Abstract
Excessive sodium intake remains a principal modifiable driver of hypertension, ischemic heart disease, and stroke across high-income nations. Although structural public health interventions targeting dietary sodium have been recommended globally, robust economic assessments incorporating comprehensive microsimulation modeling are necessary to guide long-term policy implementation. This study evaluated the lifetime health outcomes and economic impact of a comprehensive national salt reduction strategy—combining mandatory food reformulation targets, standardized front-of-pack warning labels, and a national consumer education campaign—compared with standard practice in a synthetic cohort representative of a high-income adult population (aged 30–84 years). Utilizing a validated dynamic microsimulation state-transition model parameterized with nationally representative epidemiological and cost data, we estimated quality-adjusted life years (QALYs) gained, incident cardiovascular events averted, and net healthcare cost savings from a healthcare sector perspective over a lifetime horizon. The comprehensive policy package was projected to reduce mean population daily sodium intake by 1.15 g (equivalent to ~2.9 g salt/day) within five years. Over the lifetime of the cohort, this reduction prevented an estimated 2,140 cardiovascular disease events (ischemic heart disease and stroke) per 100,000 individuals and generated an incremental gain of 14,820 QALYs per 100,000 individuals. Furthermore, the intervention was dominant, yielding net cost savings of approximately $38.4 million per 100,000 population due to averted acute hospitalizations and chronic post-event management. Structural national sodium reduction strategies represent highly cost-effective, cost-saving public health investments capable of substantially alleviating cardiovascular disease burdens.
