On February 12, 2024, Professor Hai Fang from Peking University's China Center for Health Development Studies, in collaboration with Professor Yangfeng Wu from Peking University's Clinical Research Institute, published their latest research titled "Cost-Effectiveness of Salt Substitute and Salt Supply Restriction in Eldercare Facilities: The DECIDE-Salt Cluster Randomized Clinical Trial" in JAMA Network Open (IF=""13.8)."" This study evaluated the cost-effectiveness of low-sodium salt and the gradual reduction of kitchen salt supply in elderly populations through the DECIDE-Salt cluster randomized trial. The researchers found that the low-sodium salt intervention was cost-effective, while the gradual reduction of kitchen salt supply was not. From an economic perspective, these findings provide strong support for the nationwide promotion of low-sodium salt in elderly care facilities.
The preliminary report of the DECIDE-Salt study has already found that replacing regular salt with potassium-enriched low-sodium salt in the kitchen of nursing homes significantly reduces the risk of hypertension and major cardiovascular events among elderly residents during a 2-year intervention period. This study further assessed the economic benefits of this intervention. Despite the higher retail price of low-sodium salt used in the study compared to regular salt (14.0 yuan/kg vs. 4.5 yuan/kg, with an average additional cost of 86.4 yuan per person over 2 years), and the additional management and publicity costs associated with the intervention (with an average additional cost of 6.6 yuan per person over 2 years), using low-sodium salt significantly reduced the occurrence of hypertension and major cardiovascular events, leading to savings in medical expenses (with an average saving of 272.1 yuan per person over 2 years). As a result, the total cost per person over 2 years in the low-sodium salt group was lower by 179.1 yuan compared to the regular salt group. Cost-saving results are evident in terms of decreasing disease risk and adverse health outcomes.
Furthermore, the low-sodium salt strategy helps reduce the quality-adjusted life years (QALY) lost in elderly populations. Compared to the regular salt group, elderly individuals in the low-sodium salt group experienced an average reduction of 0.093 QALY loss over the 2-year intervention period, equivalent to an additional healthy life of 34.1 days. Cost-utility analysis also shows cost-saving outcomes, with sensitivity analysis demonstrating robust results. When the price of low-sodium salt increases to 1133.0 yuan/kg, the incremental cost-effectiveness ratio (ICER) reaches the threshold of economic viability (equivalent to the 2020 per capita GDP, 72,000 yuan), representing approximately 81 times the current price of low-sodium salt. In contrast, the intervention involving the gradual reduction of kitchen salt supply did not show economically favorable outcomes due to its insignificant effects.
If low-sodium salt is promoted nationwide among elderly populations in China, it is estimated that over a period of two years, 48,000 major cardiovascular events and 108,000 cases of hypertension could be avoided. Additionally, it could reduce 198,000 QALY losses and save costs amounting to 380 million yuan. This study provides economic evidence for the implementation of low-sodium salt in elderly populations in China and similar countries. Not only does this initiative hold significant public health implications, but it also represents a cost-saving policy choice. By promoting and utilizing low-sodium salt, the government can save substantially in healthcare expenditure and improve the quality of life and health status of elderly populations amidst the backdrop of aging demographics.
Dr. Xiaozhen Lai, a graduate student from the PKU China Center for Health Development Studies (mentored by Professor Hai Fang), and Assistant Researcher Yifang Yuan from the PKU Clinical Research Institute (mentored by Professor Yangfeng Wu) are the co-lead authors. Professor Hai Fang and Professor Yangfeng Wu are the corresponding authors.
(Interpreted by Waverly Shi)
