A systematic review of economic evaluations of population-based sodium reduction interventions

Hope, Silvia; Webster, Jacqui; Trieu, Kathy; Pillay, Arti; Ieremia, Merina; Bell, Colin; Snowdon, Wendy; Neal, Bruce; Moodie, Marj

doi:10.1371/journal.pone.0173600

Cited by 51 publications

(54 citation statements)

References 52 publications

(181 reference statements)

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“…Cost-effectiveness models were included as well. However, cost data were not reported, since such policies are usually cost-saving [20], and the main focus of the present review was to assess the magnitude of the effects on intake and health outcomes, rather than cost-effectiveness. Finally, only studies in English were considered for review.…”

Section: Selection Of Studiesmentioning

confidence: 99%

The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

et al. 2019

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Background: Unhealthy diet is a risk factor for adverse health outcomes. Reformulation of processed foods has the potential to improve population diet, but evidence of its impact is limited. The purpose of this review was to explore the impact of reformulation on nutrient intakes, health outcomes and quality of life; and to evaluate the quality of modelling studies on reformulation interventions. Methods: A systematic review of peer-reviewed articles published between January 2000 and December 2017 was performed using MEDLINE, ScienceDirect, Embase, Scopus, Cochrane, and the Centre for Reviews and Dissemination of the University of York. Additional studies were identified through informal searches on Google and specialized websites. Only simulation studies modelling the impact of food reformulation on nutrient intakes and health outcomes were included. Included articles were independently extracted by 2 reviewers using a standardized, pre-piloted data form, including a self-developed tool to assess study quality. Results: A total of 33 studies met the selected inclusion criteria, with 20, 5 and 3 studies addressing sodium, sugar and fats reformulation respectively, and 5 studies addressing multiple nutrients. Evidence on the positive effects of reformulation on consumption and health was stronger for sodium interventions, less conclusive for sugar and fats. Study features were highly heterogeneous including differences in methods, the type of policy implemented, the extent of the reformulation, and the spectrum of targeted foods and nutrients. Nonetheless, partial between-study comparisons show a consistent relationship between percentages reformulated and reductions in individual consumption. Positive results are also shown for health outcomes and quality of life measures, although comparisons across studies are limited by the heterogeneity in model features and reporting. Study quality was often compromised by short time-horizons, disregard of uncertainty and time dependencies, and lack of model validation. Conclusions: Reformulation models highlight relevant improvements in diets and population health. While models are valuable tools to evaluate reformulation interventions, comparisons are limited by non-homogeneous designs and assumptions. The use of validated models and extensive scenario analyses would improve models' credibility, providing useful insights for policy-makers. Review Registration: A research protocol was registered within the PROSPERO database (ID number CRD42017057341).

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Section: Selection Of Studiesmentioning

confidence: 99%

The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

et al. 2019

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“…A score out of 24 (or the number of applicable items) was calculated for each evaluation, with each item on the checklist assigned one point where the article adequately met the criterion. Using the method described by Hope et al [19], a half point was awarded where the article partially filled the criterion. Where an evaluation was reported in more than one publication, both publications were used to assess reporting quality, with the evaluation being assigned the highest score from either publication for each CHEERS item.…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

“…A percentage score for each evaluation was then calculated. Evaluations scoring ≥ 85% were categorised as having excellent reporting quality, 70 to < 85% as very good quality, 55 to < 70% as good quality, and evaluations scoring < 55% were classified as poor quality [19].…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

et al. 2020

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Background: Sepsis is a global health priority. Interventions to reduce the burden of sepsis need to be both effective and cost-effective. We performed a systematic review of the literature on health economic evaluations of sepsis treatments in critically ill adult patients and summarised the evidence for cost-effectiveness. Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library using thesaurus (e.g. MeSH) and free-text terms related to sepsis and economic evaluations. We included all articles that reported, in any language, an economic evaluation of an intervention for the management of sepsis in critically ill adult patients. Data extracted included study details, intervention details, economic evaluation methodology, and outcomes. Included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results: We identified 50 records representing 46 economic evaluations for a variety of interventions including antibiotics (n = 5), fluid therapy (n = 2), early goal-directed therapy and other resuscitation protocols (n = 8), immunoglobulins (n = 2), and interventions no longer in clinical use such as monoclonal antibodies (n = 7) and drotrecogin alfa (n = 13). Twelve (26%) evaluations were of excellent reporting quality. Incremental costeffectiveness ratios (ICERs) ranged from dominant (lower costs and higher effectiveness) for early goal-directed therapy, albumin, and a multifaceted sepsis education program to dominated (higher costs and lower effectiveness) for polymerase chain reaction assays (LightCycler SeptiFast testing MGRADE®, SepsiTest™, and IRIDICA BAC BSI assay). ICERs varied widely across evaluations, particularly in subgroup analyses. Conclusions: There is wide variation in the cost-effectiveness of sepsis interventions. There remain important gaps in the literature, with no economic evaluations identified for several interventions routinely used in sepsis. Given the high economic and social burden of sepsis, high-quality economic evaluations are needed to increase our understanding of the cost-effectiveness of these interventions in routine clinical practice and to inform decision makers.Trial registration: PROSPERO CRD42018095980

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“…One method of reducing sodium in these food products is the use of a salt substitute, such as potassium chloride, which has been shown to be effective at lowering blood pressure [25]. While studies conducted both globally and locally in Vietnam have found salt reduction policies and campaigns to be very cost-effective [4,13,17,26,27], the cost-effectiveness of a salt substitution intervention using potassium-enriched low sodium food products in this country remains unknown.…”

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

Taylor¹,

Hoek²,

Deltetto

et al. 2020

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Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and IHD events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

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A systematic review of economic evaluations of population-based sodium reduction interventions

Cited by 51 publications

References 52 publications

The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

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