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Background The economic impact of nutritional policies has been rarely evaluated in Japan. We aimed to assess costs and benefits of salt-reduction policies for cardiovascular disease prevention. Methods We conducted a cost-benefit analysis using a Markov cohort simulation model over the period 2019 to 2028. We compared two salt-reduction policies—a national media campaign to promote healthy eating and physical activity (Policy A), and voluntary reformulation by the food industry to reduce salt added in processed food (Policy B). We used epidemiological data in Japan from national surveys and a global database, and estimates from previous meta-analyses on the changes in cardiovascular incidence and mortality associated with salt reduction. We applied a costing method in a previous study in England. We estimated benefits as a decrease in medical costs associated with cardiovascular diseases and costs as the sum of monitoring costs, policy costs, and subsidies. Results The estimated net benefits were 66.6 billion yen for Policy A and 353.5 billion yen for Policy B, and the latter was dominant. However, Policy A became dominant when the annual subsidy for Policy B exceeded 43.7 billion yen. Conclusions We employed a Markov cohort simulation by partially applying Japanese data to evaluate salt-reduction policies. In future research, it is necessary to collect data on salt reduction estimates and policy costs in Japan. Key messages As salt-reduction policies, voluntary food reformulation will be more beneficial than the media campaign as far as the annual subsidy does not exceed one-eighth of the benefit.

1333Economic impact of salt-reduction policies in Japan, 2019–2028: a Markov model simulation analysis