Journal List > Korean J Community Nutr > v.17(3) > 1038364

Korean J Community Nutr. 2012 Jun;17(3):341-352. Korean.
Published online June 30, 2012.  https://doi.org/10.5720/kjcn.2012.17.3.341
Copyright © 2012 The Korean Society of Community Nutrition
Cost-benefit Analysis of Sodium Intake Reduction Policy in Korea
Chulhee Lee, Dae-il Kim, Jeonglim Hong, Eunmi Koh,1 Baeg-won Kang,2 Jong Wook Kim,2 Hye-Kyung Park,2 and Cho-il Kim1
Department of Economics, Seoul National University, Seoul, Korea.
1Department of Health Industry & Policy, Korea Health Industry Development Institute, Choongbuk, Korea.
2Nutrition Policy Office, Korea Food & Drug Administration, Choongbuk, Korea.

Corresponding author: Cho-il Kim, Department of Health Industry & Policy, Korea Health Industry Development Institute, Osong-eup, Choongbuk 363-700, Korea. Tel: (043) 713-8611, Fax: (043) 713-8907, Email: kimci@khidi.or.kr
Received February 29, 2012; Revised April 06, 2012; Accepted May 15, 2012.

Abstract

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

Keywords: sodium intake reduction; health; cost-benefit analysis

Tables


Table 1
Diseases considered in cost-benefit analysis of sodium intake reduction policy
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Table 2
Expected effect of salt intake reduction on specific diseases
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Table 3
Estimated reduction in health-care costs
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Table 4
Estimated reduction in cost of death based on human capital approach
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Table 5
Estimated reduction in cost of death based on the estimated value of life
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Table 6
Overall benefits of sodium intake reduction
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Table 7
Estimated cost of sodium intake reduction policy
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Table 8
Rate of return (%) to investment in sodium intake reduction
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Notes

This research was supported by a grant (11162KFDA163) from Korea Food & Drug Administration in 2011.

References
1. Ahn BC, Joung H. Socioeconomic cost of obesity in Korea. Korean J Nutr 2005;38(9):786–792.
2. Blaustein MP, Hamlyn JM. Pathogenesis of essential hypertension : a link between dietary salt and high blood pressure. Hypertension 1991;18(5 Suppl):III184–III195.
3. Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. J Nephrol 2000;13(3):169–177.
4. Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, Marmot M. Intersalt Cooperative Research Group. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ 1996;312(7041):1249–1253.
5. Gaziano TA, Steyn K, Cohen DJ, Weinstein MC, Opie LH. Cost-effectiveness analysis of hypertension guidelines in South Africa. Circulation 2005;112:3569–3576.
6. Gibson J, Stillman S, Mckenzie D, Rohorua H. In: Natural experiment evidence on the effect of migration on blood pressure and hypertension. IZA Discussion Paper No. 5232. 2010.
7. He FJ, MacGregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2004;(3):CD004937.
8. He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2008;23(6):363–384.
9. He J, Oqden LG, Vupputuri S, Bazzano LA, Loria C, Whelton PK. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA 1999;282(21):2027–2034.
10. INTERSALT Cooperative Research Group. INTERSALT: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ 1988;297(6644):319–328.
11. Joffres MR, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol 2007;23(6):437–443.
12. Jung YH, Ko SJ. Estimating socioeconomic cost of five major diseases. Korean J Public Finance 2004;18(2):77–104.
13. Jung YH, Ko SJ. The socioeconomic cost of diseases in Korea. J Prev Med Public Health 2006;39(6):499–504.
14. Korea Employment Information Service2009 Occupational employment statistics. 2010 [cited 2011 May 20].
Available from http://survey.keis.or.kr.
15. Korea Food & Drug Administration. Sodium reduction initiative - promoters' meeting; Press Release 26/12/2011; 2011.
16. Korea Food & Drug Administration. Korea Health Industry Development Institute. Cost-benefit analysis of sodium intake reduction policy and international collaboration with WHO for establishing sodium intake guidelines. 2012.
17. Korean Nutrition Society. Dietary reference intakes for Koreans. 1st revision. Seoul: Hanareum; 2010. pp. 367-381.
18. Lee C. In-utero exposure to the Korean war and its long-term effects on health and economic outcomes; 2012 ASSA Meetings; 2011.
19. Meneton P, Jeunemaitre X, de Wardener HE, MacGregor GA. Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev 2005;85(2):679–715.
20. Ministry of Employment and LaborReport on 2009 Wage Structure Survey. 2010 [cited 2011 May 20].
Available from http://www.moel.go.kr.
21. Ministry of Health and Welfare. Korea Centers for Disease Control & Prevention. Korea Health Statistics 2007: Korea National Health and Nutrition Examination Survey (KNHANES IV-1) 2007. 2008.
22. Ministry of Health and Welfare. Korea Centers for Disease Control & Prevention. Korea Health Statistics 2008: Korea National Health and Nutrition Examination Survey (KNHANES IV-2) 2008. 2009.
23. Ministry of Health and Welfare. Korea Centers for Disease Control & Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3) 2009. 2010.
24. Ministry of Health and Welfare. Korea Centers for Disease Control & Prevention. Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANES V-1) 2010. 2011.
25. Ministry of Health and Welfare. Korea Institute of Health and Social Affairs. The third Korea National Health & Nutrition Examination Survey (KNHANES III), 2005 - Health Interview Survey. 2006.
26. Murray CJL, Lauer JA, Hutubessy RCW, Niessen L, Tomijima N, Rodgers A, Lawes CMM, Evans DB. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet 2003;361(9359):717–725.
27. National Health Insurance CorporationHealth Insurance Review & Assessment Service2008 National Health Insurance Statistical Yearbook. 2009 [cited 2011 March 10].
Available from http://www.nhic.or.kr.
28. National Health Insurance CorporationHealth Insurance Review & Assessment Service2009 National Health Insurance Statistical Yearbook. 2010 [cited 2011 February 10].
Available from http://www.nhic.or.kr.
29. National Health Insurance CorporationHealth Insurance Policy Research Institute2009 Survey on medical expenditure of patients insured by National Health Insurance. 2010 [cited 2011 March 10].
Available from http://www.nhic.or.kr.
30. Rhee M-Y, Yang SJ, Oh SW, Park Y, Kim C-i, Park H-K, Park SW, Park C-Y. Novel genetic variations associated with salt sensitivity in the Korean population. Hypertens Res 2011;34(5):606–611.
31. Rosen S. The theory of equalizing differences. In: Ashenfelter O, Layard R, editors. Handbook of Labor Economics. Volume 1. New York NY: North-Holland; 1986. pp. 641-692s.
32. Selmer RM, Kristiansen IS, Haglerod A, Graff-Iversen S, Larsen HK, Meyer HE, Bønaa KH, Thelle DS. Cost and health consequences of reducing population intake of salt. J Epidemiol Community Health 2000;54(9):697–702.
33. Stamler J. The INTERSALT Study: background, methods, findings, and implications. Am J Clin Nutr 1997;65(2 Suppl):626S–642S.
34. Stamler R. Implications of the INTERSALT study. Hypertension 1991;17(1 Suppl):I16–I20.
35. Statistics Korea2009 Economically Active Population Survey. 2010 [cited 2011 May 15].
Available from http://kosis.go.kr.
36. Statistics KoreaAnnual Report on the Cause of Death Statistics (2010). 2011 [cited 2011 February 16].
Available from http://kostat.go.kr.
37. Strazzullo P, D'Elia L, Kandala N-B, Cappuccio F. Salt intake, stroke, and cardiovascular disease: meta-anlaysis of prospective studies. BMJ 2009;339:b4567.
38. Tsugane S, Sasazuki S, Kobayashi M, Sasaki S. Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women. Br J Cancer 2004;90(1):128–134.
39. Tuomilehto J, Jousilahti P, Rastenyte D, Moltchanov V, Tanskanen A, Pietinen P, Nissinen A. Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet 2001;357(9259):848–851.
40. World Health Organization. Diet, nutrition and the prevention of chronic diseases. ort of a joint WHO/FAO Expert Consultation. Geneva: World Health Organization; 2003.
(WHO Technical report series, No. 916).
41. World Health Organization. Creating an enabling environment for population-based salt reduction strategies; Report of a joint technical meeting held by WHO and the Food Standards Agency; July 2010; United Kingdom. 2010a.
42. World Health OrganizationInternational statistical classification of diseases and related health problems, 10th Revision. ICD-10 Version:2010. 2010b [cited 2011 March 10].
43. World Health OrganizationCall for public comments on the scoping of sodium and potassium recommendations. 2011 [cited 2011 February 10].
44. World Health OrganizationCall for public comments - Draft WHO Guidelines sodium and potassium. 2012 [cited 2012 February 3].