Abstract
Background: Excess sodium intake is a major risk factor for CVD globally. Yet, the cost-effectiveness of policy interventions to reduce sodium consumption in every country has not been quantified. Methods: We characterized global sodium intakes, blood pressure (BP) levels, effects of sodium on BP, and CVD rates, each by age and sex in 187 countries based on the 2010 Global Burden of Diseases study. Nation-specific costs of a policy that combined education with targeted industry agreements to reduce sodium were estimated using the WHO NCD Costing Tool. Nation-specific impacts on mortality and disability-adjusted life years (DALYs) were modeled using comparative risk assessment, based on various scenarios including 10%, 30%, 1 g/d, and 3 g/d achieved sodium reductions over 10 yrs. Cost-effectiveness (CE) was evaluated as PPP-adjusted international $ per DALY saved over 10 yrs. Results: Worldwide, a 10% sodium reduction within each country was projected to avert an average of 5,655,000 CVD-related DALYs/year, at an average cost of 1.11 international dollars per capita over the 10 yr intervention. The average CE ratio was I$207/DALY. Across 21 world regions, sodium reduction would be most CE in South Asia and East/Southeast Asia (each I$120/DALY); across 187 countries, the most CE were Moldova (I$9.89/DALY), Azerbaijan (I$12.82/DALY), and Uzbekistan (I$12.85/DALY). The least CE region was Australia/New Zealand (I$922/DALY), although this CE was still substantially below the usual threshold to define an intervention as CE (3.0 GDP per capita). 99% of the world's population live in countries in which the intervention had a CE ratio < 1.0 GDP per capita, and 95% in countries with a CE ratio < 0.1 GDP per capita - far below standard acceptable CE ratios of 3.0 GDP per capita. Conclusions: National education and industry-agreement strategies to reduce dietary sodium would have substantial impacts on CVD and be extremely cost-effective in nearly every country worldwide. CE of 10% reduction intervention: GDP/capita per DALY
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