International Journal of Public Health

, Volume 60, Supplement 1, pp 23–30 | Cite as

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010–2020

  • Meredith L. WilcoxEmail author
  • Helen Mason
  • Fouad M. Fouad
  • Samer Rastam
  • Radwan al Ali
  • Timothy F. Page
  • Simon Capewell
  • Martin O’Flaherty
  • Wasim Maziak
Original Paper



This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria.


Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region’s established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake.


HP, L, and R + HP + L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R = $5,453 PPP/LYG; R + HP = $2,201 PPP/LYG; R + L = $2,125 PPP/LYG). R + HP + L provided the largest benefit with net savings using the best and maximum estimates, while R + L was cost-effective with the lowest marginal cost using the minimum estimates.


This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.


Cost-effectiveness Salt reduction Coronary heart disease CHD Syria Eastern Mediterranean Region EMR 



This work was funded by the EU FP7 grants for the MedCHAMPS project (MEDiterranean studies of Cardiovascular disease and Hyperglycaemia: Analytical Modelling of Population Socio-economic transitions) and the RESCAP-MED project (RESearch CApacity for Public health in the MEDiterranean).


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Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Meredith L. Wilcox
    • 1
    Email author
  • Helen Mason
    • 2
  • Fouad M. Fouad
    • 3
    • 4
  • Samer Rastam
    • 4
  • Radwan al Ali
    • 4
  • Timothy F. Page
    • 5
  • Simon Capewell
    • 6
  • Martin O’Flaherty
    • 6
  • Wasim Maziak
    • 1
    • 4
  1. 1.Department of EpidemiologyFlorida International UniversityMiamiUSA
  2. 2.Yunus Centre for Social Business and HealthGlasgow Caledonian UniversityGlasgowUK
  3. 3.American University of BeirutBeirutLebanon
  4. 4.Syrian Centre for Tobacco StudiesAleppoSyria
  5. 5.Department of Health Policy and ManagementFlorida International UniversityMiamiUSA
  6. 6.Department of Public Health and PolicyUniversity of LiverpoolLiverpoolUK

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