Evaluating the cost-effectiveness of preventive zinc supplementation

Abstract

BackgroundEven though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions.MethodsUsing the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplementation in a representative low-income country. We then computed the cost and cost-effectiveness for three delivery mechanisms: the direct distribution of zinc supplements, the distribution of micronutrient biscuits including zinc, and the distribution of zinc through water filtration systems.ResultsCombining all health outcomes and impact estimates, we find that systematic zinc supplementation among children of ages one to five would avert 1.423 DALYs per 100 households and year in least developed countries. The estimated cost per DALY is US$ 606 for pill supplementation, US$ 1211 for micronutrient biscuits, and US$ 879 per DALY saved for water filtration systems.ConclusionsPreventive zinc supplementation to children of ages 1–5 appears to be a highly cost-effective intervention in typical developing country settings. More research will be needed to determine the most effective mechanism to deliver zinc to this target population.

Economic evaluation of interventions to address undernutrition: a systematic review

“…Preventative supplementation ( Edejer et al , 2005 ; Ma et al , 2008 ; Bhutta et al , 2013 ; Fink and Heitner, 2014 );…”

“… Fink et al (2014) estimated an incremental cost of $606–1211 per DALY averted for preventive supplementation interventions vs doing nothing. However, it was not clear whether health system costs were also included or not.…”

Cost-effectiveness of zinc supplementation for prevention of childhood diarrhoea in Tanzania

“…While a number of studies have examined the cost-effectiveness for preventing diarrhoea (Robberstad et al, 2004;Mejia et al, 2015;Shillcutt et al, 2017), these studies have been performed in the context of therapeutic zinc supplementation, and the outcomes for prophylactic zinc may differ. In addition, the few cost-effectiveness studies for prophylactic zinc have been conducted among children older than 6 months of age (Brown et al, 2013;Chhagan et al, 2013;Fink and Heitner, 2014) and none have been performed using data from East Africa. This study was therefore conducted to fill the knowledge gap with regards to the cost-effectiveness of prophylactic zinc supplementation in preventing various forms of diarrhoea in children aged between 6 weeks and 18 months in an east African setting.…”

“…For both outpatient and hospitalbased care, cost inputs included provider costs (medications and service provision), and costs borne by caregivers (out-of-pocket spending and productivity losses). Sources of cost data included secondary cost data from WHO-CHOICE (WHO, 2019) and similar studies (Robberstad et al, 2004;Tate et al, 2009;Brown et al, 2013;Fink and Heitner, 2014;Ruhago et al, 2015;WHO, 2019). Input values and sources are shown in Table 1.…”

Cost‐effectiveness of zinc interventions in China: A cohort‐based Markov model

“…In recent decades, several relatively affordable crops and condiments (such as grains, potatoes, oil, salt, and soy sauce) have been put forward as ideal carriers of micronutrients to improve public health cost‐effectively through food fortification or biofortification, providing abundant solutions for alleviating zinc deficiencies in underdeveloped areas. Numerous studies around the world have shown that zinc supplementation, food fortification, and biofortification are highly cost‐effective (Fink & Heitner, 2014; Horton, 2006; Ma et al, 2008; Mejía et al, 2015; Stein et al, 2007; Wang et al, 2016).…”