Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries.
OBJECTIVE
To analyse the incremental costs, effects and cost-effectiveness of zinc used as adjunct therapy to standard treatment of acute childhood diarrhoea, including dysentery, and to reassess the cost-effectiveness of standard case management with oral rehydration salt (ORS).


METHODS
A decision tree was used to model expected clinical outcomes and expected costs under four alternative treatment strategies. The best available epidemiological, clinical and economic evidence was used in the calculations, and the United Republic of Tanzania was the reference setting. Probabilistic cost-effectiveness analysis was performed using a Monte-Carlo simulation technique and the potential impacts of uncertainty in single parameters were explored in one-way sensitivity analyses.


RESULTS
ORS was found to be less cost-effective than previously thought. The use of zinc as adjunct therapy significantly improved the cost-effectiveness of standard management of diarrhoea for dysenteric as well as non-dysenteric illness. The results were particularly sensitive to mortality rates in non-dysenteric diarrhoea, but the alternative interventions can be defined as highly cost-effective even in pessimistic scenarios.


CONCLUSIONS
There is sufficient evidence to recommend the inclusion of zinc into standard case management of both dysenteric and non-dysenteric acute diarrhoea.A direct transfer of our findings from the United Republic of Tanzania to other settings is not justified, but there are no indications of large geographical differences in the efficacy of zinc. It is therefore plausible that our findings are also applicable to other developing countries.
Robberstad
Bjarne
B
Centre for International Health, Department of Public Health and Primary Health Care, University of Bergen, 5021 Bergen, Norway. bjarne.robberstad@cih.uib.no
Strand
Tor
T
Black
Robert E
RE
Sommerfelt
Halvor
H
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D004359:Drug Therapy, Combination; D004403:Dysentery / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D005440:Fluid Therapy / Q000191:economics; D006801:Humans; D007223:Infant; D015532:Rehydration Solutions / Q000191:economics; D012680:Sensitivity and Specificity; D013636:Tanzania; D035501:Uncertainty; D015032:Zinc / Q000191:economics / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D015532:Rehydration Solutions; D015032:Zinc