Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010–2020

Objectives This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Methods Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region’s established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. Results HP, L, and R ? HP ? L were cost-saving using the best estimates. The remaining policies were costeffective (CERs: R = $5,453 PPP/LYG; R ? HP = $2,201 PPP/LYG; R ? L = $2,125 PPP/LYG). R ? HP ? L provided the largest benefit with net savings using the best and maximum estimates, while R ? L was cost-effective with the lowest marginal cost using the minimum estimates. Conclusions This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.