Li Xian, Jan Stephen, Yan Lijing L, Hayes Alison, Chu Yunbo, Wang Haijun, Feng Xiangxian, Niu Wenyi, He Feng J, Ma Jun, Han Yanbo, MacGregor Graham A, Wu Yangfeng
The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
The George Institute for Global Health, Sydney, Australia.
PLoS One. 2017 Sep 13;12(9):e0183033. doi: 10.1371/journal.pone.0183033. eCollection 2017.
The School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program.
Costs of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector.
The intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17-12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained.
Based on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial.
ClinicalTrials.gov NCT01821144.
“学校降低儿童及其家庭盐摄入量教育项目”是一项在中国长治28所小学五年级学生及其家庭中开展的整群随机对照试验。该项目在降低所有家庭成年人收缩压（SBP）方面取得了显著效果，使收缩压降低了2.3 mmHg，在老年人（年龄≥60岁）中收缩压降低了9.5 mmHg。本研究的目的是评估该减盐项目的成本效益。
采用成分法评估干预成本，以确定资源使用情况。基于观察到的降低收缩压的效果，估计基于试验的增量成本效益比（ICER）。使用马尔可夫模型估计干预的长期成本效益，然后根据人口数据，推算该项目在全国范围内扩大规模的情景。研究结果以每质量调整生命年（QALY）的增量成本表示。视角为卫生部门。
干预措施每个家庭的成本为19.04国际元，与对照组相比，所有参与者（儿童和成人参与者合并计算）每降低1 mmHg收缩压的ICER为2.74国际元（90%CI：1.17 - 12.30）。如果在全国范围内扩大规模实施10年，并假设在此期间治疗效果下降50%，将覆盖1.65亿家庭，预计在中国可避免42720例急性心肌梗死死亡和107512例中风死亡。这将在10年时间框架内带来635816个QALY的收益，相当于每获得一个QALY的成本为1358国际元。
根据世界卫生组织 - 选择标准，我们的分析表明，所提出的减盐策略具有很高的成本效益，如果在全国范围内扩大规模，效益将十分显著。
ClinicalTrials.gov NCT01821144
