Objectives: To estimate the potential health impact, cost, and cost-effectiveness of Australia mandating either A) the World Health Organization’s (WHO) global sodium benchmarks or B) the currently non-mandatory national sodium reformulation targets.

Methods: We used a multiple cohort proportional multi-state life table model to simulate the impact of the interventions on the adult (≥ 20 years) population. We estimated sodium intake in the base case (i.e., maintaining current sodium intake) and intervention scenarios, using nationally representative data on dietary intake, sodium levels in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Disease study. The effect of sodium reduction on blood pressure and disease risk was modelled using evidence from meta-analyses of randomized trials and prospective studies. Net costs, including implementation and healthcare costs, were used to calculate the incremental cost per health-adjusted life year (HALY) gained. Outcomes were discounted at 3%.

Results: Compared to the base case scenario, mandating the WHO benchmarks was projected to be cost saving over the first 25 years (99% probability), with 19K deaths (95% uncertainty interval [UI]: 11-28), 138K incident CVD events (95% UI: 81-200), and 100K new CKD cases (95% UI: 60-150) averted (Figure). The intervention could generate around 76K HALYs (95% UI: 44-110) and save $770 million (95% UI: 118-1,715) in healthcare costs. Mandating the less comprehensive and less stringent national targets could also be cost saving (97% probability), but with only about 1/3 of the health benefits of to the WHO benchmarks (Figure).

Conclusions: Our findings support mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Making Australia’s voluntary reformulation targets mandatory may save thousands of lives, but mandating the WHO global benchmarks could generate substantially larger health gains.