Modeling health gains and cost savings for ten dietary salt reduction targets.
BACKGROUND
Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups.


METHODS
We used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate.


RESULTS
Achieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the "full target"), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34-48 % sodium reduction in such products). All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory "full target" at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population).


CONCLUSIONS
This work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.
Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand. nick.wilson@otago.ac.nz.
Nick
N
Wilson
Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
Nhung
N
Nghiem
National Institute for Health Innovation and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Helen
H
Eyles
National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
Cliona Ni
CN
Mhurchu
University of Auckland, Auckland, New Zealand.
Emma
E
Shields
British Heart Foundation Centre on Population Approaches to NCD Prevention, Oxford University, Oxford, UK.
Linda J
LJ
Cobiac
Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
Christine L
CL
Cleghorn
Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
Tony
T
Blakely
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D004039:Diet, Sodium-Restricted; D057140:Fast Foods / Q000032:analysis; D005260:Female; D018857:Food Packaging; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D009520:New Zealand; D018673:Nutrition Policy; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012147:Restaurants; D062410:Snacks; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
D017673:Sodium Chloride, Dietary
Cardiovascular disease; Dietary salt; Economic analysis; Sodium; Targets