Societal Costs of Micronutrient Deficiencies in 6- to 59-month-old Children in Pakistan

Abstract

Background: In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development. Objective: To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months. Methods: We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and disability-adjusted life-years (DALYs). The estimation is based on large population surveys, information on the health consequences of micronutrient deficiencies extracted from randomized trials, and a variety of other sources. Results: Total societal costs amount to US$46 million in medical costs, US$3,222 million in production losses, and 3.4 million DALYs. Costs are dominated by the impaired cognitive development induced by iron-deficiency anemia in 6-to 23-month-old children and the mortality caused by vitamin A deficiency. Costs are substantially higher in poorer households. Conclusions: Societal costs amounted to 1.44% of gross domestic product and 4.45% of DALYs in Pakistan in 2013. These costs hinder the country's development. They could be eliminated by improved nutrition of 6-to 59-month-old children and public health measures. Our results may contribute to the design of cost-effective interventions aiming to reduce micronutrient deficiencies in early childhood and their lifetime consequences.

Análise do impacto econômico da falta de suplementação multivitamínica em mulheres em idade reprodutiva e suas consequências em recém-nascidos

“…A deficiência de micronutrientes tem se mostrado como um importante desafio para a saúde pública, especialmente em países em desenvolvimento e subdesenvolvidos (Bhutta et al, 2013). O custo da deficiência de micronutrientes em crianças de 6 a 59 meses foi avaliado no Paquistão, sob a perspectiva da sociedade, e foi estimado um total de 46 milhões de dólares em gastos médicos e de 3.222 milhões de dólares em perda de produtividade, representando cerca de 1,5% do produto interno bruto do país (Wieser et al, 2017). Uma avaliação similar foi conduzida nas Filipinas e foi estimado um custo total de 30,3 milhões de dólares com gastos médicos e de 618,2 milhões de dólares com perda de produtividade (Wieser et al, 2013).…”

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

“…We estimated the cost-effectiveness of price subsidies on FPCF for the reduction of iodine, iron and vitamin A deficiencies in 6–23-month-old Pakistani children. For this purpose, we adapted a previous model of the societal costs of micronutrient deficiencies in Pakistan ( 17 ) to the districts of Faisalabad and Hyderabad, and carried out a survey including a hypothetical marketing experiment among 1764 households. We then estimated the net cost per DALY averted of different price subsidies covering different socio-economic strata.…”

“…We calculated the current lifetime costs of IoD, IDA and VAD in a birth cohort of children affected by these deficiencies between the ages of 6 and 23 months. These costs were calculated by adapting the model of the societal costs of MND in Pakistan ( 17 ) to the districts of Faisalabad and Hyderabad ( 19 ) . The health and costs consequences of MND in this age group are described in detail in the online supplementary material (Section 1, Tables S1 and S2).…”

Micronutrient Deficiencies in Medical and Surgical Inpatients

“…A study focusing on estimates of disability-adjusted life years and their monetization showed that short-term economic costs of micronutrient malnutrition in India amounted to 0.8% to 2.5% of the gross domestic product [14]. The health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies were assessed in Pakistani children: Societal costs amounted to 1.44% of gross domestic product and 4.45% of disability-adjusted life-years in Pakistan in 2013, which hindered the country’s development [111].…”