Economic evaluation of iodine deficiency disorder control program in Sikkim: a cost effectiveness study.
BACKGROUND
Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches.


OBJECTIVE
To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program.


METHODS
Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD.


RESULTS
The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP.


CONCLUSIONS
The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.
Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. cpandav@iqplusin.org
Chandrakant S
CS
Pandav
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003409:Congenital Hypothyroidism / Q000453:epidemiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005260:Female; D006043:Goiter, Endemic / Q000453:epidemiology / Q000517:prevention & control; D005102:Health Expenditures; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007455:Iodine / Q000008:administration & dosage / Q000172:deficiency* / Q000191:economics / Q000627:therapeutic use; D007459:Iodized Oil / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012307:Risk Factors; D012737:Sex Factors; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*
D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007459:Iodized Oil; D007455:Iodine