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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Cost-effectiveness of price subsidies on fortified packaged infant cereals in reducing iron deficiency anemia in 6-23-month-old children in urban India
Authors: Plessow, Rafael
Arora, Narendra Kumar
Brunner, Beatrice
Wieser, Simon
DOI: 10.21256/zhaw-4675
Published in: PLOS ONE
Volume(Issue): 11
Issue: 4
Page(s): 1
Pages to: 21
Issue Date: 2016
Publisher / Ed. Institution: Public Library of Science
ISSN: 1932-6203
Language: English
Subjects: Iron-deficiency anemia; Cost of illness; Cost-benefit analysis; Edible grain; Poverty; Public health; Quality-adjusted life years; Urban population
Subject (DDC): 362.1041: Health economics
Abstract: Introduction: Iron deficiency anaemia (IDA) is a major public health problem in India and especially harmful in early childhood due to its impact on cognitive development and increased all-cause mortality. We estimate the cost-effectiveness of price subsidies on fortified packaged infant cereals (F-PICs) in reducing IDA in 6-23-monthold children in urban India. Materials and Methods: Cost-effectiveness is estimated by comparing the net social cost of price subsidies with the disability-adjusted life-years (DALYs) averted with price subsidies. The net social costs correspond to the cost of the subsidy minus the monetary costs saved by reducing IDA. The estimation proceeds in three steps: 1) the current lifetime costs of IDA are assessed with a health economic model combining the prevalence of anemia, derived from a large population survey, with information on the health consequences of IDA and their costs in terms of mortality, morbidity, and DALYs. 2) The effects of price subsidies on the demand for F-PICs are assessed with a market survey among 4801 households in 12 large Indian cities. 3) The cost-effectiveness is calculated by combining the findings of the first two steps with the results of a systematic review on the effectiveness of F-PICs in reducing IDA. We compare the cost-effectiveness of interventions that differ in the level of the subsidy and in the socio-economic strata (SES) eligible for the subsidy. Results: The lifetime social costs of IDA in 6-23-month-old children in large Indian cities amount to production losses of 3222 USD and to 726,000 DALYs. Poor households incur the highest costs, yet even wealthier households suffer substantial losses. The market survey reveals that few households currently buy F-PICs, with the share ranging from 14% to 36%. Wealthier households are generally more likely to buy FPICs. The costs of the subsidies per DALY averted range from 909 to 3649 USD. Interventions targeted at poorer households are most effective. Almost all interventions are cost saving from a societal perspective when taking into account the reduction of future production losses. Return per DALY averted ranges between gains of 1655 USD to a cost of 411 USD. Conclusion: Price subsidies on F-PICs are a cost-effective way to reduce the social costs of IDA in 6-23-month-old children in large Indian cities. Interventions targeting poorer households are especially cost-effective.
Fulltext version: Published version
License (according to publishing contract): CC BY 4.0: Attribution 4.0 International
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Published as part of the ZHAW project: Burden of micronutrient deficiencies and cost-effectiveness of interventions with fortified foods
Appears in collections:Publikationen School of Management and Law

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