Abstract
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. 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. The home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh. Caregivers of child 6-59 months and BRAC staff members including community health workers were the participants for this study. 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. 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.
Highlights
In the start-up phase, most of the costs were incurred during the training of community health workers (CHW), which accounted for s68
Home visit-related activities accounted for the major costs incurred during the implementation phase 71·45 % of the total implementation costs per year
Considering outcomes as anaemia cases averted and disability-adjusted life years (DALY) averted among the under-five children, the home fortification with micronutrient powders (MNP) programme was very costeffective
Summary
Study design and setting We compared the cost and effectiveness of the MIYCN home fortification programme with the no intervention scenario. Due to the unavailability of any comparison group in the evaluation design, the total number of anaemia cases averted was estimated using the change in anaemia prevalence considering only the endline survey between the complier group (ever taken MNP) and non-compiler groups (never taken MNP) of targeted 6–59 months aged children in 164 upazilas. The unit cost of activities at the community level (e.g. home visit for counselling) was estimated by valuing the resources utilised to perform the activities in seven selected upazilas This unit cost was multiplied by average number of activities performed (extracted from Monthly Performance Reports of BRAC) per upazila and number of implementations upazilas over the programme period to estimate the total cost. Considering the programme roll-out over the implementation period, we estimated cost of sixty-eight upazilas in the first year, 120 upazilas in the second year and all 164 upazilas in the following two and half years
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
