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Economics of preventing premature mortality and impaired cognitive development in children through home-fortification: A health policy perspective

Published online by Cambridge University Press:  04 July 2008

Waseem Sharieff ,
Stanley H. Zlotkin ,
Wendy J. Ungar ,
Brian Feldman ,
Murray D. Krahn  and
George Tomlinson
Waseem Sharieff
Affiliation:
University of Toronto and McMaster University
Stanley H. Zlotkin
Affiliation:
The Hospital for Sick Children and University of Toronto
Wendy J. Ungar
Affiliation:
The Hospital for Sick Children and University of Toronto
Brian Feldman
Affiliation:
The Hospital for Sick Children and University of Toronto
Murray D. Krahn
Affiliation:
Toronto General Hospital and University of Toronto
George Tomlinson
Affiliation:
Toronto General Hospital and University of Toronto
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Abstract

Background: Home-fortification is a new strategy of adding micronutrients including zinc and iron to home-made foods. Zinc supplementation may prevent morbidity and mortality related to diarrheal illnesses, and iron supplementation may improve cognitive development, in children.

Objectives: To project clinical and economic effects of home-fortification in children in an urban slum of Karachi, Pakistan.

Methods: This is a cost benefit analysis of 5,000 simulated male and female infants (6–12 months) assigned to micronutrients or placebo for 4 months and followed for 55 years. We linked the effect of zinc on longitudinal prevalence of diarrhea to mortality, and the effect of iron on hemoglobin to IQ scores and lifetime earnings. Cost estimates were based on volumes of resource utilization from the Pakistan Sprinkles Diarrhea study. Main outcome was incremental benefit defined as the gain in lifetime earnings after accounting for the incremental costs of micronutrients over placebo (societal perspective).

Results: Our model projected that the reduction in diarrhea and improvement in hemoglobin concentrations through home-fortification was associated with reduced child mortality, higher IQ scores, and higher earnings. The present value of incremental benefit was $106 (95 percent probability interval = $17 to $193) U.S. dollars, which corresponds to $464.79 ($74.54 to $846.27) international dollars using a purchasing power parity exchange rate.

Conclusions: Home-fortification appears to improve clinical outcomes at a reasonable cost, and may actually be cost beneficial when lifetime earnings are considered.

Keywords

Markov modelMonte Carlo simulationDiarrheaIron deficiencyMicronutrientsCost benefitCost effectivenessSprinkles
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 3 , July 2008 , pp. 303 - 311
Copyright
Copyright © Cambridge University Press 2008

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