The potential health impact and healthcare cost savings of different sodium reduction strategies in Canada

Background High dietary sodium is the main dietary risk factor for non-communicable diseases due to its impact on cardiovascular diseases, the leading cause of death globally. The Government of Canada has taken measures to reduce average dietary sodium intakes, such as setting voluntary sodium reduction targets for packaged foods and recently approving regulations mandating ‘high in’ front-of-pack labeling (FOPL) symbols. Objectives To estimate the number of avoidable ischemic heart disease (IHD) and stroke incidence cases, and their associated healthcare cost and Quality-Adjusted Life Year (QALY) savings resulting from different sodium reduction strategies and recommendations in Canada. Methods We used the PRIMEtime model, a proportional multi-state lifetable model. Outcomes were modeled over the lifetime of the population alive in 2019, at a 1.5% discount rate, and from the public healthcare system perspective. Nationally representative data were used as inputs for the model. Results Fully meeting Health Canada’s sodium reduction targets was estimated to prevent 219,490 (95% UI, 73,409–408,630) cases of IHD, and 164,435 (95% UI, 56,121–305,770) strokes. This led to a gain of 276,185 (95% UI, 85,414–552,616) QALYs, and healthcare costs savings of CAD$ 4,212(95% UI, 1,303–8,206) million over the lifetime of the 2019 cohort. Sodium reduction intake through FOPL regulations has the potential to prevent between 35,930 (95% UI, 8,058– 80,528) and 124,744 (95% UI, 40,125–235,643) cases of IHD, and between 26,869 (95% UI, 5,235–61,621) and 93,129 (95% UI, 30,296–176,014) strokes. This results in QALY gains ranging from 45,492 (95% UI, 10,281–106,579) to 157,628 (95% UI, 46,701–320,622), and healthcare costs savings ranging from CAD$ 695 (95% UI, 160–1,580) to CAD$ 2,415 (95% UI, 722–4,746) million over the lifetime of the 2019 Canadian cohort. Greater health and healthcare costs gains were estimated if Canadians were to meet the population-level sodium intake recommendations of the World Health Organization (2,000 mg/day) and the Adequate Intake recommendation (1,500 mg/day). All sodium reduction strategies tested were cost saving. Conclusions Reducing population-level sodium intakes is feasible and has the potential to improve health outcomes and save healthcare costs in Canada. From interventions tested, most health and healthcare costs gains were attributed to fully meeting sodium reduction targets, which highlights the importance of changing the voluntary nature of these targets to mandatory. A combination of strategies, mandatory sodium reduction targets and implementation of the ‘high in’ FOPL symbol would provide the most benefit from a public health standpoint.