PLOS ONE: Highly cost-effective School-EduSalt intervention program for salt reduction

On September 13, 2017, the world’s first multidisciplinary Open Access journal, PLOS ONE published a study “Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China” from The George Institute, China, which demonstrated that the School-EduSalt intervention program for salt reduction is of low cost and highly cost-effective.

Given that reducing salt consumption at a national level is a particular challenge for China where sodium intake is mainly derived from salt added during the preparation of food at home, the School-based Education Program to Reduce Salt Intake in Children and Their Families (School-EduSalt) study has provided an innovative approach to reduce salt intake and therefore reduce BP among general population.

The study was a cluster randomized control trial recruited 279 students and 553 parents from 28 primary schools in Changzhi, Shanxi province, Northern of China in 2013. The primary outcome for trial assessment was the change of salt intake as measured by 24-h urine sodium from baseline to the end of the trial and secondary outcome was the change in SBP. To provide insight into the potential long-term public health impact at national level, the researchers also simulated the total impact of implementing this program over 10 years from 2016 through a 5-state Markov model compared with no program. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY).

Based on a trial-based analysis as well as modelled over 10 years scaled up nationwide, implementing the education program is of low cost, costing Int$2.74 to achieve 1 mmHg net reduction in SBP per participant (adults and children together) and Int$3.28 per adult participant. The nationwide implementation program over 10 years is predicted to prevent at least 42,720 AMI deaths and 107,512 stroke deaths and achieve significant medical cost savings (Int$1,358 per QALY gained).

Professor Yangfeng Wu, Senior Director of The George Institute China, calls for public attention to salt reduction. He said,” Elevated blood pressure (BP) is a major cause of cardiovascular disease and high dietary salt intake is the major factor that increases BP. We hope reducing salt intake through effective intervening measures could sustainably reduce cardiovascular disease burden.”

Associate Professor Xian Li, Head of Statistics and Economics Evaluation of The George Institute China, said, “ The current study provides the evidence of the affordability of School-EduSalt program and a template for policy-makers to upscale their efforts to reduce salt consumption across the country, whose benefit would be substantial.”