Salt substitution at age 40 years cost-effective for high-risk adults with prehypertension
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Key takeaways:
- Salt substitution and antihypertensive drug treatment combined were cost-effective among adults with hypertension at high risk for CVD.
- Interventions were most cost-effective when started at an earlier age.
Salt substitution intervention beginning at age 40 years was cost-effective among Chinese adults with prehypertension compared with antihypertensive drug treatment alone, according to findings published in Hypertension.
“A few randomized controlled trials have shown that early intervention in prehypertensive individuals reduced the risk of hypertension and CVD events effectively, including salt substitution intervention and antihypertensive drug treatment,” Zhijia Sun, of the department of epidemiology and biostatistics in the School of Public Health at Peking University in Beijing, and colleagues wrote. “Few studies have investigated the cost-effectiveness of these interventions in the prehypertensive population.”
To evaluate the cost-effectiveness of salt substitution, antihypertensive drug treatment and both interventions combined among Chinese adults with prehypertension, Sun and colleagues used data from the China Kadoorie Biobank, a large-scale prospective cohort study that enrolled 512,723 Chinese adults aged 30 to 79 years from five urban and five rural areas in China from 2004 to 2008. The researchers developed a decision-analytic Markov cohort model to forecast the incidence of CVD events, associated costs and quality-adjusted life-years.
The researchers evaluated the cost-effectiveness of each intervention among the overall prehypertensive population, adults with prehypertension who were at high risk for CVD (10-year CVD risk 10%) and across age groups starting at age 40, 50, 60 and 70 years.
The primary outcome measure was incremental cost per QALY gained.
The Markov cohort model revealed that salt substitution intervention at age 40 years was cost-effective compared with no intervention among adults with prehypertension, with an incremental cost-effectiveness ratio (ICER) of $6,413.62 per QALY gained. However, antihypertensive drug treatment was not cost-effective for adults with prehypertension compared with no intervention, with an ICER of $27,738.80 per QALY gained.
Among adults with hypertension and at high CVD risk, salt substitution (ICER, $2,009.11/QALY), antihypertensive drug treatment (ICER, $4,573.81/QALY) and both interventions combined (ICER, $2,639.05/QALY) were cost-effective compared with no intervention.
Compared with salt substitution alone, the most cost-effective intervention strategy for adults with hypertension and high CVD risk was the combination of salt substitution and antihypertensive drug treatment at age 40 years, with an ICER of $2,913.30 per QALY gained, according to the study.
The researchers noted that interventions were more cost-effective when started at a younger age, yielding greater CVD risk reductions and lower ICER compared with interventions initiated later in life.
“The findings indicate the benefit of salt substitution in prehypertensive adults and provide evidence for choosing the appropriate primary intervention strategy in prehypertensive adults in China,” the researchers wrote.
Sun and colleagues acknowledged several study limitations, including that adverse clinical events were not accounted for due to a lack of relevant evidence.
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