Salt substitute cost-effective compared to antihypertensive drugs for treating prehypertensive individuals: Study

A recent study published in the Hypertension journal highlights the cost-effectiveness of salt substitution over antihypertensive drug treatment in managing prehypertension among Chinese adults, particularly for the individuals aged 40 and above. The findings illuminate the potential for significant public health benefits and cost savings through early lifestyle interventions.

The research incorporated data from the China Kadoorie Biobank, using real-world information on cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs). By utilizing Markov cohort model, this study evaluated 3 interventions: salt substitution, antihypertensive drug treatment, and a combination of both. Costs and utilities were derived from published sources, and the interventions were assessed across different age groups and risk levels. Incremental cost-effectiveness ratios (ICERs) provided a measure of value for each intervention per QALY gained.

By replacing traditional salt with a salt substitute for prehypertensive individuals starting at age 40 proved to be the most cost-effective strategy. With an ICER of $6413.62/QALY, this intervention showed substantial benefits in reducing CVD risk without the high costs associated with drug treatments.

For individuals at high risk of CVD, combining salt substitution with antihypertensive drug treatment offered the greatest reduction in CVD events. Initiating this combined approach at age 40 was effective by achieving a 5.3% reduction in CVD events with an ICER of $2913.30/QALY. This represented a better value when compared to starting at older ages, where the cost per QALY gained increased significantly.

Across all interventions, younger starting ages yielded better outcomes and lower ICERs. For instance, initiating a combined intervention at age 40 reduced CVD events by 5.3% when compared to 4.9% at age 70. Further, the cost per QALY gained at age 70 ($32,635.33/QALY) was more than 10-times higher than at age 40. This emphasizes the importance of early intervention in managing prehypertension.

The sensitivity analyses confirmed the robustness of these findings by reinforcing the outcome that salt substitution when started early, is a highly cost-effective measure. Overall, the study found that replacing standard salt with a low-sodium salt substitute is a simple yet impactful intervention for prehypertensive adults in China by offering significant health benefits at a fraction of the cost of drug treatments.

Reference:

Sun, Z., Zhang, H., Ding, Y., Yu, C., Sun, D., Pang, Y., Pei, P., Yang, L., Chen, Y., Du, H., Hu, W., Avery, D., Chen, J., Chen, Z., Li, L., & Lv, J. (2024). Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults. In Hypertension (Vol. 81, Issue 12, pp. 2529–2539). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/hypertensionaha.124.23412