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

Objective To estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and Vitamin A deficiency in Pakistani children.Design The study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-Adjusted life years (DALY) averted.Setting Districts of Faisalabad and Hyderabad in Pakistan.Subjects Households with 6-23-month-old children stratified by socio-economic strata.Results The lifetime social costs of iodine deficiency, iron-deficiency anaemia and Vitamin A deficiency in 6-23-month-old children amounted to production losses of US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of US 783 to US 65. Interventions targeted at poorer households were most cost-effective.Conclusions Price subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6-23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.