title: Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations.
abstract: OBJECTIVE
  To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.
  
  
  METHODS
  Global modeling study.
  
  
  METHODS
  183 countries.
  
  
  METHODS
  Full adult population in each country.
  
  
  METHODS
  A "soft regulation" national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness MAIN OUTCOME MEASURE:  Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years.
  
  
  RESULTS
  Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction was best in South Asia (I$116/DALY); across the world's 30 most populous countries, best in Uzbekistan (I$26.08/DALY) and Myanmar (I$33.30/DALY). Cost effectiveness was lowest in Australia/New Zealand (I$880/DALY, or 0.02×gross domestic product (GDP) per capita), although still substantially better than standard thresholds for cost effective (<3.0×GDP per capita) or highly cost effective (<1.0×GDP per capita) interventions. Most (96.0%) of the world's adult population lived in countries in which this intervention had a cost effectiveness ratio <0.1×GDP per capita, and 99.6% in countries with a cost effectiveness ratio <1.0×GDP per capita.
  
  
  CONCLUSIONS
  A government "soft regulation" strategy combining targeted industry agreements and public education to reduce dietary sodium is projected to be highly cost effective worldwide, even without accounting for potential healthcare savings.
authors.affiliation: Stanford University, Stanford, CA, USA, and Institute for Fiscal Studies, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Webb
authors.affiliation: Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Saman
authors.initials: S
authors.lastname: Fahimi
authors.affiliation: Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Ave, Boston, MA 02111, USA.
authors.forename: Gitanjali M
authors.initials: GM
authors.lastname: Singh
authors.affiliation: Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Shahab
authors.initials: S
authors.lastname: Khatibzadeh
authors.affiliation: Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Ave, Boston, MA 02111, USA.
authors.forename: Renata
authors.initials: R
authors.lastname: Micha
authors.affiliation: Cambridge Institute of Public Health, Cambridge, UK.
authors.forename: John
authors.initials: J
authors.lastname: Powles
authors.affiliation: Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Ave, Boston, MA 02111, USA dariush.mozaffarian@tufts.edu.
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
mesh_terms: D019985:Benchmarking; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004039:Diet, Sodium-Restricted / Q000191:economics*; D005260:Female; D006076:Government; D006801:Humans; D008297:Male; D018673:Nutrition Policy / Q000191:economics*; D017673:Sodium Chloride, Dietary; D014944:World Health Organization
chemical_list: D017673:Sodium Chloride, Dietary