Abstract
BackgroundThe therapeutic effects of zinc and copper in reducing diarrheal morbidity have important cost implications. This health services research study evaluated the cost of treating a child with acute diarrhea in the hospital, the impact of micronutrient supplementation on the mean predicted costs and its cost-effectiveness as compared to using only standard oral rehydration solution (ORS), from the patient's and government's (providers) perspective.MethodsChildren aged 6 months to 59 months with acute diarrhea were randomly assigned to receive either the intervention or control. The intervention was a daily dose of 40 mg of zinc sulfate and 5 mg of copper sulfate powder dissolved in a liter of standard ORS (n = 102). The control was 50 mg of standard ORS powder dissolved in a liter of standard ORS (n = 98). The cost measures were the total mean cost of treating acute diarrhea, which included the direct medical, the direct non-medical and the indirect costs. The effectiveness measures were the probability of diarrhea lasting ≤ 4 days, the disability adjusted life years (DALYs) and mortality.ResultsThe mean total cost of treating a child with acute diarrhea was US $14 of which the government incurred an expenditure of 66%. The factors that increased the total were the number of stools before admission (p = 0.01), fever (p = 0.01), increasing grade of dehydration (p = 0.00), use of antibiotics (p = 0.00), use of intra-venous fluids (p = 0.00), hours taken to rehydrate a child (p = 0.00), the amount of oral rehydration fluid used (p = 0.00), presence of any complications (p = 0.00) and the hospital stay (p = 0.00). The supplemented group had a 8% lower cost of treating acute diarrhea, their cost per unit health (diarrhea lasting ≤ 4 days) was 24% less and the incremental cost-effectiveness ratio indicated cost savings (in Rupees) with the intervention [-452; 95%CI (-11306, 3410)]. However these differences failed to reach conventional levels of significance.ConclusionAn emphasis on the costs and economic benefits of an alternative therapy is an important aspect of health services research. The cost savings and the attractive cost-effectiveness indicates the need to further assess the role of micronutrients such as zinc and copper in the treatment of acute diarrhea in a larger and more varied population.
Highlights
The therapeutic effects of zinc and copper in reducing diarrheal morbidity have important cost implications
Diarrhea remains a major cause of morbidity and mortality in developing countries with a significant proportion experiencing a depletion of zinc and copper micronutrient stores
Our research questions were : What does it cost to treat a child of acute diarrhea in the hospital? Does the supplementation of zinc and copper to the oral rehydration solution (ORS) have an impact on the mean predicted costs of treating acute diarrhea and what is its incremental costs-effectiveness as compared to standard ORS?. Patient enrollment This is a clinical trial that evaluated the therapeutic effect of zinc and copper supplementation added to standard oral rehydration solution (ORS) for treating acute diarrhea at the Nagpur city's Government Medical College and Hospital, India
Summary
The therapeutic effects of zinc and copper in reducing diarrheal morbidity have important cost implications. Zinc supplementation has the potential to aggravate marginal copper deficiency, which in turn may impact negatively on the diarrheal morbidity [1] This health services research study evaluated the economic impact and benefits of zinc and copper supplementation for treatment of acute diarrhea in a randomized, double blind, clinical trial. Adding supplements of micronutrients to the standard management of diarrhea requires a change in treatment practices This appears to be minimal and feasible from a cost perspective, in the face of limited resources, the effectiveness of this intervention must be considered to ensure that the opportunity costs incurred are minimized
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