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The New England Journal of Medicine published a computer simulation online late this week showing that salt reduction would reduce new onset of heart disease by 1/3 and stroke by almost half -- saving between $10 and $24 billion dollars of health care costs annually.As we've seen, changes to the payment system are complicated and difficult to implement - since there is always a loser as we move to lower unit prices, or insist on more accountability from various parties in the health care system. Changes to the delivery system are even more difficult.
This is another example of a public health intervention being cost saving -not merely cost effective. The intervention is not free. Regulatory effort is necessary, since a large portion of the sodium in the American diet comes from processed food. The authors estimate that salt reduction would yield between 200,000 and 400,000 QALYs annually - with cost saving as opposed to incremental costs. The authors note that this is substantially better value than antihypertensive therapy for those with hypertension -which at between $6,000 and $26,000 per QALY is also a very good value!
We need to reform health care payment and health care delivery - but that seems further away today than last week. Let's not forget the value of public health interventions as we contemplate making health care more affordable . I'll be skipping salt from now on, too.
