building