Economic evaluations of the Mediterranean Diet: a systematic review

Context: The Mediterranean Diet (MD) is widely recognized for its health benefits and increasing relevance in health system planning and dietary policy. Understanding the costs and cost-effectiveness of MD adherence is critical for informing public health policy and dietary interventions. Objective: This systematic review summarizes the evidence on the economic implications of the MD, distinguishing between studies assessing health outcome–based cost-effectiveness and those examining the monetary costs of adhering to the MD for households. Methods: This review was conducted in accordance with PRISMA 2020. We searched PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library to February 2024. Data extraction and quality assessment followed standardized protocols using CHEC-Extended and Newcastle-Ottawa tools. Results: Of 6,733 screened records, 24 studies met inclusion criteria and were included. Studies were grouped into: (A) economic evaluations (cost-effectiveness, cost-utility, cost-benefit, cost-of-illness – 13 studies) and (B) cost analyses of MD adherence (11 studies). Group A studies, conducted primarily from health system perspectives, found MD interventions generally cost-effective, particularly in cardiovascular prevention, despite higher initial dietary costs. Several reported favorable incremental cost-effectiveness ratio. Group B studies, adopting a societal perspective, consistently showed that greater MD adherence is associated with higher food costs, with a disproportionate impact on low-income populations. Conclusions: MD is a cost-effective intervention from a health system perspective, with potential for substantial long-term savings. However, economic barriers at the household level may limit uptake. Future evaluations should integrate environmental co-benefits and equity considerations to fully capture the MD’s public health value.