Australia: Salt Substitute and Stroke Study (SSaSS)

Replacing conventional salt with a salt substitute was a cost-effective strategy for stroke prevention and quality of life improvement among The Salt Substitute and Stroke Study (SSaSS) participants, says an article published in Circulation Journal.

The SSaSS, a five-year cluster randomized controlled trial, found that replacing regular salt with a reduced-sodium added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death in people with a history of stroke or uncontrolled high blood pressure in rural China. Ka-Chun Li and colleagues conducted this study to analyze the cost-effectiveness profile of the intervention.

This was a within-trial economic evaluation of SSaSS, carried out from the standpoint of the healthcare system and customers. The major health outcome studied was a stroke, and the impacts on quality-adjusted life years were measured (QALYs). The expenses of healthcare were derived from participant health insurance information and the literature. All expenses (Chinese Yuan - CNY) and QALYs were discounted at a rate of 5% each year. Bivariate multilevel models were used to estimate incremental expenditures, stroke events avoided, and QALYs gained.

Results of the Study

• The average length of follow-up for the 20,995 individuals was 4.7 years.
• During this time, substituting conventional salt with salt replacement lowered the risk of stroke by 14%, and the salt substitute group had 0.054 more QALYs per person on average.
• The salt replacement group had reduced average expenses (CNY 1,538 for the intervention group and CNY 1,649 for the control group) (CNY 110 less).
• The intervention was dominating in terms of stroke prevention as well as QALYs gained.
• Sensitivity tests revealed that these results were robust, with the exception of when the price of salt replacement was raised to the median and maximum market values observed in China.
• The salt replacement intervention had a 95.0% chance of being cost-effective and a greater than 99.9% chance of being cost-saving.

In conclusion, the findings of this study showed the efficiency of the salt-based substitution for regular salt in stroke prevention and improving the quality of life.

Reference

Li, K.-C., Huang, L., Tian, M., Di Tanna, G. L., Yu, J., Zhang, X., Yin, X., Liu, Y., Hao, Z., Zhou, B., Feng, X., Li, Z., Zhang, J., Sun, J., Zhang, Y., Zhao. Cost-effectiveness of a Household Salt Substitution Intervention: Findings From 20,995 Participants of the Salt Substitute and Stroke Study (SSaSS). In Circulation. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/circulationaha.122.059573

Keywords

Circulation, salt, stroke, salt substitute, cardiovascular events, quality of life, rock salt, blood pressure, sodium, potassium, American Heart Association, AHA