Abstract
<p>Top 10 Poster Award. </br>Use of over-the-counter (OTC) diet pills and weight control products are common weight loss behaviors among youth. Use of these products may set youth on a pathway to disordered eating and is associated with increased odds of being diagnosed with an eating disorder (ED). Furthermore, lack of regulatory oversight of dietary supplements puts youth at risk of unknowingly consuming toxic ingredients such as methamphetamines and banned substances. Restructuring access to diet pills via an age-restriction policy has the potential to reduce the upward trend in EDs among youth through young adulthood. Several U.S. states have proposed an age restriction bill to prohibit the sale of OTC diet pills to minors under the age of 18. Policymakers often commission cost-effectiveness studies to gain an understanding of the total costs and benefits of a potential policy. However, interventions can have differential impacts on subgroups. Distributional cost-effectiveness analysis (DCEA) provides insight into differing levels of costs and benefits along health equity-informed categories, e.g., a policy resulting in more health gained among White vs. non-White youth. This study aimed to adapt the “staircase of inequality” framework and to enable a DCEA of the proposed ban of the sale of diet pills to minors in Massachusetts. Findings from a targeted literature review were used to identify key inputs and inform the conceptualization of equity distribution of health outcomes associated with the hypothetical implementation of the diet pill age restriction bill. Several health equity variables were considered; we chose race/ethnicity based on anticipated salience to decisionmakers and data availability. The newly developed conceptual framework uses race/ethnicity as the health-equity distribution variable and covers all minors in the state of Massachusetts. The “staircase” portion of the framework includes the following “steps,” each to be populated and calculated by race/ethnicity subgroups: (1) need (users of diet pills, prevalence of ED among minors), (2) receipt (of prevention, of treatment for ED), (3) short-term effects (financial savings to society, number of ED prevented), and (4) lifetime health benefits (quality-adjusted life-years gained). Our conceptual framework will facilitate an equity-focused economic evaluation of a prevention policy restricting OTC diet pill sales to minors, illuminating both the policy’s value and a health-equity distribution of that value.</p>