The Lancet Regional Health. Western Pacific · Published 2026-07-01 · DOI 10.1016/j.lanwpc.2026.101914
Xuanjing Li, Xiong Ding, Maoyi Tian, Liping Huang, Zhifang Li, Yi Zhao, Bo Zhou, Yangfeng Wu, Bruce Neal, Qiushi Chen, Lijing L. Yan, Yan Li
Summary: Background: Randomized trials have shown that potassium-enriched salt substitutes can lower blood pressure and reduce cardiovascular risk. Although several within-trial cost-effectiveness analyses of these salt substitutes have been reported, the long-term health and economic impacts among Chinese stroke survivors remain unclear. Methods: We adapted the China Cardiovascular Disease Prevention Model to estimate the lifetime health and economic impacts of replacing regular salt with a potassium-enriched salt substitute among Chinese adult stroke survivors from a healthcare sector perspective. Key inputs were drawn from the Salt Substitute and Stroke Study in China (N = 15,249), New Rural Cooperative Medical Scheme, Global Burden of Disease Study, and published literature. Outcomes included quality-adjusted life years (QALYs), direct healthcare costs (2023 USD), and incremental costs per QALY gained, all discounted at 3% annually. We conducted extensive sensitivity analyses to explore the robustness of the findings. Findings: Among 24·1 million Chinese stroke survivors (mean age 64·3 years; 46·5% women), salt substitution was projected to prevent 454,559 recurrent stroke events (a 3·7% reduction) and 482,632 stroke deaths (a 15·0% reduction). The intervention also reduced coronary heart disease events by 72,902 (a 3·8% reduction) and increased life expectancy by 0·74 years over the lifetime horizon. The intervention was estimated to yield 10·79 million additional QALYs (a 5·7% increase) and $417·28 million lower direct healthcare costs (a 0·8% decrease). Results were robust across all sensitivity analyses. Interpretation: Salt substitution was deemed cost-saving—producing better health outcomes at lower costs. Comprehensive adoption of potassium-enriched salt substitutes among Chinese stroke survivors could save lives, improve quality of life, and reduce healthcare costs. Funding: China-NNSF: 72293585; Australia-NHMRC: APP1049417, APP1164206; China-NKRDP: 2023YFC3605000.
Abstract from DOAJ. Public domain (CC0 1.0).
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Li, X., Ding, X., Tian, M., et al. (2026). Lifetime health benefits, costs, and cost-effectiveness of salt substitution for stroke survivors in China: a microsimulation modeling study. The Lancet Regional Health. Western Pacific. https://doi.org/10.1016/j.lanwpc.2026.101914