January 24, 2017
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Government-supported salt reduction strategy cost-effective worldwide

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A moderate government intervention strategy to reduce dietary sodium would be highly cost-effective worldwide, even without factoring potential health care savings, new data show.

“Excessive sodium consumption is common and linked to [CV] burdens in most countries,” Dariush Mozaffarian, MD, MPH, DrPH, dean of the Tufts Friedman School of Nutrition Science and Policy, and colleagues wrote. “Overall, 181 of 187 countries, representing 99.2% of the global adult population, have mean sodium intakes exceeding [WHO]-recommended maximum of 2 g [per] day.”

Mozaffarian and colleagues analyzed the cost-effectiveness of intervention strategies that sought to reduce national sodium intake by 10% over 10 years in 183 countries. They used data from 2010 to analyze sodium intake, BP levels and CVD rates.

Dariush Mozaffarian
Dariush Mozaffarian

Salt-reduction program

The interventions analyzed for the study were based off an existing program in the United Kingdom including government-supported industry agreements to reduce sodium in processed food, government compliance and a public health campaign. The U.K. intervention achieved a 14.7% reduction in population sodium intake over 10 years and a similar program in Turkey achieved a 16% reduction over 4 years, the researchers wrote.

Intervention costs were determined for individual countries using a WHO noncommunicable disease costing tool and then converted into international dollars (I$) for comparison.

Estimated health care savings were not evaluated to have a conservative cost-saving estimate.

Using country-specific data on population demographics, sodium consumption and rates of CVD, the researchers calculated the number of disability-adjusted life-years (DALYs) that would be averted by the interventions during a 10-year period.

Cost-effectiveness ratios were calculated by dividing total effect on DALYs by total cost of the intervention by country.

Overall, the global cost-effectiveness ratio of the 10-year intervention was about I$204 per DALY saved (95% uncertainty interval, 149-322). The researchers derived the figure from projected savings of 5.8 million DALYs per year related to CVD at a population-weighted mean cost of I$1.13 per capita over the 10 years.

The cost-effectiveness ratios were lower in lower middle income and upper middle income countries, higher in lower-income countries and highest in high-income countries, according to the researchers.

“Best buy”

“However you slice it, national salt reduction programs that combine industry targets and public education are a ‘best buy’ for governments and policymakers,” Mozaffarian said in a press release.

According to WHO benchmarks (a cost-effectiveness ratio < three times the gross domestic product per capita is cost-effective; a cost-effectiveness ratio < one time the GDP per capita is highly cost-effective), only one of the 183 countries did not meet the benchmark for cost-effectiveness (Marshall Islands, 4.7 times GDP per capita), and all but seven countries met the benchmark for high cost-effectiveness. Additionally, 96% of the world’s population (130 countries) had a cost-effectiveness ratio of < 0.1 time the GDP per capita.

“Our novel results, together with prior studies in selected countries, provide evidence that a national policy for reduction in sodium intake is highly cost-effective, and substantially more so than even highly cost-effective medical prevention strategies,” the researchers wrote. – by Cassie Homer

Disclosure: Mozaffarian reports receiving ad hoc honoraria or consultant fees from AstraZeneca, Boston Heart Diagnostics, Global Organization for EPA and DHA Omega-3, Haas Avocado Board and Royal DSM. The other researchers report no relevant financial disclosures.