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A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries

Lookup NU author(s): Dr Helen Mason, Professor Julia Critchley, Dr Balsam Ahmad, Professor Peter Phillimore, Dr Shahaduz Zaman, Madona Elias, Dr Wasim Maziak, Faten Tlili, Professor Nigel Unwin



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. © 2014 Mason et al.

Publication metadata

Author(s): Mason H, Shoaibi A, Ghandour R, O'Flaherty M, Capewell S, Khatib R, Jabr S, Unal B, Sozmen K, Arfa C, Aissi W, Ben Romdhane H, Fouad F, Al-Ali R, Husseini A, Critchley J, Ahmad B, Phillimore P, Zaman S, Dherani M, Vartjes I, Bennett K, Altun D, Arik H, Aslan O, Demiral Y, Doganay S, Ergor G, Gerceklioglu G, Kilic B, Saatli G, Simsek H, Satman I, Gogen S, Kalaca S, Elias M, Rastam S, Soulaiman N, Moukeh G, Maziak W, Abou Mayaleh M, Abu-Rmeileh N, Jaber S, Khatib R, Mikki N, Abu-Kteish H, Allani R, Beltaifa L, Ben Mansour N, Lassoued O, Saidi O, Tlili F, Achour N, Ben Salah N, Collins M, Roglic G, Fadhil I, Unwin N

Publication type: Article

Publication status: Published

Journal: PLoS ONE

Year: 2014

Volume: 9

Issue: 1

Online publication date: 07/01/2014

Acceptance date: 15/11/2013

Date deposited: 24/08/2017

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0084445

PubMed id: 24409297


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Funder referenceFunder name
European Community' Seventh Framework Programme (FP7/2007–2013) under grant agreement n°223075 – the MedCHAMPS project.