Aminde Leopold Ndemnge, Nugraheni Wahyu Pudji, Mubasyiroh Rofingatul, Rachmawati Tety, Dwirahmadi Febi, Martini Santi, Kusumawardani Nunik, Veerman J Lennert
Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.
Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia.
Lancet Reg Health Southeast Asia. 2024 Jun 13;26:100432. doi: 10.1016/j.lansea.2024.100432. eCollection 2024 Jul.
Evidence suggests low-sodium potassium-rich salt substitutes (LSSS) are effective in reducing blood pressure (BP). However, the health and economic impacts of LSSS in Indonesia are currently unknown.
We developed a proportional multistate lifetable Markov model to assess a government-led strategy implementing the use of LSSS compared to current regular salt consumption. BP data were derived from the Indonesian Basic Health Research Survey (RISKESDAS 2018), while epidemiological data were from the Global Burden of Disease 2019 study. We estimated implementation costs and the impact of changes in BP on disease events and healthcare costs, and incremental cost-effectiveness ratios. Outcomes were simulated over different time horizons for the 2019 Indonesian population overall, and by income quintiles. Probabilistic sensitivity analysis was done to capture uncertainty.
Over the first 10 years, LSSS could prevent 1.5 million non-fatal cardiovascular disease (CVD) events (8.3%-19.4% reduction) and 643,000 incident chronic kidney disease (CKD) cases (8.2% reduction), while averting over 200,000 CVD and CKD deaths (0.2%-5.2% reduction). This translated to over 24.6 million health-adjusted life years (HALYs) gained over the lifetime of the population, and reduced CVD-related health inequalities (concentration index, -0.075, 95% CI: -0.088 to -0.062). Implementation cost (US$ 1.2 billion [IDR 17.2 trillion] total; US$ 4.5 [IDR 63,665] per capita, as of July 2019) was outweighed by the net health expenditure savings (∼US$ 2 billion [IDR 27.7 trillion] total; US$ 7.3 [IDR 103,300] per capita) in the first 10 years. LSSS were cost-saving over the lifetime, and very cost-effective even with a high LSSS price.
Scaling the use of LSSS nationally could be a cost-saving strategy to prevent substantial cardiovascular and kidney disease burden in Indonesia.
Griffith University Postdoctoral Fellowship.
有证据表明，低钠富钾盐替代品（LSSS）在降低血压（BP）方面有效。然而，LSSS在印度尼西亚对健康和经济的影响目前尚不清楚。
我们开发了一个比例多状态生命表马尔可夫模型，以评估与当前常规食盐消费相比，政府主导实施LSSS使用的策略。血压数据来自印度尼西亚基本卫生研究调查（2018年印度尼西亚家庭健康调查），而流行病学数据来自《2019年全球疾病负担》研究。我们估计了实施成本以及血压变化对疾病事件和医疗成本的影响，以及增量成本效益比。对2019年印度尼西亚总体人口以及按收入五分位数划分的人群在不同时间范围内的结果进行了模拟。进行了概率敏感性分析以捕捉不确定性。
在最初的10年里，LSSS可以预防150万例非致命性心血管疾病（CVD）事件（减少8.3%-19.4%）和64.3万例新发慢性肾脏病（CKD）病例（减少8.2%），同时避免20多万例CVD和CKD死亡（减少0.2%-5.2%）。这意味着在人群的一生中可获得超过2460万个健康调整生命年（HALYs），并减少了与CVD相关的健康不平等（集中指数为-0.075，95%置信区间：-0.088至-0.062）。实施成本（截至2019年7月，总计12亿美元[17.2万亿印尼盾]；人均4.5美元[63665印尼盾]）被前10年的净卫生支出节省（总计约20亿美元[27.7万亿印尼盾]；人均7.3美元[103300印尼盾]）所抵消。LSSS在一生中具有成本节约效益，即使LSSS价格很高，其成本效益也非常显著。
在全国范围内推广LSSS的使用可能是一种节省成本的策略，可预防印度尼西亚大量的心血管和肾脏疾病负担。
格里菲斯大学博士后奖学金。
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