Cost effectiveness of Zinc Supplementation for the Treatment of Acute Diarrhoea in Children under 5 Years in Colombia
Aurelio Mejia
Instituto de Evaluación Tecnológica en Salud, Bogota, Colombia.
Sara Atehortua
Universidad de Antioquia, Medellin, Colombia.
Ivan D. Florez *
Instituto de Evaluación Tecnológica en Salud, Bogota, Colombia and Universidad de Antioquia, Medellin, Colombia.
Javier M. Sierra
Universidad de Antioquia, Medellin, Colombia.
Maria E. Mejia
Universidad de Antioquia, Medellin, Colombia.
Carolina Ramirez
Universidad de Antioquia, Medellin, Colombia.
*Author to whom correspondence should be addressed.
Abstract
Objectives: To determine the relative cost-effectiveness of zinc supplementation for the treatment of acute diarrhoea in children under five years in Colombia.
Methods: Cost-effectiveness analysis from the perspective of the Colombian Health System. We evaluated standard treatment with addition of zinc versus standard treatment without zinc supplement for children from birth to five years. The time horizon was the duration of the diarrhoea. Effectiveness information was extracted from a Cochrane systematic review and Colombian databases and observational studies. Identification and measurement of resource use was based in clinical guidelines, protocols and expert opinion. Unit costs were obtained from Colombian tariff manuals. We performed deterministic sensitivity analysis to assess the impact of changes in the cost and effectiveness of the strategies on the results of the model.
Results: The average treatment cost of one diarrhoea episode in Colombia is USD $40.77 using standard treatment, and USD $32.96 with zinc supplementation, a reduction of $7.81 USD. Additionally, zinc supplementation is more effective than standard treatment without zinc: it reduces diarrhoea-related mortality and incidence of persistent diarrhoea. The results are sensitive to changes in the probability of hospitalization and persistent diarrhoea, but conclusions do not change substantially.
Conclusions: Zinc for the treatment of acute diarrhoea is a highly cost-effective strategy from the perspective of the Colombian Health System. It is more cost-effective in children with higher risk of persistent diarrhoea and hospitalization.