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 cost-effective (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.