Table 1.
Cost effectiveness by income and geographic region of a national government supported policy intervention to reduce sodium consumption by 10% over 10 years*
| Variables | Population characteristics | Costs/capita (I$) (10 year total) | Total DALYs averted per year (average) | 10 year intervention | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Adult population (millions) | Sodium (g/day) (95% UI) | SBP (mm Hg) (95% UI) | Intervention cost | GDP | All CVD (95% UI) | CHD† (95% UI) | Stroke (95% UI) | Other CVD (95% UI) | I$/DALY (95% UI) | ||||
| Total | Weighted average | Weighted average | Weighted average | Weighted average | Total | Total | Total | Total | Weighted average | ||||
| World‡ | 3818 | 4.0 (3.5 to 4.4) | 126 (121 to 132) | 1.13 | 13 529 | 5 781 193 (3 839 910 to 7 649 940) | 2 426 749 (1 592 687 to 3 251 879) | 2 318 402 (1 560 469 to 3 035 231) | 1 036 042 (688 446 to 1 368 222) | 204 (149 to 322) | |||
| High income§ | 755 | 4.0 (3.6 to 4.3) | 127 (122 to 133) | 2.07 | 38 818 | 783 883 (510 386 to 1 054 176) | 396 007 (259 797 to 534 578) | 222 376 (146 908 to 295 486) | 165 500 (107 651 to 221 276) | 465 (341 to 724) | |||
| Upper middle income | 1528 | 4.4 (4.0 to 4.8) | 127 (122 to 132) | 1.09 | 11 001 | 2 660 459 (1 763 649 to 3 486 628) | 1 003 729 (652 361 to 1 333 710) | 1 237 874 (838 534 to 1 617 955) | 418 856 (280 732 to 547 912) | 146 (109 to 223) | |||
| Lower middle income | 1212 | 3.7 (3.3 to 4.3) | 124 (119 to 130) | 0.74 | 4100 | 1 940 077 (1 267 576 to 2 587 018) | 902 273 (578 668 to 1 217 060) | 679 192 (451 077 to 905 715) | 358 612 (234 396 to 476 896) | 111 (81 to 175) | |||
| Low income | 323 | 3.1 (2.3 to 3.8) | 126 (118 to 135) | 0.62 | 1456 | 396 773 (269 537 to 527 676) | 124 739 (84 056 to 166 821) | 178 959 (121 972 to 236 400) | 93 075 (62 353 to 124 737) | 215 (139 to 400) | |||
| Australia and New Zealand | 17 | 3.4 (3.3 to 3.7) | 124 (117 to 131) | 2.63 | 40 181 | 11 254 (7 189 to 15 198) | 6 659 (4 217 to 9 081) | 2 495 (1 588 to 3 357) | 2 100 (1 333 to 2 876) | 880 (646 to 1382) | |||
| Canada and US | 226 | 3.6 (3.4 to 3.8) | 123 (118 to 127) | 1.67 | 48 940 | 238 357 (156 342 to 326 196) | 136 604 (88 092 to 189 180) | 48 032 (31 392 to 64 965) | 53 721 (34 784 to 72 166) | 350 (257 to 537) | |||
| Central Asia/Eastern and Central Europe | 273 | 4.3 (3.6 to 5.0) | 133 (126 to 140) | 2.71 | 14 833 | 944 059 (615 884 to 1 245 547) | 530 472 (347 931 to 707 931) | 307 475 (204 004 to 403 720) | 106 112 (69 804 to 140 615) | 211 (157 to 324) | |||
| East and Southeast Asia | 1354 | 4.6 (4.3 to 5.1) | 126 (121 to 130) | 0.83 | 10 777 | 2 139 880 (1 428 092 to 2 809 299) | 617 817 (405 227 to 826 603) | 1 176 978 (793 689 to 1 535 809) | 345 084 (230 836 to 449 547) | 123 (93 to 184) | |||
| Latin America and Caribbean | 316 | 3.5 (3.1 to 3.9) | 126 (120 to 133) | 0.93 | 12 505 | 325 607 (212 912 to 437 512) | 140 529 (90 822 to 191 668) | 110 632 (72 322 to 146 709) | 74 446 (48 485 to 99 236) | 236 (171 to 375) | |||
| North Africa and Middle East | 225 | 3.9 (3.3 to 4.7) | 125 (118 to 131) | 1.31 | 12 436 | 367 829 (235 762 to 498 060) | 171 883 (109 403 to 233 374) | 112 826 (72 727 to 152 981) | 83 120 (53 259 to 111 970) | 300 (215 to 490) | |||
| South Asia | 786 | 3.7 (3.4 to 4.1) | 123 (117 to 128) | 0.74 | 3551 | 1 136 614 (733 267 to 1 534 026) | 582 096 (364 382 to 791 879) | 331 062 (218 435 to 444 645) | 223 456 (143 221 to 299 264) | 116 (85 to 182) | |||
| Sub-Saharan Africa | 320 | 2.5 (2.0 to 3.0) | 130 (123 to 137) | 0.83 | 2743 | 335 053 (202 998 to 468 036) | 95 140 (58 076 to 133 355) | 156 910 (95 447 to 218 782) | 83 003 (50 151 to 116 135) | 255 (166 to 473) | |||
| Western Europe | 301 | 3.8 (3.5 to 4.3) | 130 (124 to 136) | 1.98 | 35 676 | 282 541 (183 440 to 380 484) | 145 548 (94 348 to 196 380) | 71 992 (46 942 to 96 720) | 65 000 (41 894 to 87 414) | 477 (350 to 744) | |||
DALYs=disability adjusted life years; UI=uncertainty interval; SBP=systolic blood pressure; GDP=gross domestic product; CVD=cardiovascular disease; CHD=coronary heart disease.
*National program including: public health campaign targeting consumer knowledge and choices, government supported industry agreements to reduce sodium in processed foods to specific targets, and government monitoring of industry compliance. These results reflect the total effect over a 10 year policy intervention that includes planning (year 1), development (year 2), partial implementation (years 3-5), and full implementation (years 6-10). To enable comparisons between countries, all costs were evaluated in international dollars (I$), accounting for each nation’s currency and purchasing power parity. One I$ in any given country can be interpreted as the funds needed to purchase the same amounts of goods or services in that country as one US$ would purchase in the US. For countries with lower income than in the US, conversion of our findings from I$ to US$ would substantially increase the apparent cost effectiveness (ie, the cost in US$ per DALY saved would be much lower).
†Stroke includes ischemic stroke and hemorrhagic and other non-ischemic stroke; and other CVD includes aortic aneurysm, atrial fibrillation and flutter, cardiomyopathy and myocarditis, endocarditis, hypertensive heart disease, peripheral vascular disease, rheumatic heart disease, and other cardiovascular and circulatory diseases.
‡In 2010 globally, the total burden of CVD was 295 035 800 DALYs, of which CHD accounted for 129 819 900 DALYs, stroke 102 232 300 DALYs, and other CVD 62 983 600 DALYs. There were 14 669 000 total CVD deaths, of which 6 963 000 were CHD deaths, 5 798 000 stroke deaths, and 1 909 000 other CVD deaths. The numbers of deaths in each subtype may not exactly sum to the total CVD deaths owing to rounding.
§Income categorizations are based on the World Bank classification system (http://data.worldbank.org/about/country-classifications/country-and-lending-groups).