(P28-005-24) Estimated Health Benefits, Costs, and Cost-Effectiveness of Implementing WHO Global Sodium Benchmarks in India

Objectives: To estimate the potential health impact, economic impact, and cost-effectiveness of adopting the World Health Organization (WHO) global sodium benchmarks for packaged foods in India.

Methods: We estimated the incremental impact on the adult (≥20 years) population of the intervention (i.e., mandating compliance to WHO global sodium benchmarks within 4 years) compared to a base case scenario (i.e., current practice, the ‘Eat Right India’ initiative which includes ongoing educational campaigns), using a multiple cohort proportional multi-state life table model. Sodium intake, with and without the intervention, was estimated using Indian Food Composition Table, Euromonitor packaged foods sales data, and sodium content of packaged foods data obtained from food labels. Data on blood pressure, cardiovascular diseases (CVD) and chronic kidney disease (CKD) burden were obtained from the Global Burden of Disease study. The effect of sodium reduction on blood pressure and disease risk was modelled using evidence from meta-analyses of randomized trials and prospective studies. Intervention and healthcare costs were used to estimate net costs, and to calculate the incremental cost per health-adjusted life year (HALY) gained. Health gains and costs were discounted at 3%. Deterministic sensitivity analyses were conducted to assess the impact of alternative assumptions and inputs regarding implementation time, sodium intake, and discount rate.

Results: Compared to current practice, mandating the WHO benchmarks was projected to be cost-saving over the first 25 years (100% probability), with ~2.4 million deaths (95% uncertainty interval [UI]: 1.4-3.4), ~7.4 million incident CVD events (95% UI: 4.2-10), and ~3.0 million new CKD cases (95% UI: 1.7-4.3) averted. The intervention could generate ~11 million HALYs (95% UI: 6.2-15), of which about 1/3 would accrue to women. An estimated $3.5 billion (95% UI: 1.3-6.5) in healthcare costs could be saved. The intervention was consistently estimated to be cost-saving (≥99.8% probability) across deterministic sensitivity analyses.

Conclusions: Large projected health gains and cost-savings strongly support the case for India adopting the WHO global sodium benchmarks for packaged foods.

Funding Sources: The World Health Organization Country Office India