Cost-Effectiveness of Expanding Home Cook Interventions for Salt Reduction in China

Excessive salt intake is a major risk factor for cardiovascular disease and premature mortality in China and globally. A recent cluster RCT demonstrated the effectiveness of home cook interventions in reducing salt intake and blood pressure among participants from 6 provinces in China. Yet, it remains unclear whether expanding these interventions across China would be cost-effective.

The China Cardiovascular Disease Prevention Model, a validated microsimulation model that captures the development and consequences of cardiovascular disease among adults aged ≥35 years in China, was used to estimate lifetime averted cardiovascular disease events and deaths, direct medical costs (2022 international dollar), quality-adjusted life years gained, and the incremental cost-effectiveness ratio of home cook interventions versus the status quo. Costs and quality-adjusted life years were discounted at 3%.

Compared with the status quo, home cook interventions were projected to avert 1.97 million coronary heart disease events, 3.69 million stroke events, 0.77 million deaths due to coronary heart disease, and 1.29 million deaths due to stroke in women. The interventions would also avert 1.62 million coronary heart disease events, 3.8 million stroke events, 0.6 million deaths due to coronary heart disease, and 1.15 million deaths due to stroke in men. The interventions resulted in an incremental cost-effectiveness ratio of 3,552 international dollar per quality-adjusted life year in women and 5,445 international dollar per quality-adjusted life year in men and, thus, were cost-effective considering a willingness-to-pay threshold of 21,318 international dollar (1-time gross domestic product per capita).

Public health policymakers in China should consider widely adopting home cook interventions to better prevent cardiovascular disease and reduce healthcare costs.