HEALTH AND ECONOMIC IMPACT OF SALT AND ALCOHOL REDUCTION STRATEGIES FOR HYPERTENSION AND CARDIOVASCULAR DISEASE PREVENTION IN GHANA
Author(s)
Joseph P. Mensah, MPH, MSc, PhD1, Chloe Thomas, PhD2, Robert Akparibo, PhD2, Alan Brennan, BSc, MSc, PhD3;
1University of Oxford, Primary Care Health Sciences, Oxford, United Kingdom, 2University of Sheffield, Sheffield, United Kingdom, 3ScHARR, University of Sheffield, Sheffield, United Kingdom
1University of Oxford, Primary Care Health Sciences, Oxford, United Kingdom, 2University of Sheffield, Sheffield, United Kingdom, 3ScHARR, University of Sheffield, Sheffield, United Kingdom
OBJECTIVES: To estimate the long-term health and economic impact, and the maximum justifiable per-person implementation cost of two primary prevention strategies for hypertension and cardiovascular disease (CVD) in Ghana: a national mass-media salt-reduction campaign and brief alcohol-reduction interventions delivered in primary care, evaluated individually and in combination.
METHODS: A Ghana-adapted health economic microsimulation model was applied to a nationally representative synthetic adult population derived from the 2014 Ghana Demographic and Health Survey (≈17.4 million adults). Intervention effects on salt and alcohol consumption were informed by regional effectiveness studies and modelled with attenuation. Lifetime transitions across blood-pressure states and downstream CVD events were simulated using a multi-state Markov model parameterised with WHO SAGE Ghana data. Outcomes included disability-adjusted life years (DALYs) averted and costs (2025 USD), estimated from a societal perspective with 3% discounting. Cost-effectiveness was assessed using probabilistic sensitivity analysis at a willingness-to-pay (WTP) threshold of 0.5× GDP per capita (USD 1,203 per DALY).
RESULTS: Over the lifetime horizon, the salt-reduction campaign averted 647,502 DALYs (95% CrI: -797,523 to 1,993,928) and yielded mean net savings of USD 67.2 million (95% CrI: -318.7 to 474.1 million). Brief alcohol interventions averted 1.70 million DALYs (95% CrI: 82,248 to 3.22 million), with a small net cost increase (USD 5.7 million; 95% CrI: -419.6 to 389.2 million). The combined strategy produced the largest benefit, averting 2.82 million DALYs (95% CrI: 1.33 to 4.29 million). Maximum justifiable per-person implementation costs at the WTP threshold were USD 48.68 (salt), USD 117.40 (alcohol), and USD 193.26 (combined).
CONCLUSIONS: Both interventions are likely cost-effective in Ghana. Salt reduction may be cost-saving, while the combined salt and alcohol strategy delivers the greatest health gains and remains cost-effective provided implementation costs fall within estimated thresholds. These findings support integrated prevention approaches and highlight the need for local costing and budget-impact analyses to assess affordability.
METHODS: A Ghana-adapted health economic microsimulation model was applied to a nationally representative synthetic adult population derived from the 2014 Ghana Demographic and Health Survey (≈17.4 million adults). Intervention effects on salt and alcohol consumption were informed by regional effectiveness studies and modelled with attenuation. Lifetime transitions across blood-pressure states and downstream CVD events were simulated using a multi-state Markov model parameterised with WHO SAGE Ghana data. Outcomes included disability-adjusted life years (DALYs) averted and costs (2025 USD), estimated from a societal perspective with 3% discounting. Cost-effectiveness was assessed using probabilistic sensitivity analysis at a willingness-to-pay (WTP) threshold of 0.5× GDP per capita (USD 1,203 per DALY).
RESULTS: Over the lifetime horizon, the salt-reduction campaign averted 647,502 DALYs (95% CrI: -797,523 to 1,993,928) and yielded mean net savings of USD 67.2 million (95% CrI: -318.7 to 474.1 million). Brief alcohol interventions averted 1.70 million DALYs (95% CrI: 82,248 to 3.22 million), with a small net cost increase (USD 5.7 million; 95% CrI: -419.6 to 389.2 million). The combined strategy produced the largest benefit, averting 2.82 million DALYs (95% CrI: 1.33 to 4.29 million). Maximum justifiable per-person implementation costs at the WTP threshold were USD 48.68 (salt), USD 117.40 (alcohol), and USD 193.26 (combined).
CONCLUSIONS: Both interventions are likely cost-effective in Ghana. Salt reduction may be cost-saving, while the combined salt and alcohol strategy delivers the greatest health gains and remains cost-effective provided implementation costs fall within estimated thresholds. These findings support integrated prevention approaches and highlight the need for local costing and budget-impact analyses to assess affordability.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE4
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Thresholds & Opportunity Cost
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)