title: A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.
abstract: BACKGROUND
  Coronary 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.
  
  
  RESULTS
  Three 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.
  
  
  CONCLUSIONS
  Decreasing 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.
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Mason
authors.affiliation: Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory.
authors.forename: Azza
authors.initials: A
authors.lastname: Shoaibi
authors.affiliation: Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory.
authors.forename: Rula
authors.initials: R
authors.lastname: Ghandour
authors.affiliation: Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.affiliation: Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.affiliation: Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory.
authors.forename: Rana
authors.initials: R
authors.lastname: Khatib
authors.affiliation: Department of Health Economics, Ministry of Health, Nablus, Palestine, Occupied Palestinian territory.
authors.forename: Samer
authors.initials: S
authors.lastname: Jabr
authors.affiliation: Dokuz Eylül University Faculty of Medicine, Department of Public Health, İnciraltı- İzmir, Turkiye.
authors.forename: Belgin
authors.initials: B
authors.lastname: Unal
authors.affiliation: Narlidere Community Health Center, Provincial Health Directorate of Izmir, Izmir, Turkey.
authors.forename: Kaan
authors.initials: K
authors.lastname: Sözmen
authors.affiliation: INTES/University of Carthage, Tunis, Tunisia.
authors.forename: Chokri
authors.initials: C
authors.lastname: Arfa
authors.affiliation: Cardiovascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.
authors.forename: Wafa
authors.initials: W
authors.lastname: Aissi
authors.affiliation: Cardiovascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.
authors.forename: Habiba
authors.initials: H
authors.lastname: Ben Romdhane
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Fouad
authors.initials: F
authors.lastname: Fouad
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Radwan
authors.initials: R
authors.lastname: Al-Ali
authors.affiliation: Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory ; Public Health Program, Department of Health Sciences, Qatar University, Doha, Qatar.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Husseini
mesh_terms: D003327:Coronary Disease / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006293:Health Promotion / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D008877:Middle East / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D017673:Sodium Chloride, Dietary / Q000009:adverse effects*; D013593:Syria; D014416:Tunisia; D014421:Turkey
chemical_list: D017673:Sodium Chloride, Dietary