Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study-Reference-Cited by-同舟云学术

Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study

Published:2022-05-17 Issue:20 Volume:145 Page:1534-1541
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Li Ka-Chun¹,Huang Liping¹^ORCID,Tian Maoyi¹²^ORCID,Di Tanna Gian Luca¹^ORCID,Yu Jie¹³^ORCID,Zhang Xinyi⁴,Yin Xuejun¹^ORCID,Liu Yishu¹,Hao Zhixin⁴,Zhou Bo⁵,Feng Xiangxian⁶,Li Zhifang⁶,Zhang Jianxin⁷,Sun Jixin⁷,Zhang Yuhong⁸,Zhao Yi⁸,Zhang Ruijuan⁹,Yu Yan⁹,Li Nicole¹,Yan Lijing L.⁴¹⁰,Labarthe Darwin R.¹¹,Elliott Paul¹²^ORCID,Wu Yangfeng⁴¹³^ORCID,Neal Bruce¹¹²^ORCID,Lung Thomas¹¹⁴^ORCID,Si Lei¹^ORCID

Affiliation:

1. The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.-C.L., L.H., M.T., G.L.D.T., J.Y., X.Y., Y.L., N.L., B.N., T.L., L.S.).

2. School of Public Health, Harbin Medical University, China (M.T.).

3. Department of Cardiology, Peking University Third Hospital, Beijing, China (J.Y.).

4. The George Institute for Global Health at Peking University Health Science Center, Beijing, China (X.Z., Z.H., L.L.Y., Y.W.).

5. First Hospital of China Medical University, Shenyang, China (B.Z.).

6. Changzhi Medical College, China (X.F., Z.L.).

7. Center for Disease Control of Hebei, Shijiazhuang, China (J.Z., J.S.).

8. Ningxia Medical University, Yinchuan, China (Y. Zhang, Y. Zhao).

9. Xi’an Jiaotong University School of Medicine, Xi’an, China (R.Z., Y.Y.).

10. Global Health Research Centre, Duke Kunshan University, Kunshan, China (L.L.Y.).

11. Northwestern University Feinberg School of Medicine, Chicago, IL (D.R.L.).

12. School of Public Health, Imperial College London, United Kingdom (P.E., B.N.).

13. Peking University Clinical Research Institute, Beijing, China (Y.W.).

14. Sydney School of Public Health, University of Sydney, Australia (T.L.).

Abstract

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 [¥]) 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 20 995 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 (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference38 articles.

1. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

2. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

3. Dietary Potassium Intake Remains Low and Sodium Intake Remains High, and Most Sodium is Derived from Home Food Preparation for Chinese Adults, 1991–2015 Trends

4. World Health Organization. Salt reduction. Published 2020. Accessed August 20 2021. https://www.who.int/news-room/fact-sheets/detail/salt-reduction

5. Salt Reduction to Prevent Hypertension and Cardiovascular Disease

Cited by 23 articles. 订阅此论文施引文献订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献

1. Global burden and cross-country inequalities in stroke and subtypes attributable to diet from 1990 to 2019;BMC Public Health;2024-07-08

2. Cost-effectiveness analysis of low-sodium potassium-rich salt substitutes in Indonesia: an equity modelling study;The Lancet Regional Health - Southeast Asia;2024-07

3. Association between Salt-Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion in Nepal;Nutrients;2024-06-18

4. The Guidelines for use and promotion of low sodium salt in China;Journal of Evidence-Based Medicine;2024-06

5. Secondary Analysis of the Salt Substitute and Stroke Study (SSaSS): Effects of Potassium-Enriched Salt on Cardiac Outcomes;Hypertension;2024-05