Population dietary salt reduction and burden of cardiovascular disease in cameroon: A cost-effectiveness modelling study

Abstract

Objectives Cardiovascular disease (CVD) is the leading cause of death among non-communicable diseases in Cameroon. Interventions that reduce dietary salt intake at population levels have been shown to be a promising strategy to reduce blood pressure and CVD burden. There is no evidence on the cost-effectiveness of such strategies in Cameroon.

Methods A cost-utility analysis of three population salt reduction interventions: school-based salt education program, mass media campaign, and low-sodium salt substitute was conducted using a multi-state lifetable Markov model. Using a healthcare system perspective, adults (≥ 30 years) alive in 2016 were simulated over their lifetime. Outcomes were changes in mortality, health-adjusted life years (HALYs) and incremental cost-effectiveness ratios (ICER). Probabilistic sensitivity analysis was used to quantify uncertainty.

Results For the remaining lifetime, over 10,000 CVD deaths, 79,000 CVD deaths and 84,000 CVD deaths could be averted from the mass media, school education program and salt substitute interventions respectively. Corresponding health gains over the lifetime were 46,700 (95%UI: 25,100 to 71,000) HALYs, 348,800 (95%UI: 270,600 to 433,800) HALYs and 368,400 (95%UI: 282,500 to 462,200) HALYs respectively. ICERs showed that all interventions were dominant, with probabilities of being cost-saving of 84% for school education program, 89% for mass media campaign and 99% for the salt substitute intervention.

Conclusions All three population salt reduction strategies evaluated were highly cost-effective with very high probabilities of being cost-saving. Dietary salt reduction in Cameroon has the potential to save many lives and offers good value money.