TY - JOUR
T1 - Cost-effectiveness of a household salt substitution intervention : findings from 20995 participants of the Salt Substitute and Stroke Study
AU - Li, Ka-Chun
AU - Huang, Liping
AU - Tian, Maoyi
AU - Di Tanna, Gian Luca
AU - Yu, Jie
AU - Zhang, Xinyi
AU - Yin, Xuejun
AU - Liu, Yishu
AU - Hao, Zhixin
AU - Zhou, Bo
AU - Feng, Xiangxian
AU - Li, Zhifang
AU - Zhang, Jianxin
AU - Sun, Jixin
AU - Zhang, Yuhong
AU - Zhao, Yi
AU - Zhang, Ruijuan
AU - Yu, Yan
AU - Li, Nicole
AU - Yan, Lijing L.
AU - Labarthe, Darwin R.
AU - Elliott, Paul
AU - Wu, Yangfeng
AU - Neal, Bruce
AU - Lung, Thomas
AU - Si, Lei
PY - 2022
Y1 - 2022
N2 - BACKGROUND: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. METHODS: A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [Â¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. RESULTS: Mean follow-up of the 20995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77–0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs ( Â¥1538 for the intervention group and Â¥1649 for the control group) were lower in the salt substitute group (Â¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective. CONCLUSIONS: Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants.
AB - BACKGROUND: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. METHODS: A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [Â¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. RESULTS: Mean follow-up of the 20995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77–0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs ( Â¥1538 for the intervention group and Â¥1649 for the control group) were lower in the salt substitute group (Â¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective. CONCLUSIONS: Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants.
UR - https://hdl.handle.net/1959.7/uws:68152
U2 - 10.1161/CIRCULATIONAHA.122.059573
DO - 10.1161/CIRCULATIONAHA.122.059573
M3 - Article
SN - 0009-7322
VL - 145
SP - 1534
EP - 1541
JO - Circulation
JF - Circulation
IS - 20
ER -
