Spackman, EldonOlstad, Dana LeeSteer, Kieran James Daniel2023-07-242023-07-242023-07-21Steer, K. J. D. (2023). A systematic review and theoretical economic analysis of the impacts of providing material benefits to improve food access in people with diabetes (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.https://hdl.handle.net/1880/116792https://dx.doi.org/10.11575/PRISM/41634Background: Providing material benefits to increase access to healthy food (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) for people with diabetes may be an effective healthcare intervention to improve food insecurity, dietary patterns, clinical parameters, and ultimately health outcomes. There are several studies that have investigated the impact of providing material benefits to improve food access among people with diabetes. There is also interest in Alberta, Canada in potentially implementing a healthy food prescription incentive for people with type 2 diabetes mellitus (T2DM) and food insecurity, which is being investigated in the “Food Rx” trial (NCT04725630). However, there has not been a systematic review or cost-effectiveness analysis on the impacts of providing material benefits to improve food access among people with diabetes. Thesis studies: a systematic review on the impacts of providing material benefits to improve food access on food insecurity, dietary patterns, and clinical parameters in people with diabetes; and a theoretical economic analysis to determine the minimum A1C improvement required for the Food Rx intervention to be cost-effective from the third-party healthcare payer perspective. Results: The systematic review showed that providing material benefits to improve food access for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality but is less likely to change clinical parameters and whole grain intake. The evidence from randomized controlled trials was limited to only six studies at high risk of bias, most commonly due to unblinded subjective outcomes measurement and high participant attrition. The economic threshold analysis showed that providing a healthy food prescription incentive to people with T2DM and food insecurity was unlikely to be cost-effective at $50,000/QALY, when projecting health outcomes from improvements in A1C and diabetes-related clinical parameters. Conclusion: The evidence of clinical effectiveness from providing material benefits to improve food access among people with T2DM is highly uncertain, and a healthy food prescription incentive for people with T2DM and food insecurity in Alberta has a low likelihood of cost-effectiveness, when measuring outcomes from improvements in diabetes-related clinical parametersenUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.diabetesfood insecuritysystematic revieweconomic evaluationPublic HealthEconomicsmaster thesis