Outline. Definitions Background Objectives Methodology Results and Discussion Conclusion and Recommendations

Transcription

1 An Economic Evaluation of Salt Reduction as a Population Based Intervention for the Prevention of Coronary Heart Disease in Four Eastern Mediterranean Countries (Palestine, Syria, Tunisia, Turkey) Cost Effectiveness Study H Mason, A Shoaibi, R Ghandour, M O Flaherty, S Capewell, R Khatib, S Jabr, B Unal, K Sözmen, C Arfa, H Ben Romdhane, F Fouad, R Al-Ali, A Husseini, and the MedCHAMPS project team

2 Outline Definitions Background Objectives Methodology Results and Discussion Conclusion and Recommendations

3 Definitions - Economic evaluation: an analytical approach that examines the costs and consequences of alternative programs in order to inform decisions about the allocation of scarce resources. - Cost effectiveness analysis: a type of economic evaluation used to determine the best use of money available for health care. It compares different kinds of interventions with similar, but not identical effects on the basis of the cost per unit effect achieved, usually (cost/lyg).

4 Background Cardiovascular disease (CVDs) is number one cause of death worldwide. Coronary heart diseases (CHDs) as one of the CVDs pose a growing challenge in the world. It is important to make recommendations for cost-effective policy initiatives, both within and outside the health sector, likely to reduce the burden of CHD mortality and morbidity. A major modifiable risk factor for CHD is dietary salt intake International past experiences have proved that reducing salt intake in communities is possible and is one of the most costeffective and affordable public health interventions.

5 Background There is direct a dose response relationship between salt intake and blood pressure Reducing salt intake by 5 g à 17% of cardiovascular events worldwide Reducing blood pressure by 10 mmhg à CHD events by 22% Recommended Salt Intake: 5 g/person/day (WHO) Global level: 9-12 g/person/day In Palestine, Syria and Tunisia: 14 g/person/day In Turkey : 18 g/ Person /day

6 Aim To assess the cost-effectiveness of population-based interventions aiming to reduce salt intake and hence prevent coronary heart diseases diseases in 4 Eastern Mediterranean countries (Palestine, Syria, Tunisia and Turkey) Consequences (Outputs) Costs (Inputs)

7 Methodology Step 1: Identify SALT REDUCTION polices at the population level. Step 2: Identify and quantify the cost of implementing these policies Step 3 :Identify and quantify effectiveness measures: life years gained (LYG) Step 4: Evaluate the cost effectiveness measures (Incremental Cost Effectiveness Ratio - ICER) of each policy compared with doing nothing

8 Methodology-cont. Time frame for the analysis: 10 years Future costs were discounted by 3% The analysis was done from the societal perspective with reference to other perspectives such as industry and government Sensitivity analysis was performed using minimum and maximum costs Costs were quantified using the international$ (PPP) to allow comparison

9 Methodology-cont. Step1: identify the policies 3 main Salt Reduction Policies were identified: Population-wide information campaigns (Health Promotion) Declaration of salt content in processed food, through labeling Decrease in salt content of processed foods (Reformulation)

10 Step 1-cont. Methodology-cont. 6 different alternatives were identified: 1. Population-wide information campaigns 2. Declaration of salt content in processed food (labeling) 3. Decrease in salt content of processed foods (Reformulation) 4. Reformulation and labeling 5. Reformulation and health promotion 6. ALL THREE (Health promotion, labeling and reformulation) All alternatives were compared to doing nothing scenario

11 Methodology-cont. Step 2: Identifying Costs 1. Cost of policy Cost of implementing each policy Cost of illness on health sector 2. Cost of doing nothing (baseline) Cost of illness on the health sector (burden of the disease) Indirect Cost: cost of illness on the society (productivity loss) The incremental cost was calculated as the difference between these 2 costs.

12 Methodology- cont. Step3: Iden4fy effec4veness (LYG) Life years gained (LYG) for each policy: The incremental years gained compared to the baseline Salt Reduction Policy reduces salt intake (source: literature) Reduction in Salt intake will reduce the SBP on the population level (source: literature) Reduction in SBP will reduce CHD attributable deaths (source: Palestinian IMPACT model) Outcome measured in LYG

13 Results Palestinian Results

14 Palestinian Results Policy Total Cost (PPP) Discounted Total Cost (PPP) Incremental cost over the baseline (PPP) Discounted incremental cost over the baseline (PPP) Life Years Gained Over Baseline ICER Baseline 354,719, ,616,109 Health Promotion 344,231, ,781,187-10,487,653-6,834, Labelling 341,136, ,165,868-13,582,543-9,450, Reformulation 350,715, ,741,346-4,007, , Reformulation + Labelling Reformulation + Health Promotion All 3 Policies together 348,382, ,777,907-6,337,103-1,838, ,683, ,028,495-6,036,400-1,587, ,638, ,921,135-12,081,323-6,694,

15 Pales4ne Discounted Cost Saving Against the Baseline min costs Best Es4mate max costs Health Promo4on Labelling Reformula4on Reformula4on + Labelling Reformula4on + Health Promo4on All 3 Policies together LYG ,398 1,398 2,682 ICER 132

16 Syria - Disoucnted cost Saving against the baseline min costs Best Es4mate max costs Health Promo4on Labelling Reformula4on Reformula4on + Labelling Reformula4on + Health Promo4on All 3 Policies together LYG 5,679 11,192 11,192 16,543 16,543 31,674 ICER

17 Tunisia : Cost Saving against Baseline min costs Best Es4mate max costs 450,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000,000 50,000, ,000, ,000,000 Health Promo8on Labelling Reformula8on Reformula8on + Reformula8on + Labelling Health Promo8on All 3 Policies together LYG 1,151 2,272 2,272 3,361 3,361 6,455 ICER 5377

18 Turkey - Cost Saving against the baseline min costs Best Es8mat max costs 2E E E E E+09 1E Health Promo4on Labelling Reformula4on Reformula4on + Labelling Reformula4on + Health Promo4on All 3 Policies together LYG 68, , , , , ,439

19 Conclusion and Recommendations Decreasing salt intake reduces the long-term risk of CHD events. In the opt, as well other study countries, most of the population based interventions to reduce salt intake is not only cost effective but also cost saving. A combination of health education and cooperation with the food industry to label and reduce salt content would save both money and lives. Intersectoral collaboration is highly important in reducing the burden of CHDs

20 Acknowledgment The research leading to these results has received funding from the European Community s Seventh Framework Programme (FP7/ ) under grant agreement n the MedCHAMPS project We would like to thank all people at the clinics and the hospitals in as well as the industry union who helped us in collecting the data and making this analysis possible.