Estimated Health Impact, Cost, and Cost-Effectiveness of Taxation on Unhealthy Packaged Foods in the Philippines

Background
In 2018, the Philippines implemented a tax on sugar-sweetened beverages. A broader tax on unhealthy foods is being considered. We aimed to estimate the effect of a tax on unhealthy packaged foods.
Methods
In this modelling study, we used a multiple-cohort, proportional multistate life table model to estimate the effect of a 20% tax on packaged foods exceeding WHO thresholds for sodium or sugar, excluding beverages already taxed. Using nationally representative nutrition, sales, and Global Burden of Diseases, Injuries, and Risk Factors Study data, we projected changes in sodium and sugar intake and related health outcomes (cardiovascular disease and type 2 diabetes) and economic outcomes (health-care costs, tax revenue, and implementation costs) over 20 years, comparing Filipino adults aged 25 years and older in 2020 (reference population) with the same population under the intervention with reduced intakes from the tax, assuming 100% pass-through to prices. Cost-effectiveness was estimated from extended health-care and government perspectives and stratified by wealth quintile.
Findings
Compared with the base-case scenario (ie, the status quo), the tax was estimated to avert 2775 deaths (95% uncertainty interval 2685–2853), 13 632 incident ischaemic heart disease events (13 153–14 029), 5287 ischaemic strokes (5090–5445), and 21 763 type 2 diabetes cases (21 532–22 006) over 20 years, generating 326 253 health-adjusted life-years (321 577–330 434). The tax could be cost saving from the government perspective and cost-effective from the health-care perspective, with an estimated 2·37 billion Philippine pesos (PHP; 2·32–2·42) in health-care savings, PHP 647·99 billion (646·42–649·45) in tax revenue, and PHP 12·96 billion (12·93–12·99) in implementation costs over 20 years. Estimated health gains were concentrated among people in middle-income groups, whereas tax revenue increased with income.
Interpretation
A nutrient-based tax on unhealthy packaged foods could reduce diet-related disease burden and generate sustained tax revenue in the Philippines. These findings support nutrient-based food taxes as a cost-effective strategy to reduce disease burden, and raise revenue in low-income and middle-income countries.