Economic gains of a home fortification program: evaluation of "Sprinkles" from the provider's perspective.
BACKGROUND
This paper models the effects of a home-fortification program (using Sprinkles which contain zinc and iron and other micronutrients), in Pakistan, a country with high levels of infant mortality, anemia, and diarrhea. It uses the results of randomized trials of the effect of Sprinkles on anemia and on longitudinal prevalence of diarrhea.


METHODS
Based on previous literature, the effect of Sprinkles on intermediate outcomes (diarrhea and anemia) is linked to longer-term outcomes (infant and young child mortality, and cognitive achievement and hence adult wages). Three different measures of cost effectiveness are presented: the cost per death averted (effect via zinc supplementation on reduction of longitudinal prevalence of diarrhea); the cost per 'disability adjusted life year' (DALY) saved (same modality); and the gain in earnings due to higher cognitive functioning for each dollar spent (effect via iron supplementation on reduced anemia).


RESULTS
We estimated that the cost per death averted is dollars406 (dollars273-dollars3248), the cost per DALY saved is dollars12.2 (dollars8-dollars97) and the present value of the gain in earnings is dollars37 (dollars18-dollars51) for each dollar spent on the Sprinkles program. These estimates were developed for a low-income country (GDP per capita = dollars417) with a high infant mortality rate (IMR = 83/1000), high prevalence of anemia (93%), and high mean longitudinal prevalence of diarrhea (17%).


CONCLUSIONS
These outcomes are particularly favourable in Pakistan. The outcomes are more favourable when used with children 6-12 months. Further longer-run field trials of Sprinkles with larger populations would be helpful.
Sharieff
Waseem
W
Department of Health Policy, Management and Evaluation, the Research Institute, The Hospital for Sick Children, University of Toronto, Ontario. doc.sharieff@utoronto.ca
Horton
Susan E
SE
Zlotkin
Stanley
S
D000740:Anemia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D015362:Child Nutrition Disorders / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D002675:Child, Preschool; D017281:Cost of Illness; D003677:Deficiency Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003967:Diarrhea / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D019587:Dietary Supplements / Q000191:economics*; D005260:Female; D005527:Food, Fortified / Q000191:economics*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D019266:Iron, Dietary / Q000008:administration & dosage*; D008297:Male; D017063:Outcome Assessment, Health Care; D010154:Pakistan / Q000453:epidemiology; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D014815:Vitamins / Q000008:administration & dosage*; D015032:Zinc / Q000008:administration & dosage*
D019266:Iron, Dietary; D014815:Vitamins; D015032:Zinc