The Six-Food Elimination Diet for Eosinophilic Esophagitis Increases Grocery Shopping Cost and Complexity

• Published in: Dysphagia Vol. 31; no. 6; pp. 765 - 770
• Main Authors: Asher Wolf, W., Huang, Kevin Z., Durban, Raquel, Iqbal, Zahra J., Robey, Benjamin S., Khalid, Farah J., Dellon, Evan S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2016; Springer; Springer Nature B.V
• Subjects: Commerce; Comparative analysis; Costs and Cost Analysis - statistics & numerical data; Diet; Diet - economics; Diet - methods; Economic aspects; Eosinophilic Esophagitis - diet therapy; Eosinophilic Esophagitis - economics; Esophagitis; Food - economics; Gastroenterology; Hepatology; Humans; Imaging; Medicine; Medicine & Public Health; Nutrition; Original Article; Otorhinolaryngology; Patient education; Prices and rates; Radiology; Requirements; Supermarkets; United States; Deglutition; Eosinophilic esophagitis; Six-food elimination diet; Dietary therapy; Cost analysis; Deglutition disorders; Targeted elimination diet
• ISSN: 0179-051X; 1432-0460
• DOI: 10.1007/s00455-016-9739-1

The six-food elimination diet (SFED), where dairy, wheat, eggs, soy, nuts, and seafood are avoided, is an effective treatment for eosinophilic esophagitis (EoE). Patient-related costs of this approach, however, are unknown. We aimed to assess the cost of and ease of shopping for an SFED compared to an unrestricted diet. A dietitian with expertise in EoE generated menus meeting dietary requirements for a week’s worth of meals for the SFED and an unrestricted diet. We compared prices and the number of missing items for both diets at standard and specialty grocery stores. The average weekly price of the SFED at a standard supermarket was $92.54 compared to $79.84 for an unrestricted diet ( p  = 0.0001). A patient shopping at a standard grocery store needed a higher proportion of items from a second store compared to an unrestricted diet (32 vs. 3 %, p  = 0.0001). The prices of the SFED and unrestricted diet using a specialty supermarket were comparable ($106.47 vs. $105.96, p  = 0.81), as was the percentage of items requiring a trip to a second store (6 vs. 2 % items, p  = 0.03). Shopping at a specialty grocery store increased weekly grocery costs by $13.93 ( p  = 0.04) for the SFED and $26.12 ( p  = 0.03) for the unrestricted diet. In conclusion, for patients shopping at standard grocery stores, the cost of an SFED is higher, and an SFED requires more items from a second store. These differences disappear at specialty grocery stores, but costs were significantly higher. This cost and logistical burden can inform patients when selecting dietary therapy.