Abstract WE558: Projected Health and Economic Impact of National Sodium Reformulation Policies in India: A Comparative Modeling Study

Background: Excess sodium intake contributes to nearly 200 000 cardiovascular deaths annually in India, where average daily salt consumption (8–11 g) exceeds the WHO recommendation by more than twofold. Despite global progress, India lacks large-scale implementation of sodium-reduction policies. This study modeled the potential health and economic benefits of national salt-reformulation strategies to inform policy design and prioritization. Methods: A comparative risk-assessment model estimated annual cardiovascular deaths and healthcare costs averted under three policy scenarios: voluntary 10 % sodium reduction, mandatory 20 % reduction, and mandatory 20 % reduction combined with front-of-pack labeling. Baseline sodium intake distributions were derived from national dietary surveys and adjusted for age, sex, and rural–urban strata. Relative risk functions for systolic blood pressure and cardiovascular outcomes were sourced from meta-analyses and the Global Burden of Disease study. Model inputs incorporated compliance assumptions, latency effects, and probabilistic sensitivity analyses. Direct medical costs were estimated from national health expenditure data (2024 USD). Results: Compared with current intake levels, the modeled policies were projected to avert approximately 79 000 (95 % UI 68 000–96 000), 158 000 (115 000–210 000), and 205 000 (150 000–270 000) cardiovascular deaths annually for the voluntary, mandatory, and combined scenarios, respectively. The comprehensive policy (Scenario 3) would yield an estimated US $1.2 billion (0.9–1.6 billion) in annual healthcare savings, with consistent benefits across sensitivity analyses. Potential risks of hyperkalemia from potassium substitution were minimal and offset by overall cardiovascular gains. Conclusions: National sodium-reformulation and labeling policies could prevent up to 200 000 cardiovascular deaths and generate substantial economic savings in India each year. Even partial adoption would produce meaningful health returns. Integration of mandatory sodium targets, industry monitoring, and consumer education into India’s National NCD Action Plan offers a cost-effective path toward achieving WHO sodium-reduction goals.