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Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis

机译：南非因减盐政策而避免了心血管疾病和贫困：扩展的成本效益分析

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The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts—substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care.
机译：南非政府最近制定了通过减少食盐来减少心血管疾病（CVD）的目标。我们进行了扩展的成本效益分析（ECEA），以模拟此盐政策的潜在健康和经济影响。我们使用调查和流行病学研究来估计由于盐摄入量减少而导致的CVD减少。我们使用设施收费表和药品价格计算了CVD护理的平均自付费用（OOP）。由于该政策，我们估计了OOP支出和政府补贴的减少。我们估算了政策实施的公共和私营部门成本。我们从该政策中估算了财务风险保护（FRP），涉及（1）避免了灾难性医疗支出（CHE）或（2）避免了贫困。我们还进行了敏感性分析。我们发现，食盐政策可以将CVD死亡人数降低11％，而收入五等分群体的健康收益也差不多。该政策每年可为家庭节省OOP支出406万美元（2012年人均0.29美元），并为政府节省5125万美元的医疗补贴（人均2.52美元）。政府的人均费用仅为0.01美元；因此，该政策将节省成本。如果将私营部门的食品调整成本转嫁给消费者，则所有收入五分之一人口的食品支出将增加<0.2％。预防CVD每年可避免2400例CHE或2000例贫困。我们的结果对基线CVD死亡率和治疗费用敏感。我们得出的结论是，除了增加健康以外，减少人口盐分还会产生积极的经济影响-大大减少OOP支出并提供FRP，特别是对于中产阶级。该政策还可以为政府节省大量医疗费用。

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