A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

Abstract

BackgroundCoronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey.Methods and FindingsThree policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey.ConclusionDecreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…Also, legislation aimed at decreasing salt and the trans fatty acid content of foods and smoking habits is cost effective in preventing CVD. 12,13,19 Cholesterol lowering using statins 15,16 and improvement in BP control are cost effective if targeted at persons with high CV risk. 22 Importantly, a sizable portion of patients on lipid-lowering or BP-lowering drug treatment fails to take their treatment adequately or to reach therapeutic goals, 23,24 with clinical and economic consequences.…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…Also, legislation aimed at decreasing salt and the trans fatty acid content of foods and smoking habits is cost effective in preventing CVD. 12,13,19 Cholesterol lowering using statins 15,16 and improvement in BP control are cost effective if targeted at persons with high Classes of recommendations a Class of recommendation. b Level of evidence.…”

Setting targets for salt levels in foods: A five-step approach for low- and middle-income countries

“…Although there has been recent controversy about the potential health consequences of salt reduction (Alderman and Cohen, 2012;Institute of Medicine, 2013), the majority of research demonstrates that reducing salt intake at the population level will have a significant public health impact (Whelton et al, 2012;Appel et al, 2011). Salt reduction has been shown to be a cost-effective way to reduce cardiovascular disease (Brown et al, 2009;Mason et al, 2014;Cobiac et al, 2010;Barton et al, 2011;Wang and Labarthe, 2011) and is considered a ''best buy'' for reducing the burden of non-communicable diseases (NCDs) in LMICs (World Economic Forum, 2011;World Bank, 2006 In May 2013 Member States approved the Global Monitoring Framework for NCD prevention and control at the World Health Organization General Assembly (World Health Organization, 2013a). The framework includes nine targets and 25 indicators aimed at achieving a 25% reduction in premature deaths from NCDs by 2025 (World Health Organization, 2013a).…”