Abstract
BackgroundSodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy.Methods and findingsWe used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY < $100,000) by 2021 and to become cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect estimates in the model are based on interventional and prospective observational studies. They are therefore subject to biases and confounding that may have influenced also our model estimates.ConclusionsImplementing and achieving the FDA sodium reformulation targets could generate substantial health gains and net cost savings.
Highlights
Sodium consumption is a leading modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD) [1]
We found that the optimal scenario—100% compliance with the 10-year Food and Drug Administration (FDA) targets— could prevent approximately 450,000 CVD cases, result in the gain of 2.1 million quality-adjusted life years (QALYs), and produce discounted cost savings of approximately $41 billion
The sources of uncertainty we considered were the sampling errors of baseline sodium intake, baseline systolic BP (SBP), and the relative risk of coronary heart disease (CHD) and stroke based on SBP; the uncertainties around the lowest sodium and SBP exposures below which no risk is observed; the uncertainty around the effect of sodium on SBP; the uncertainty around the true incidence of CHD and stroke; the uncertainty of mortality forecasts; the uncertainty around which foods will be reformulated; the uncertainty around the quality of life decrements used to calculate QALYs; and the uncertainty of all the costs
Summary
Sodium consumption is a leading modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD) [1]. CVD remains the leading cause of mortality and morbidity in the US, generating approximately 800,000 deaths and 6 million hospital admissions annually [3]. These CVD burdens cost $318 billion annually in healthcare costs and an additional $237 billion in lost productivity, with further costs of informal care [4]. About 75% of sodium intake comes from processed and commercially produced foods, making industry reformulation a major priority for reducing population sodium intake [6,7]. Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). We aimed to quantify the potential health and economic impact of this policy.
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