Background: Stroke is a leading cause of death and disability in Indonesia. Evidence suggests that low-sodium potassium-enriched salt substitutes (LSSS) are a cost-effective strategy to reduce blood pressure (BP) and stroke burden. However, the potential impact of switching from regular salt to LSSS in Indonesia is not known.
Methods: A simulation model was developed using the proportional multistate lifetable Markov framework. Data on BP and sodium intake were sourced from the 2018 Indonesian Basic Health Research Survey and Total Diet Study respectively. Baseline stroke epidemiology data came from the Global Burden of Disease 2019 study and meta-analyses were used to derive the dose-response relationships between LSSS and BP, and BP changes and stroke risk. Data on healthcare costs were from the National Health Insurance program – BPJS Kesehatan. Stroke outcomes and healthcare cost (discounted at 3%) were simulated over 10 years for the 2019 Indonesian population. We implemented probabilistic sensitivity analysis to capture the combined uncertainty in model inputs.
Results: Gradually switching population consumption of the current regular salt to LSSS over 10 years could avert 406,900 (95% UI: 361,200 – 447,300) non-fatal cases and 91,200 (74,800 – 105,000) fatal cases of haemorrhagic stroke, 384,800 (325,200 – 438,000) non-fatal cases and 35,200 (24,900 – 43,700) fatal cases of ischaemic stroke. These reductions in stroke burden translated to a US$ 1.1 billion (US$ 3.9 per capita) saving in stroke-related health expenditures.
Conclusions: Substantial disease burden and healthcare cost savings could be realised if LSSS were used in Indonesia.