Cost-effective Policy Research Articles

Machine learning and national health data to improve evidence: Finding segmentation in individuals without private insurance

ObjectiveIndividuals without private health insurance have less access to healthcare, therefore are more prone to experience poor health when compared to those who have. Segmentation is an approach to find homogenous groups of people with the purpose of tailoring services and products. In public policy, segmentation might be used to identify characteristics and needs of specific groups and deliver targeted programs and spare costs. We aim to identify and describe segments within the uninsured population to aid targeted policy actions and improve health. MethodsWe used secondary data collected from a representative, nationwide health survey (n=18,204). For the purpose of our analysis, we included data from individuals who answered “no” to the question: “Do you have private health insurance?” (n=12,134). Variables pertaining information on socio-demographic, health status, access and care were used. A multiple correspondence analysis was performed to find principal components followed by a hierarchical cluster. ResultsWe found three clusters. The first (54.12% of our sample) composed by a group of young, middle aged and professionally active individuals without health problems. The second (36.70%), a cluster of aging individuals composed especially by elderly women, either retired or fulfilling domestic tasks, with a long-term health problem. The last (9.17%) composed by elder people, with long-term health problem and scoring low in mental health related questions. ConclusionOur study found three clusters (profiles of individuals) among the uninsured. Ultimately, our findings aim to support policy makers to deliver customized actions to improve health and provide cost-effective policies.

Applying latent class analysis to investigate rural highway single-vehicle fatal crashes in China

Rural highways are an important component of highway networks in developing countries. The high fatality rates of single-vehicle crashes in these highways recently attracted increasing attention. Given that most studies on the factors that affect the severity of single-vehicle crashes in rural highways were conducted in developing countries, the present study investigated this issue in a Chinese setting by analyzing the single-vehicle crash data of rural highways in Anhui Province, China from 2014 to 2017. First, in consideration of the unobserved heterogeneity of crash data, a method that combines latent class analysis (LCA) and binary logistic regression (BLR), which is called LC-BLR, was applied to identify the significant factors that affect the severity of single-vehicle crashes in rural highways. Second, the goodness-of-fit and prediction accuracy of the LC-BLR model and the BLR model were compared. Results revealed that the performance of the former was more satisfactory than that of the latter. Finally, countermeasures were proposed based on the analysis of the main factors that affect each sub-class crash in the LC-BLR model. The LC-BLR model results indicated that collision typewas significant in all three sub-class models considered in the analysis, but the effects on crash severity varied. Several variables (e.g., driving license state, time of week, driver age) demonstrated a significant effect in a specific sub-class model, thereby indicating that these factors were only effective in mitigating the crash severity of one sub-class. The findings of this study can facilitate the development of cost-effective policies or countermeasures for reducing the severity of single-vehicle crashes in rural highways.

Alcohol Control Policy in Europe: Overview and Exemplary Countries.

Alcohol is a major risk factor for burden of disease. However, there are known effective and cost-effective alcohol control policies that could reduce this burden. Based on reviews, international documents, and contributions to this special issue of International Journal of Environmental Research and Public Health (IJERPH), this article gives an overview of the implementation of such policies in the World Health Organization (WHO) European Region, and of best practices. Overall, there is a great deal of variability in the policies implemented between countries, but two countries, the Russian Federation and Lithuania, have both recently implemented significant increases in alcohol taxation, imposed restrictions on alcohol availability, and imposed bans on the marketing and advertising of alcohol within short time spans. Both countries subsequently saw significant decreases in consumption and all-cause mortality. Adopting the alcohol control policies of these best-practice countries should be considered by other countries. Current challenges for all countries include cross-border shopping, the impact from recent internet-based marketing practices, and international treaties.

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors

The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals. We review key aspects of the GBD and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected. We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment. A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy.

Be the Match: Optimizing Capacity Allocation for Allogeneic Stem Cell Transplantation

Problem definition: Treating many blood-related diseases requires transplantation of genetically compatible hematopoietic stem cells (HSCs) extracted from the bone marrow (BM) of live donors or the umbilical cord blood (CB) of babies. To facilitate the search for HSCs, institutions known as BM registries collect the details of potential donors and CB banks store units of CB. This paper focuses on the problem of joint optimization of the capacity of these two institutions. Academic: With over 10 million genetic variants, limited inventory relative to this variety, and random replenishment, BM registry and CB bank compositions are random, inter-dependent, and change nondeterministically over time. Furthermore, BM and CB differ in their supply, costs, genetic matching criteria, and influenc s on medical outcomes, giving rise to important trade-offs such that neither is preferred exclusively to the other. Jointly determining the optimal capacity of both sources is therefore both technically challenging and has immediate policy implications. Methodology: We develop a simulation-based approach to estimate the temporal variation in matching probabilities before incorporating the associated regression parameters into a mathematical model closely matching the research context. Results are contrasted against a simplified mathematical model, highlighting the importance of the dynamic setup. Results: Inventories of 17.5 million registered BM donors and 335 thousand CB units are estimated as optimal for the U.S. population under reasonable assumptions. Expanding capacity to these levels would satisfy 33% of the currently unmet demand, increasing the transplantation rate to 98.7% and delivering $770 million of extra social surplus annually. Managerial Implications: Rigorous policy analyses are imperative for designing evidence-based, cost-effective policies that deliver societal benefits. To this end, we provide quantitative evidence in support of calls for further expansion of the national BM registry and CB banks in the U.S. We also propose annual recruitment targets for BM donors and CB units to maintain the two institutions at their suggested levels.

Cost-effectiveness of medically assisted reproduction or expectant management for unexplained subfertility: when to start treatment?

Cost-effectiveness of medically assisted reproduction or expectant management for unexplained subfertility: when to start treatment?

Policies to prevent non-communicable disease: implementation trends in 194 countries 2015–2020

Abstract Background Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide. The WHO proposed 19 “Best Buy” policies to prevent NCDs, mainly addressing four leading risk factors: tobacco, alcohol, unhealthy diets and insufficient physical exercise. Yet, little is known about how implementation has changed over time and the role of geopolitical factors. This study addresses that crucial gap. Methods We calculated policy implementation scores for all 194 WHO member states from the 2015, 2017 and 2020 WHO NCD Progress Monitor Reports. We analyzed global trends across the three years for all countries and by geopolitical group and used linear regression to assess association with health, economic and political indicators. Results The global average implementation score in 2020 was 47.0% (SD 19.8%), compared to 44.9% (SD 19.1%) in 2017 and 39.0% (SD 19.3%) in 2015. Implementation scores varied by income level (p < 0.001), with high-income countries' average implementation score over twice that of low-income countries (59.7% vs. 28.9%). Implementation improved for all policies in 2015-2020 except the three alcohol policies which decreased. Implementation scores were associated with the proportion of deaths due to NCDs (β 0.8, 95% confidence interval 0.7-0.9, p < 0.001); however, on average, countries with a greater increase in the proportion of deaths due to NCDs were less likely to implement NCD policies (p < 0.001). Conclusions Implementation of policies to prevent NCDs is improving over time, but the average implementation score remains below 50% and progress is uneven. Our findings suggest the need to increase implementation of recommended interventions, particularly in low- and middle-income countries and where the proportion of NCD deaths is growing fastest, and to urgently address the decreasing level of implementation of alcohol interventions. Key messages Implementation of recommended, cost-effective policies to prevent NCDs is improving but remains low, and alcohol policies are decreasing. Low-income countries, and countries where the proportion of deaths due to NCDs is growing the fastest, are least likely to have recommended policies in place to prevent NCDs.

Impact of a recent tobacco tax reform in Argentina.

The literature on policies for the control of the tobacco epidemic suggests that increasing excise taxes on the consumption of tobacco products is the most cost-effective policy. Cigarette tax structure in Argentina is very complex. All the tax bases for cigarette consumption taxes are related and, therefore, any modification of a tax affects the collection of the rest of the taxes. This is important given that funds raised by one of the taxes, the Special Tobacco Fund (FET), are allocated among the tobacco provinces according to the value of tobacco production. These provinces oppose in the congress to any reform that increase taxes on cigarette consumption that negatively affects these funds. In May 2016, the government decided to increase the rate of one of the taxes, the internal tax, from 60% to 75%. We study the impact on cigarettes' demand price elasticity, consumption and tax revenues of this tobacco tax reform. Using an Error Correction Model, we estimate short-run and long-run demand price and income elasticities. We find that the tax reform of May 2016 induced an increase in the magnitude, in absolute value, of the short-run demand price elasticity and at the same time increased the funds collected by the FET. We simulate the effects of the tax reform over the government revenues and per-capita consumption of cigarettes showing that additional increments in taxes would increase revenues and diminish consumption of cigarettes.

Alcohol policy in Chile: a systematic review of policy developments and evaluations.

To comprehensively review enacted and proposed alcohol laws and existing impact evaluations of national alcohol policies in Chile. We searched enacted laws in the Chilean National Library of Congress, proposed laws in the websites of the House of Deputies and Senate and impact evaluations in PubMed, Web of Science, Scopus, Scielo, JSTOR, Epistemonikos and OpenGrey from inception to February 2019. Eligibility criteria included enacted laws and proposed laws on national alcohol policies and research studies evaluating the impact of national alcohol policies. One author screened enacted laws and proposed laws; two authors independently screened research records. We included any national alcohol policy intervention and classified policies according to 10 World Health Organization (WHO) alcohol policy domains. We used the Cochrane EPOC Review Group criteria to assess risk of bias of research records. We registered the review protocol in PROSPERO, registration record CRD42016050156. We identified and screened 229 enacted laws, 138 proposed laws and 1538 research records. Of these, 72 enacted laws, 118 proposed laws and three research articles were eligible for synthesis. We found enacted policies in all WHO alcohol policy domains. Regarding the most cost-effective policies, Chile has made limited use of taxation, has not regulated alcohol marketing and has weakened alcohol availability regulation. We found a large number of proposed laws, 79% of which would strengthen alcohol control. The few impact evaluation studies examined drink-driving policies and found a short-term reduction of alcohol-related injuries and deaths. Chile has enacted alcohol policies in all World Health Organization policy domains, but has not adopted policies with highest likely cost-effectiveness. Only the impact of drink-driving policies has been evaluated.

INVESTIGATING COST-EFFECTIVE POLICY INCENTIVES FOR RENEWABLE ENERGY IN JAPAN: A RECURSIVE CGE APPROACH FOR AN OPTIMAL ENERGY MIX

The Great East Japan Earthquake (GEJE) and Fukushima nuclear disaster that occurred in 2011 gave a sharp reminder to Japan’s energy security to reconsider the reduction of nuclear power dependence with a better energy mix. We use a recursive CGE model based on Japan’s renewable energy input–output model to analyze the energy composite of power generation and consumption to investigate cost-effective policy incentives to achieve an optimal energy mix to reduce the nuclear power dependence to less than 5% within 10 years. Moreover, we create scenarios of: (1) nuclear power decommission, (2) renewable energy promotion and (3) virtual power plant (VPP) implementation with public R&D expenditure and power infrastructure investment. The simulation results show that renewable energy could gradually replace nuclear power with capital-use subsidies. Under the direction of nuclear power decommission, the VPP installation could reduce the fiscal cost of wind power by 13%, solar energy by 8% and the social cost by 36%. We provide empirical evidence that the implementation of VPP should be promoted in addition to the renewable policy promotion policy to facilitate power allocation and overcapacity problems better.

Cost-effectiveness of health technologies in adults with type 1 diabetes: a systematic review and narrative synthesis

BackgroundWith the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We therefore aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of cost-effectiveness.MethodsA systematic search was conducted in April 2019 that focused on modelling or trial based economic evaluations. Searched databases included Medline, Medline in-process and other non-indexed citations, EMBASE, PubMed, All Evidenced Based Medicine Reviews, EconLit, Cost-effectiveness analysis Registry, Research Papers in Economics, Web of Science, PsycInfo, CINAHL, and PROSPERO from inception. We assessed quality of included studies with the Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making an ISPOR-AMCP-NPC good practice task force report. Screening of abstracts and full-texts, appraisal, and extraction were performed by two independent researches.ResultsWe identified 16,772 publications, of which 35 were analysed and included 11 health technologies. Despite a lack of consensus, most studies reported that insulin pumps (56%) or interstitial glucose sensors (62%) were cost-effective, although incremental cost-effectiveness ratios ranged widely ($14,266–$2,997,832 USD). Cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Determinants of cost-effectiveness included treatment effects on glycosylated haemoglobin and hypoglycaemia, costing of technologies and complications, and measures of utility.ConclusionsInsulin pumps or glucose sensors appeared cost-effective, particularly in populations with higher HbA1c levels and rates of hypoglycaemia. However, cost-effectiveness for combined insulin pumps and glucose sensors was less clear.RegistrationThe study was registered with PROSPERO, number CRD42017077221.

Using Place-Based Jobs Policies to Help Distressed Communities

Place-based jobs policies seek to create jobs in particular local labor markets. Such policies include business incentives provided by state and local governments, which cost almost $50 billion annually. The most persuasive rationale for these policies is that they can advance equity and efficiency by increasing long-term employment rates in distressed local labor markets. However, current incentives are not targeted at distressed areas. Furthermore, incentives have high costs per job created. Lower costs can be achieved by public services to business, such as manufacturing extension, customized job training, and infrastructure. Reforms to place-based jobs policies should focus on greater targeting of distressed areas and using more cost-effective policies. Such reforms could be achieved by state and local governments acting in their residents’ interests or could be encouraged by federal interventions to cap incentives and provide aid to distressed areas.

Knowledge Spillover and Positive Environmental Externality in Agricultural Decision Making under Performance-Based Payment Programs

Agricultural activities have imposed significant impacts on water resources, leading to hypoxic zones and harmful algal blooms all over the world. Government agencies, nongovernmental organizations, and individuals have been making various efforts to reduce this non-point source pollution. Among those efforts, even the more cost-effective examples of performance-based environmental payment programs generally have low participation rates. We investigate the effects of externalities in farmers’ decisions on neighboring farms, incorporating both a knowledge spillover effect and a positive environmental outcome externality of farmers’ best-management practice (BMP) adoption decisions. Our focus is on how these effects may influence the outcome of performance-based payment programs and how policy makers might recognize these effects in the design of cost-effective policies to promote program participation and BMP adoption. Rather than imposing an assumption of profit-maximization or forward-looking behavior, we allow outcomes to emerge from interactions among neighboring farmers. We recommend cost-effective policies across communities depending on their composition. It is more cost-effective to target communities with fewer innovators and/or target the programs towards the least-innovative individuals.

Higher-order patterns of aquatic species spread through the global shipping network.

The introduction and establishment of nonindigenous species (NIS) through global ship movements poses a significant threat to marine ecosystems and economies. While ballast-vectored invasions have been partly addressed by some national policies and an international agreement regulating the concentrations of organisms in ballast water, biofouling-vectored invasions remain largely unaddressed. Development of additional efficient and cost-effective ship-borne NIS policies requires an accurate estimation of NIS spread risk from both ballast water and biofouling. We demonstrate that the first-order Markovian assumption limits accurate modeling of NIS spread risks through the global shipping network. In contrast, we show that higher-order patterns provide more accurate NIS spread risk estimates by revealing indirect pathways of NIS transfer using Species Flow Higher-Order Networks (SF-HON). Using the largest available datasets of non-indigenous species for Europe and the United States, we then compare SF-HON model predictions against those from networks that consider only first-order connections and those that consider all possible indirect connections without consideration of their significance. We show that not only SF-HONs yield more accurate NIS spread risk predictions, but there are important differences in NIS spread via the ballast and biofouling vectors. Our work provides information that policymakers can use to develop more efficient and targeted prevention strategies for ship-borne NIS spread management, especially as management of biofouling is of increasing concern.

Cost-Effectiveness of Utilization of Hepatitis B Virus-Positive Liver Donors for HBV-Negative Transplant Recipients

BackgroundUtilization of hepatitis B virus (HBV)-infected donors represents an opportunity to expand the liver transplantation (LT) donor pool. However, benefits of accepting HBV-positive donors for HBV-negative candidates, potentially expanding the donor pool resulting in earlier transplantation, must be balanced with costs of lifelong antiviral therapy. The aim of this study was to evaluate cost-effectiveness of this strategy. MethodsWe developed a Markov model with two strategies, transplant with (1) a HBV-positive donor versus and (2) a HBV-negative donor for a HBV-negative LT candidate. A healthcare system perspective was utilized, effectiveness measured in quality-adjusted life-years, and costs in 2018 USD. ResultsIn the base-case, the HBV-positive donor strategy is more effective (gain of 0.46 QALYs), but $26,159 more expensive, yielding an incremental cost-effectiveness ratio (ICER) of $57,389/QALY. However, increasing the candidate’s Model for End-Stage Liver Disease score resulted in increasing cost-effectiveness, ICER of $69,507/QALY (MELD 6–10) to $47,385/QALY (MELD > 30). Results were most sensitive to antiviral cost and cost after first year of LT. In probabilistic sensitivity analysis, the HBV-positive strategy was always more effective but more expensive, with average ICER of $64,883/QALY. This strategy was highly cost-effective (ICER < $50,000/QALY) 21% of the time and cost < $100/000/QALY 94% of the time. ConclusionsConsideration of these donors must be individualized to each candidate’s severity of liver disease, associated costs, and personal preferences that impact quality of life. Expansion of the donor pool to include HBV-positive donors for appropriate recipients may be a cost-effective policy and may provide significant benefit for individual patients.

COVID-19 in Iran: the Good, the Bad, and the Ugly Strategies for Preparedness - A Report From the Field.

The emergence of coronavirus disease 2019 (COVID-19), a novel unknown virus that is challenging whole countries all over the world, has prompted different strategies from various governments. Iran, as one of the first countries to experience the onset of the virus outbreak, made and implemented some policies that should be assessed, so that lessons may be learned for the future. Although some negative actions and policies, such as delays in cancellation of international flights especially from China, not taking the disease seriously and comparing it with seasonal influenza, and the like, are hard to ignore, some impressive actions are also vividly clear. Policies, such as social distancing, dramatically increasing social awareness about preventive actions in terms of public health, and using masks and hand washing, were cost-effective policies that resulted in successful control of the virus in the first onset. While some quite clearly ineffective decisions were made by Iranian authorities, the huge catastrophic effect of sanctions cannot be forgotten. Possibly in level situations with similar countries, Iran will have far better results regarding preparedness for future pandemics like COVID-19.

Epidemiological Realities of Alcoholic Liver Disease: Global Burden, Research Trends, and Therapeutic Promise

Globally, alcohol consumption contributes to more than 3 million deaths each year. While much of its ramifications is preventable, a coherent public health discourse on how to limit alcohol-related harm has been overdue. By synthesizing information from national and global databases, we show in this analysis that alcohol consumption level and alcohol-attributable burden of diseases, particularly alcoholic liver disease (ALD), are intimately linked to national income distribution, cultural norms, religion, sex, age, and health status. Prevalence and burden of ALD are positively associated with economic standing in most countries, which necessitate active governmental control via cost-effective policies, such as the best buys proposed by the World Health Organization. To date, a number of critical questions remain unanswered over the molecular mechanisms underlying ALD pathophysiology; the insights gained thereof should provide new opportunities for the advancement of novel diagnostic and management strategies. In comparison with other prevailing liver diseases (e.g., viral hepatitis and nonalcoholic fatty liver disease), governmental support to ALD investigation has been sluggish in most Western countries and China, resulting in a dearth of breakthroughs on both the basic and clinical research fronts in the past decades. Emerging foci of clinical trials for ALD therapy include empirical use of probiotics, antioxidants, growth factors, monoclonal antibodies against key inflammatory mediators, and technology-enhanced behavioral interventions. In this article, we seek to provide a comprehensive analysis on the progress and challenges in tackling ALD as a global health problem, with particular emphasis on global disease burden, socioeconomic influences, research trends, government roles, and future therapies.

Distributional impacts of soil erosion on agricultural productivity and welfare in Malawi

We investigate the economic distributional effects of soil loss in Malawi, where erosion deprives rural households of the natural capital necessary to boost agricultural production and lifts food security. We employ a two-year dataset combining unique topsoil loss data with socio-economic, agro-ecological and climatic information both at household and plot level. We consider heterogenous impacts of soil loss in productivity, total consumption and caloric intake by estimating an unconditional quantile regression model. The role of different agricultural practices in mitigating the negative impacts of soil loss is also considered to assess cost-effective policy options and compensation mechanisms and to provide aggregated effects. We show that large heterogeneous impacts currently exist across the most exposed population groups and such impacts could translate in a production loss equivalent to 1 to 3% of Malawi’s GDP under different increasing soil erosion scenarios.

Sustainability and development after COVID-19.

Developing countries are highly vulnerable to the COVID-19 pandemic, in part due to the lack of international support for ensuring progress towards the 17 Sustainable Development Goals (SDGs). Yet the mounting financial burden faced by all countries means that additional support is unlikely to be forthcoming in the near future. It is critical that developing countries find innovative policy mechanisms to achieve sustainability and development aims in a cost-effective manner. This requires identifying affordable policies that can yield immediate progress towards several SDGs together and aligns economic incentives for longer term sustainable development. We identify three policies that meet these criteria: a fossil fuel subsidy swap to fund clean energy investments and dissemination of renewable energy in rural areas; reallocating irrigation subsidies to improve water supply, sanitation and wastewater infrastructure; and a tropical carbon tax, which is a levy on fossil fuels that funds natural climate solutions. Such innovative and cost-effective policy mechanisms do not require substantial external support, and they foster greater progress towards achieving the SDGs in poorer economies.

Modelling the effect of compliance with WHO salt recommendations on cardiovascular disease mortality and costs in Brazil.

IntroductionCardiovascular diseases (CVDs) represent the main cause of death among non-communicable diseases (NCDs) in Brazil, and they have a high economic impact on health systems. Most populations around the world, including Brazilians, consume excessive sodium, which increases blood pressure and the risk of CVDs.ObjectiveTo model the estimated deaths and costs associated with CVDs, which are mediated by increased blood pressure attributable to excessive sodium consumption in adults from the perspective of the Brazilian public health system in 2017.MethodsWe employed two macrosimulation methods, using top-down approaches and based on the same relative risks. The models estimated the mortality and costs-of-illness attributable to excessive sodium intake and mediated by hypertension for adults aged over 30 years in 2017. Direct healthcare cost data (inpatient care, outpatient care and medications) were extracted from the Ministry of Health information systems and official records.ResultsIn 2017, an estimated 46,651 deaths from CVDs could have been prevented if the average sodium consumption had been reduced to 2 g/day in Brazil. Premature deaths related to excessive sodium consumption caused 575,172 Years of Life Lost and US$ 752.7 million in productivity losses to the economy. In the same year, the National Health System’s costs of hospitalizations, outpatient care and medication for hypertension attributable to excessive sodium consumption totaled US$192.1 million. The main causes of death and costs associated with CVDs were coronary heart disease and stroke, followed by hypertensive disease, heart failure and aortic aneurysm.ConclusionExcessive sodium consumption is estimated to account for 15% of deaths by CVDs and to 14% of the inpatient and outpatient costs associated with CVD. It also has high societal costs in terms of premature deaths. CVDs are a leading cause of disease and economic burden on the global, regional and country levels. As a largely preventable and treatable conditions, CVDs require the strengthening of cost-effective policies, supported by evidence, including modeling studies, to reduce the costs relating to illness borne by the Brazilian public health system and society.