title: An economic evaluation of salt reduction policies to reduce coronary heart disease in England: a policy modeling study.
abstract: OBJECTIVE
  Dietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD).
  
  
  METHODS
  The validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a "do nothing" baseline.
  
  
  RESULTS
  All policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million.
  
  
  CONCLUSIONS
  All policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease.
authors.affiliation: Yunus Centre of Social Business and Health, Glasgow Caledonian University, Glasgow, UK. Electronic address: marissa.collins@gcu.ac.uk.
authors.forename: Marissa
authors.initials: M
authors.lastname: Collins
authors.affiliation: Yunus Centre of Social Business and Health, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Mason
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Guzman-Castillo
authors.affiliation: Division of Population Health Sciences and Education (PHSE) St George's, University of London, London, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Critchley
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D003327:Coronary Disease / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004039:Diet, Sodium-Restricted / Q000191:economics*; D004739:England; D005515:Food Labeling / Q000191:economics / Q000379:methods; D017048:Health Care Costs; D006291:Health Policy / Q000191:economics*; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D017673:Sodium Chloride, Dietary
keywords: UK policy; cardiovascular disease; economic evaluation; population health; salt