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Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

  • Simon Wieser (a1), Beatrice Brunner (a1), Christina Tzogiou (a1), Rafael Plessow (a1), Michael B Zimmermann (a2), Jessica Farebrother (a2), Sajid Soofi (a3), Zaid Bhatti (a3), Imran Ahmed (a3) and Zulfiqar A Bhutta (a3) (a4)...

Abstract

Objective

To estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children.

Design

The study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted.

Setting

Districts of Faisalabad and Hyderabad in Pakistan.

Subjects

Households with 6–23-month-old children stratified by socio-economic strata.

Results

The lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6–23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective.

Conclusions

Price subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6–23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Corresponding author: Email zulfiqar.bhutta@aku.edu

References

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Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

  • Simon Wieser (a1), Beatrice Brunner (a1), Christina Tzogiou (a1), Rafael Plessow (a1), Michael B Zimmermann (a2), Jessica Farebrother (a2), Sajid Soofi (a3), Zaid Bhatti (a3), Imran Ahmed (a3) and Zulfiqar A Bhutta (a3) (a4)...

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