Lifetime health benefits, costs, and cost-effectiveness of salt substitution for stroke survivors in China: a microsimulation modeling study.

Abstract

Randomized trials have shown that potassium-enriched salt substitutes can lower blood pressure and reduce cardiovascular risk. Although several within-trial cost-effectiveness analyses of these salt substitutes have been reported, the long-term health and economic impacts among Chinese stroke survivors remain unclear. We adapted the China Cardiovascular Disease Prevention Model to estimate the lifetime health and economic impacts of replacing regular salt with a potassium-enriched salt substitute among Chinese adult stroke survivors from a healthcare sector perspective. Key inputs were drawn from the Salt Substitute and Stroke Study in China (N = 15,249), New Rural Cooperative Medical Scheme, Global Burden of Disease Study, and published literature. Outcomes included quality-adjusted life years (QALYs), direct healthcare costs (2023 USD), and incremental costs per QALY gained, all discounted at 3% annually. We conducted extensive sensitivity analyses to explore the robustness of the findings. Among 24·1 million Chinese stroke survivors (mean age 64·3 years; 46·5% women), salt substitution was projected to prevent 454,559 recurrent stroke events (a 3·7% reduction) and 482,632 stroke deaths (a 15·0% reduction). The intervention also reduced coronary heart disease events by 72,902 (a 3·8% reduction) and increased life expectancy by 0·74 years over the lifetime horizon. The intervention was estimated to yield 10·79 million additional QALYs (a 5·7% increase) and $417·28 million lower direct healthcare costs (a 0·8% decrease). Results were robust across all sensitivity analyses. Salt substitution was deemed cost-saving-producing better health outcomes at lower costs. Comprehensive adoption of potassium-enriched salt substitutes among Chinese stroke survivors could save lives, improve quality of life, and reduce healthcare costs. China-NNSF: 72293585; Australia-NHMRC: APP1049417, APP1164206; China-NKRDP: 2023YFC3605000.