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Colman Taylor
George Institute for Global Health
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1034-0191
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Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.
Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy.
Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained).
Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.
Keywords
Diet, Sodium, CHD, Stroke, Cost-effectiveness, Health economics
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- Supplementarymaterialupdated2.pdf
Supplementary Table 1 Estimated systolic blood pressure according to salt substitute strategy and age strata, Vietnam. Supplementary Table 2 Baseline incidence of stroke and IHD according to salt substitute strategy and age strata, Vietnam. Supplementary Table 3 Relative risk reduction of stroke according to salt substitute strategy and age strata, Vietnam. Supplementary Table 4 Relative risk reduction of IHD according to salt substitute strategy and age strata, Vietnam. Supplementary Table 5 Results of the sensitivity analysis: Regulatory strategy. Supplementary Table 6 Results of the sensitivity analysis: Subsidised strategy. Supplementary Table 7 Results of the sensitivity analysis: Voluntary strategy. Supplementary Table 8 Comparison of cost-effectiveness studies.
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CURRENT STATUS: Published
View the published article at Archives of Public Health.
Version 2
Posted 12 Feb, 2021
No community comments so far
Editorial decision: Accept
On 06 Feb, 2021
Editor assigned
On 01 Feb, 2021
Submission checks complete
On 01 Feb, 2021
Editor invited
On 01 Feb, 2021
Version (no preprint)
Posted 29 Jan, 2021
Editorial decision: Minor Revision
On 29 Jan, 2021
Editor assigned
On 23 Jan, 2021
Submission checks complete
On 23 Jan, 2021
Editor invited
On 23 Jan, 2021
This version was not preprinted
Version (no preprint)
Posted 12 Jan, 2021
Editorial decision: Minor Revision
On 12 Jan, 2021
Reviewer #2 agreed
On 17 Dec, 2020
Review #2 received
Received 17 Dec, 2020
Reviewers invited
Invitations sent on 17 Dec, 2020
Reviewer #1 agreed
On 17 Dec, 2020
Review #1 received
Received 17 Dec, 2020
Editor assigned
On 16 Dec, 2020
Submission checks complete
On 16 Dec, 2020
Editor invited
On 16 Dec, 2020
This version was not preprinted
No comments provided
Review #2 received
Received 27 Nov, 2020
Editorial decision: Major Revision
On 27 Nov, 2020
Review #1 received
Received 26 Nov, 2020
Review #3 received
Received 14 Nov, 2020
Reviewer #5 agreed
On 09 Nov, 2020
Reviewer #4 agreed
On 08 Nov, 2020
Reviewer #3 agreed
On 08 Nov, 2020
Reviewer #2 agreed
On 07 Nov, 2020
Reviewer #1 agreed
On 06 Nov, 2020
Editor assigned
On 09 Oct, 2020
Reviewers invited
Invitations sent on 09 Oct, 2020
Submission checks complete
On 08 Oct, 2020
Editor invited
On 08 Oct, 2020
First submitted
On 07 Oct, 2020
Metrics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Archives of Public Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Colman Taylor
George Institute for Global Health
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1034-0191
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Archives of Public Health.
Version 2
Posted 12 Feb, 2021
No community comments so far
Editorial decision: Accept
On 06 Feb, 2021
Editor assigned
On 01 Feb, 2021
Submission checks complete
On 01 Feb, 2021
Editor invited
On 01 Feb, 2021
Version (no preprint)
Posted 29 Jan, 2021
Editorial decision: Minor Revision
On 29 Jan, 2021
Editor assigned
On 23 Jan, 2021
Submission checks complete
On 23 Jan, 2021
Editor invited
On 23 Jan, 2021
This version was not preprinted
Version (no preprint)
Posted 12 Jan, 2021
Editorial decision: Minor Revision
On 12 Jan, 2021
Reviewer #2 agreed
On 17 Dec, 2020
Review #2 received
Received 17 Dec, 2020
Reviewers invited
Invitations sent on 17 Dec, 2020
Reviewer #1 agreed
On 17 Dec, 2020
Review #1 received
Received 17 Dec, 2020
Editor assigned
On 16 Dec, 2020
Submission checks complete
On 16 Dec, 2020
Editor invited
On 16 Dec, 2020
This version was not preprinted
No comments provided
Review #2 received
Received 27 Nov, 2020
Editorial decision: Major Revision
On 27 Nov, 2020
Review #1 received
Received 26 Nov, 2020
Review #3 received
Received 14 Nov, 2020
Reviewer #5 agreed
On 09 Nov, 2020
Reviewer #4 agreed
On 08 Nov, 2020
Reviewer #3 agreed
On 08 Nov, 2020
Reviewer #2 agreed
On 07 Nov, 2020
Reviewer #1 agreed
On 06 Nov, 2020
Editor assigned
On 09 Oct, 2020
Reviewers invited
Invitations sent on 09 Oct, 2020
Submission checks complete
On 08 Oct, 2020
Editor invited
On 08 Oct, 2020
First submitted
On 07 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Archives of Public Health.
Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.
Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy.
Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained).
Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- Supplementarymaterialupdated2.pdf
Supplementary Table 1 Estimated systolic blood pressure according to salt substitute strategy and age strata, Vietnam. Supplementary Table 2 Baseline incidence of stroke and IHD according to salt substitute strategy and age strata, Vietnam. Supplementary Table 3 Relative risk reduction of stroke according to salt substitute strategy and age strata, Vietnam. Supplementary Table 4 Relative risk reduction of IHD according to salt substitute strategy and age strata, Vietnam. Supplementary Table 5 Results of the sensitivity analysis: Regulatory strategy. Supplementary Table 6 Results of the sensitivity analysis: Subsidised strategy. Supplementary Table 7 Results of the sensitivity analysis: Voluntary strategy. Supplementary Table 8 Comparison of cost-effectiveness studies.
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