Abstract P369: Population Strategies to Reduce Sodium Intake in Iran: A Cost-Effectiveness Analysis
BACKGROUND: High intake of sodium is a major preventable risk factor for CVD mortality in Iran. While effective population strategies to reduce sodium intake have been identified, the cost-effectiveness of these strategies in Iran is not established.
Objective: To evaluate the cost-effectiveness of a national sodium reduction program in Iran consisting of a voluntary agreement with industry to reduce the sodium content in processed foods and a mass media campaign to encourage consumers to make low-sodium choices.
METHODS: We developed a Monte Carlo microsimulation model and simulated CVD events for a sequence of individuals by randomly drawing characteristics of each person (age, sex, CVD risk factors) from their corresponding population distributions and tracking the person individually one after the other from entry into the model until death. The study population included Iranian adults (>25 y) free of CVD and diabetes. Data on population distributions of the CVD risk factors, by age and sex, were obtained from the 2010 Global Burden of Disease study. Yearly risk of the first MI/stroke/CVD death was estimated based on characteristics of each person using the Framingham risk function. Yearly probability of non-CVD death was obtained from WHO life tables. Using the most recent meta-analysis of dose-response effects of sodium on systolic blood pressure (SBP), we modelled the SBP-mediated effect of the intervention on CVD events and mortality and quantified the effect of the intervention based on the number of Quality-adjusted Life Years (QALYs) gained. Intervention costs and healthcare costs, in international dollar, were obtained from WHO-CHOICE database. We performed a range of sensitivity analyses based on varying assumptions about the effectiveness of the intervention on sodium intake, effect of sodium on SBP, and a range of intervention costs.
RESULTS: A multicomponent population intervention to reduce sodium intake by 10% among Iranian adults with no history of CVD or diabetes would result in average gain of 0.01 QALY and saving of $67.5 per person and a total gain of 407,487 QALYs and estimated savings of $2.85 billion. This national sodium reduction initiative is associated with higher QALYs, lower costs and dominated the status quo. In sensitivity analyses, we found that such an intervention would be cost-saving even if the effectiveness is reduced by 80% or the cost is increased by 500%.
CONCLUSION: A national program to reduce sodium intake in Iran is cost-saving and should be a priority intervention to reduce the burden of CVD in this country.
Author Disclosures: A. Afshin: None. S. Fahimi: None. J. Powles: None. G. Danaei: None. D. Mozaffarian: None.
- © 2015 by American Heart Association, Inc.