Cost-effectiveness of a market-based home fortification of food with micronutrient powder programme in Bangladesh

Abstract

Objective: We estimated the cost-effectiveness of home fortification with micronutrient powder delivered in a sales-based programme in reducing the prevalence of Fe deficiency anaemia among children 6–59 months in Bangladesh. Design: Cross-sectional interviews with local and central-level programme staff and document reviews were conducted. Using an activity-based costing approach, we estimated start-up and implementation costs of the programme. The incremental cost per anaemia case averted and disability-adjusted life years (DALY) averted were estimated by comparing the home fortification programme and no intervention scenarios. Setting: The home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh. Participants: Caregivers of child 6–59 months and BRAC staff members including community health workers were the participants for this study. Results: The home fortification programme had an estimated total start-up cost of 35·46 million BDT (456 thousand USD) and implementation cost of 1111·63 million BDT (14·12 million USD). The incremental cost per Fe deficiency anaemia case averted and per DALY averted was estimated to be 1749 BDT (22·2 USD) and 12 558 BDT (159·3 USD), respectively. Considering per capita gross domestic product (1516·5 USD) as the cost-effectiveness threshold, the home fortification programme was highly cost-effective. The programme coverage and costs for nutritional counselling of the beneficiary were influential parameters for cost per DALY averted in the one-way sensitivity analysis. Conclusions: The market-based home fortification programme was a highly cost-effective mechanism for delivering micronutrients to a large number of children in Bangladesh. The policymakers should consider funding and sustaining large-scale sales-based micronutrient home fortification efforts assuming the clear population-level need and potential to benefit persists.

Comparing costs and cost‐efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda

“…The estimated cost of scaling up to country level for Uganda would likely surpass scale-up estimates for Bangladesh estimated in Ahmed et al: 19 the total cost in our study was $600,000-$800,000 for one of the 111 districts, likely exceeding the 14 million USD implementation cost estimated for Bangladesh. Methods do vary across studies, which may lead to varying estimates.…”

“…An MNP intervention in Bangladesh had an estimated total 5-year program cost of 14 million USD. 19 This study estimates costs based on programmatic elements using two delivery platforms in a single rural site in Uganda: (1) delivery by community health workers (community-based platform) and (2) delivery using facility-based health providers (facility-based platform). The cost, reach, adherence, and cost-efficiency, using reach and adherence as measures of project outcome of this intervention, are relevant for LMICs with similar healthcare infrastructure.…”

Implementation science in nutrition: a summary and synthesis

“…MNP home-fortification with food has fewer side effects compared with other similar interventions, such as supplements in Fe syrups and drops (15) . The economic evaluation of MNP home fortification demonstrates that it is cost effective in terms of per capita disability-adjusted life years (fifth article of this supplement) (8,16,17) .…”

“…For example, the third article addresses the implementation fidelity of a home-fortification programme (5) , and the fourth article describes the use of concurrent evaluation to course correct the implementation plan that resulted in improved implementation fidelity (6) . The fifth article explains the outcome of course correction in the programme coverage (7) , and the sixth article describes the cost-effectiveness of the Bangladesh Rural Advancement Committee (BRAC) home-fortification programme (8) . The following sections of this paper clarify each of the components of our implementation science framework, summarise key findings reported in Papers 3-6 of this supplement and critically synthesises these findings with support from the relevant literature.…”

Effective food systems innovations: An inventory of evidence from Bangladesh, Ethiopia, Nigeria, Viet Nam, and other low-and middle-income countries

“…3 We identified descriptive low-quality studies of experiences of private sector-initiated marketing of fortified foods including Bee et al (2015) and Nwuneli et al (2014) for Nigeria, and descriptive studies of social business models based on collaboration between non-profit and private sector for the marketing of fortified foods in Bangladesh (Agnew & Henson, 2018), Vietnam (Rocha et al, 2018a;Rocha et al, 2018b) and Ethiopia (Danse et al, 2020). Only one study uses a higher-quality quasiexperimental study of impact of marketing a fortified product in a social business model with a private sector partner on nutritional outcomes in Bangladesh (S. Ahmed et al, 2020;Danse et al, 2020). Overall, local sourcing of inputs for locally-produced fortified products, albeit as a social goal, is found to be relatively expensive and subject to price and supply fluctuations.…”