The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease
The anti-salt here:
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.
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.
“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