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


OBJECTIVE
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.
Sharieff
Waseem
W
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. doc.sharieff@utoronto.ca
Zlotkin
Stanley H
SH
Ungar
Wendy J
WJ
Feldman
Brian
B
Krahn
Murray D
MD
Tomlinson
George
G
D002657:Child Development; D003071:Cognition / Q000502:physiology; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000401:mortality; D005260:Female; D005527:Food, Fortified / Q000191:economics*; D006291:Health Policy; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000191:economics*; D007226:Infant Mortality; D007501:Iron / Q000008:administration & dosage; D000090463:Iron Deficiencies; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D009026:Mortality; D010154:Pakistan / Q000453:epidemiology; D011203:Poverty; D015032:Zinc / Q000008:administration & dosage / Q000172:deficiency
D007501:Iron; D015032:Zinc