title: Health and economic impacts of eight different dietary salt reduction interventions.
abstract: BACKGROUND
  Given the high importance of dietary sodium (salt) as a global disease risk factor, our objective was to compare the impact of eight sodium reduction interventions, including feasible and more theoretical ones, to assist prioritisation.
  
  
  METHODS
  Epidemiological modelling and cost-utility analysis were performed using a Markov macro-simulation model. The setting was New Zealand (NZ) (2.3 million citizens, aged 35+ years) which has detailed individual-level administrative cost data.
  
  
  RESULTS
  Of the most feasible interventions, the largest health gains were from (in descending order): (i) mandatory 25% reduction in sodium levels in all processed foods; (ii) the package of interventions performed in the United Kingdom (UK); (iii) mandatory 25% reduction in sodium levels in bread, processed meats and sauces; (iv) media campaign (as per a previous UK one); (v) voluntary food labelling as currently used in NZ; (vi) dietary counselling as currently used in NZ. Even larger health gains came from the more theoretical options of a "sinking lid" on the amount of food salt released to the national market to achieve an average adult intake of 2300 mg sodium/day (211,000 QALYs gained, 95% uncertainty interval: 170,000-255,000), and from a salt tax. All the interventions produced net cost savings (except counseling--albeit still cost-effective). Cost savings were especially large with the sinking lid (NZ$ 1.1 billion, US$ 0.7 billion). Also the salt tax would raise revenue (up to NZ$ 452 million/year). Health gain per person was greater for Māori (indigenous population) men and women compared to non-Māori.
  
  
  CONCLUSIONS
  This study substantially expands on the range of previously modelled salt reduction interventions and suggests that some of these might achieve major health gains and major cost savings (particularly the regulatory interventions). They could also reduce ethnic inequalities in health.
authors.affiliation: Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand.
authors.forename: Nhung
authors.initials: N
authors.lastname: Nghiem
authors.affiliation: Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
authors.affiliation: Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand; School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Cobiac
authors.affiliation: Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Pearson
authors.affiliation: Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand.
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009017:Morbidity; D009520:New Zealand; D062486:Public Health Surveillance; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D017673:Sodium Chloride, Dietary
chemical_list: D017673:Sodium Chloride, Dietary