Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China.

Xian Li,Yangfeng Wu,Yunbo Chu,Alison Hayes,Graham A Macgregor,Jun Ma,Stephen Jan,Lijing L Yan,Haijun Wang,Yanbo Han,Xiangxian Feng,Feng J He,Wenyi Niu,Marissa Collins

doi:10.1371/journal.pone.0183033

Abstract

ObjectiveThe School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program.MethodsCosts of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector.ResultsThe intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained.ConclusionBased on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial.Trial registrationClinicalTrials.gov NCT01821144

Highlights

Cardiovascular disease (CVD), is the leading cause of death and disability worldwide, with approximately 80% of this burden in low-income and middle-income countries and accounting for 42% of total deaths in 2013 in China [1].Elevated blood pressure (BP) is a major cause of cardiovascular disease and dietary salt intake is the major factor that increases BP [2,3,4]
Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY)
Based on World Health Organization (WHO)-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial

Summary

Introduction

Cardiovascular disease (CVD), is the leading cause of death and disability worldwide, with approximately 80% of this burden in low-income and middle-income countries and accounting for 42% of total deaths in 2013 in China [1].Elevated blood pressure (BP) is a major cause of cardiovascular disease and dietary salt intake is the major factor that increases BP [2,3,4]. The School-based Education Program to Reduce Salt Intake in Children and Their Families (School-EduSalt) study provided an innovative approach to reduce salt intake and reduce BP among general population. The study achieved a significant net reduction in salt intake of 1.9 g/d (27%) in children and of 2.9 g/d (25%) in adults, measured by 24-h urine sodium, over a period of one school semester [9]. This reduction in salt intake was accompanied by a significant net fall in systolic blood pressure (SBP) in adults (2.3 mmHg, 95% confidence interval (CI): 0.04–4.5) [9]. In this paper we report on a cost-effectiveness analysis of the School-EduSalt intervention program, both a trial-based analysis as well as modelled over 10 years scaled up nationwide

Methods

Results

Conclusion