10% sodium intake reduction over 10 years cost effective in all nations
Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nationsWebb M, Fahimi S, Singh GM, et al. - BMJ, 2017, In Press
Reducing population sodium intake by 10% over 10 years would be extremely cost effective in nearly 183 nations. This was published last month in BMJ. These reductions can be achieved by a government “soft regulation” strategy, combined with targeted industry agreements and public education.
These were the conclusions of Webb and colleagues, who 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. The proposed interventions should avert approximately 5.8 million disability adjusted life years (DALYs) per year related to cardiovascular diseases globally. The population weighted mean cost effectiveness ratio was approximately 204 international dollars per DALY. However, it should be noted that the total 10 year cost differed substantially between countries and therefore cost effectiveness were variable between them.
The estimated cost effectiveness ratio was lowest (best) in lower middle income and upper middle income countries and highest in high income countries. Moreover, the estimated intervention efficacy was highest in Kazakhstan, Georgia, Belarus, Ukraine, Mongolia and Russia. Of note, a national intervention policy remained highly cost effective globally as well as by world region, when other alternative effectiveness (eg. reduction of 30%, 0.5 g or 1.5 g a day) or thresholds of optimal intake were considered.
Currently, 181 of 187 countries, representing 99.2% of the global adult population, have mean sodium intakes exceeding the WHO recommended maximum of 2 grams a day. An estimated 1 648 000 annual deaths from cardiovascular disease worldwide were attributable to excess dietary sodium in 2010. However, implementation of intervention recommendations can be hampered by cost. Although the cost effectiveness to reduce excess sodium have been calculated for some, predominantly high income nations, these were globally uncertain. The study by Webb and colleagues now sheds light on this.