The potential health impact and healthcare cost savings of different sodium reduction strategies in Canada.

BACKGROUND

High dietary sodium is the main dietary risk factor for non-communicable diseases due to its impact on cardiovascular diseases, the leading cause of death globally. The objective of the study was to estimate the number of avoidable ischemic heart disease (IHD) and stroke incidence cases, and their associated healthcare cost and Quality-Adjusted Life Year (QALY) savings resulting from different sodium reduction strategies and recommendations in Canada.

METHODS

We used the PRIMEtime model, a proportional multi-state lifetable model. Outcomes were modeled over the lifetime of the population alive in 2019, at a 1.5% discount rate, and from the public healthcare system perspective. Nationally representative data were used as inputs for the model.

RESULTS

Fully meeting Health Canada's sodium reduction targets was estimated to prevent 219,490 (95% UI (Uncertainty Interval), 73,409-408,630) cases of IHD, and 164,435 (95% UI, 56,121-305,770) strokes. This led to a gain of 276,185 (95% UI, 85,414-552,616) QALYs, and healthcare costs savings of CAD 4,212 (95% UI, 1,303-8,206) million over the lifetime of the 2019 cohort. Sodium reduction intake through front-of-package labeling (FOPL) regulations has the potential to prevent between 35,930 (95% UI, 8,058-80,528) and 124,744 (95% UI, 40,125-235,643) cases of IHD, and between 26,869 (95% UI, 5,235-61,621) and 93,129 (95% UI, 30,296-176,014) strokes. This results in QALY gains ranging from 45,492 (95% UI, 10,281-106,579) to 157,628 (95% UI, 46,701-320,622), and healthcare costs savings ranging from CAD 695 (95% UI, 160-1,580) to CAD 2,415 (95% UI, 722-4,746) million over the lifetime of the 2019 Canadian cohort. All sodium reduction strategies tested were cost saving.

CONCLUSIONS

Reducing population-level sodium intakes is feasible and has the potential to improve health outcomes and save healthcare costs in Canada. From interventions tested, most health and healthcare costs gains were attributed to fully meeting sodium reduction targets, which highlights the importance of changing the voluntary nature of these targets to mandatory. A combination of strategies, mandatory sodium reduction targets and implementation of the 'high in' FOPL symbol would provide the most benefit from a public health standpoint.