| (31) |
Cobiac et al., 2017Australia |
Salt tax: A 0.30/g of sodium in excess of Australian maximum recommended levels, excluding fresh fruits, vegetables, meats, and dairy products.Other interventions tested:
Saturated fat tax of A 1.37/100 g Sugar-sweetened beverage tax of A 0.47/L Fruit and vegetable subsidy of A 0.14/100 g Sugar tax of A 0.94/100 mL of ice cream and A 0.85/100 g of sugar
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Modeling study using price survey data from Australian supermarkets; price elasticity data and a proportional multistate lifetable model |
Changes to dietary intake and dietary cost DALYS averted Cost-savings from reduced disease burden Cost-effectiveness of each intervention modeled
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Excess salt tax would reduce salt consumption by 67 mg/d and total energy intake by 161 kJ/d. Marginally negative effect on fruit and vegetable intake. Negligible impact on food costs Estimated 130,000 DALYS averted (total population 22 million) saving A 2 billion in health costs Sugar tax resulted in the largest health gain (270,000 DALYs averted) and cost savings (A 4 billion), followed by salt Combination of taxes and subsidy could avert 470,000 DALYs with a net cost saving of A 3.4 billion to the health sector Excess salt tax led to a “dominant” cost-effectiveness (i.e., increase in net health gain and cost-savings)
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| (32) |
Harding and Lovenheim, 2017 United States |
Salt tax: 20% tax applied to products based on their salt content, across 14 product groups.Other interventions tested:
20% product-specific tax: applied on products considered to be unhealthy 20% nutrient-specific tax: applied based on a product's fat and sugar content 20% sugar-sweetened beverage tax: applied on products that have large sugar content
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Modeling study based on transaction-level data from a large sample of US consumers and product-specific nutrient information |
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The 20% salt-specific tax was estimated to reduce the total salt purchased by households by 10.0%/mo, which is equivalent to 18,792 mg of salt. Across the 14 product groups, the salt tax was estimated to reduce the salt purchased in 12 groups, ranging from 35.5 mg (baking goods) to 4591.1 mg (canned foods and sauces). The utility cost of this tax was low, at 1.2% (US 10.95) The tax was estimated to also reduce the calories, total fat, and sugar purchased by households monthly by 10.63%, 10.51%, and 1.53%, respectively
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| (38) |
Caro et al., 2017 Chile |
Salt tax: stand-alone salt tax was not considered. Other interventions tested:
18% price tax on foods and beverages high in fat, salt, and added sugar 40% sugar-sweetened beverage tax 1 Chilean peso per gram of sugar tax on products with added sugar
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Modeling study looking at changes in nutrient availability, based on income and expenditure data survey using a utility-based structural model |
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Scenarios 1 and 3 led to significant reductions in sodium from all food groups, by 22.52 mg and 11.49 mg, respectively Of the 3 scenarios, the 18% tax produced the largest reductions in calories, carbohydrates, sugar, sodium, total fats, and saturated fats from the “junk” food group (i.e., sweets and desserts, salty snacks and chips, ready-to-drink SSBs, and SSBs from concentrates) The changes in nutrient availability for both low-income and mid-to-high-income households were comparable, and consistent with the overall results
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| (34) |
Nghiem et al., 2015 New Zealand |
Salt tax: excise tax on salt increased progressively by ≤20% annually to achieve a salt intake level of 2300 mg/d.Other interventions tested:
Dietary counseling by dietitians Endorsement label program Mandatory reduction of salt in breads, processed meats, and sauces Mandatory reduction of salt in processed foods by 25% UK Package: media campaigns, voluntary food reformulation, and food labeling Mass media campaign component of the UK Package Reduction in the amount of food-grade salt released to NZ market
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Modeling and cost-utility analysis using Markov model, based on a cohort of 2.3 million adults aged >35 y |
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Salt tax was associated with 195,000 QALYs gained, and produced discounted net savings of NZ 1.0 billion over the remainder of the cohort's life, due to CVD treatment costs averted The tax was estimated to produce NZ 452 million in revenue per year
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| (35) |
Ni Mhurchu et al., 2015 New Zealand |
Salt tax:
20% tax on major dietarysources of sodium Combination of 20% tax on major sources of sodium and saturated fat, and 20% subsidy on fruit and vegetables. Other interventions tested:
20% subsidy on fruit and vegetables 20% tax on major dietary sources of saturated fat 20% tax on major food contributors to carbon emissions
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Modeling study looking at dietary intake and resulting effects on diet-related diseases using household expenditure data and demand elasticities |
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The sodium tax was estimated to reduce the total energy and sodium purchases by 7.17% and 10.77%, respectively, but increase saturated fat purchases by 2.19%. The combination of taxes (sodium and saturated fat) and subsidy (fruit and vegetables) reduced household purchases of total energy, sodium, and saturated fat by 6.15%, 10.79%, and 3.64%, respectively The sodium tax and the combination scenario were associated with 1977 and 2352 lives saved per year, respectively, mostly from deaths averted due to CVDs Effects were equal or larger in low-income and Maori households
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| (37) |
Smith-Spangler et al., 2010 United States |
Salt tax: excise tax on sodium used for food production at the industrial level, which would increase the price of salty foods by 40%.Other interventions tested: collaboration with food industry through voluntary reduction in sodium content of processed foods |
Modeling study using Markov model to assess cost-effectiveness of the interventions |
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The sodium tax was estimated to avert 327,892 strokes and 306,137 MIs over the lifetime of adults aged 40–85 y, leading to ∼840,113 LGYs and 1.3 billion QALYs gained, and saving US 22.4 billion in direct medical costs
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| (36) |
Nnoaham et al., 2009 United Kingdom |
Salt tax: stand-alone salt tax was not considered.Other interventions tested:
17.5% VAT on major dietary sources of saturated fat 17.5% VAT on foods defined as less healthy by WXYfm nutrient profiling (includes foods high in salt) Scenario 2 combined with 17.5% subsidy on fruit and vegetables Scenario 2 combined with 32.5% subsidy on fruit and vegetables
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Modeling study based on national data on food expenditure and consumption |
Changes in food and nutrient purchases Changes in annual deaths from CHD, stroke, cancer, and CVD Economic impact on households (by income quintile)
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Scenarios 2, 3, and 4 reduced average salt consumption by 1.86%, 1.10%, and 0.45%, respectively. Scenario 1 led to a small increase in salt intake, of 0.24% Scenarios 1 and 2 marginally increased total deaths annually, due to falling intake of fruit and vegetables that outweighs impact of reduced consumption of unhealthy foods Scenarios 3 and 4 prevented 1563–2870 and 3689–6435 deaths annually, a relatively small number in the UK context All 4 scenarios are economically regressive, with the poorest households absorbing proportionally higher costs than richer households. By contrast, the health gain is even across income quintiles
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| (33) |
Mytton et al., 2007 United Kingdom |
Salt tax: stand-alone salt tax was not considered.Other interventions tested:To extend 17.5% VAT to
Main sources of saturated fat Foods classified as unhealthy using SSCg3d model (includes high salt) A targeted “best outcome” package of unhealthy foods identified by the authors
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Modeling study based on consumption, expenditure, and elasticity data from National Food Survey |
Changes to household food expenditure Changes to consumption, including salt intake Changes to mortality for IHD, stroke, and overall CVD deaths
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The 3 scenarios predicted a decrease in fruit and vegetable intake by 1.2–3.9%, and increase in household food expenditure by 3.2–4.6% Scenario 1 increased salt intake by 5.2%, whereas scenarios 2 and 3 reduced salt consumption by 5.8% and 6.6%, respectively Scenario 1 resulted in more IHD, stroke, and overall CVD deaths. Scenario 2 predicted 2100–2500 fewer deaths annually, primarily due to reduction in salt intake. Scenario 3 produced a larger reduction in CVD deaths (2600–3200), due to reduced salt intake
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| (45) |
Schorling et al., 2017 OECD countries |
Salt tax: Nghiem et al. (34) and Smith-Spangler et al. (37) modeling studies, included above.Other interventions tested: voluntary and mandatory salt substitution and reduction, dietary advice, labeling, and awareness campaign |
Review of cost-effectiveness and cost-utility analyses of salt reduction studies |
Changes in salt intake and SBP Incremental benefit as QALYs, DALYs, or life-years gained
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Fourteen studies covering 62 scenarios were found, of which 59 were cost-saving The ICER for salt taxation was Intl. 19,000 per QALY or Intl. 29,702 per LYG (Smith-Spangler) or Intl. 3660 per QALY (Nghiem) By comparison, the ICER for other interventions was Intl. 7–109,324 per QALY, with salt taxation, voluntary and mandatory salt reduction in processed foods, and labeling scoring especially low ICER. Targeted dietary advice was cost-ineffective
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, Australian dollar; CHD, coronary heart disease; CVD, cardiovascular disease; DALY, disability-adjusted life year; ICER, incremental cost-effectiveness ratio; IHD, ischemic heart disease; Intl.
, International dollar; LYG, life-year gained; MI, myocardial infarction; NZ
, New Zealand dollar; QALY, quality-adjusted life year; SBP, systolic blood pressure; SSB, sugar-sweetened beverage; SSCg3d, simple scoring system, group C nutrients, per 100g; VAT, value added tax; WXYfm, United Kindgom Food Standards Agency/Of com model.