Cost-Effectiveness of Zinc Supplementation for the Prevention or Treatment of Diarrhea among Young Children in Rural Burkina Faso
Lea Prince *
Department of Agricultural and Resource Economics, University of California, Davis, CA, USA.
Stephen Vosti
Department of Agricultural and Resource Economics, University of California, Davis, CA, USA.
Oula Ouattara
Direction Régionale de l’Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.
Elodie Becquey
Department of Nutrition, University of California, Davis, CA, USA and Helen Keller International, New York, NY, USA.
Césaire Ouédraogo
Direction Régionale de l’Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.
Sonja Hess
Department of Nutrition, University of California, Davis, CA, USA.
Noel Rouamba
Direction Régionale de l’Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.
Jean-Bosco Ouédraogo
Direction Régionale de l’Ouest, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.
Kenneth Brown
Department of Nutrition, University of California, Davis, CA, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Zinc supplements may decrease incidence of diarrhea among young children at risk of zinc deficiency. We estimated the cost-effectiveness of three approaches for delivery of preventive and therapeutic zinc supplements in rural Burkina Faso.
Methods: Cost estimates were derived from data collected during a community-based randomized zinc trial, information on ongoing child-health days to distribute public health services, and an in-depth study of the current health care system. Diarrhea incidence reduction is based on intent-to-treat analysis of zinc trial data. Activity-based costing using an ingredients approach accounts for the costs of mutually exclusive inputs related to defined program activities for each approach. Cost-effectiveness is analyzed and compared across an intermittent preventive zinc (IPZ) approach (quarterly delivery of 10-days of 10 mg/d supplements to childrens’ homes), and a therapeutic approach (10-days of 20 mg/d supplements delivered during an ill-child consultation at a local clinic (TZ-CSPS) or via community-based health worker (TZ-CHW)). We assume 81.6% of children are reached with IPZ and .06% and 52% of diarrhea cases treated with TZ-CSPS and TZ-CHW, respectively.
Results: Estimated annual program cost per additional child reached is $3.52 (IPZ), $3.49 (TZ-CSPS) and $17.59 (TZ-CHW). Cost per death averted in the first program-year is estimated to be $3164 (IPZ), $7363 (TZ-CSPS), and $14068 (TZ-CHW), assuming a diarrhea case fatality rate of 0.3% and 2.64 episodes of diarrhea/child/year. Estimated cases of diarrhea averted per year are 11.5% (IPZ), 0.9% (TZ-CSPS), and 8.2%(TZ-CHW).
Conclusions: IPZ is the most cost-effective approach for a zinc program among our study population.