Cost effectiveness of fortified bouillon in addressing Burkinabe children's vitamin A inadequacy: An economic optimization model

Abstract

Vitamin A dietary inadequacy remains a serious public health problem among young children 6-59 months of age in Burkina Faso. Planners face several interrelated challenges: Selecting concrete policy objectives regarding vitamin A inadequacy reductions, identifying cost-effective vitamin A intervention programs that can achieve those objectives, and being reasonably sure that proposed intervention programs are robust to uncertainty in program benefits and costs. A 10-year, subnational economic optimization model making use of secondary dietary intake data and program cost data was developed and implemented to address these issues and included the following vitamin A program options: existing or improved edible oils fortification, a pair of hypothetical vitamin A-fortified bouillon programs, and a set of subnational vitamin A supplementation (VAS) programs. The model consistently identified the improved edible oils and bouillon fortification programs as the core national programs upon which the more expensive subnational VAS programs could be layered, depending on policy objectives and available funding. These results were robust to uncertainty in program nutritional benefits and costs. However, even if the most impactful set of modeled programs was implemented, vitamin A inadequacy among children would remain a serious public health problem; hence, additional efforts to address it would be needed.

Keywords: Burkina Faso; costs; economic optimization; nutritional adequacy; vitamin A.

FIGURE 1

Regions and constructed macro‐regions of Burkina Faso.

FIGURE 2

Annual flows of children effectively covered and program costs for selected vitamin A programs and program packages.

FIGURE 3

Total costs (A) and cost effectiveness (B) of economically optimal vitamin A programs and program packages. Scenario labels A through K represent alternative sets of optimal vitamin A intervention programs; see Table 3. Scenario A0 represents the (benchmark) current vitamin A–fortified edible oils program.

FIGURE 4

Ranges and distributions of children effectively covered and costs of vitamin A programs and program packages deemed economically optimal under central estimates. (A) Distributions of the total number of children effectively covered under stochastic benefits. (B) Distribution of the total costs under stochastic costs. The labels A through K represent different economically optimal programs and program packages, as identified in Table 3. The whisker diagrams associated with each program or program package depict the mean, and the first and third quartiles of the marginal distribution. The red masses to the right of each whisker diagram depict the marginal distributions of benefits or costs.

FIGURE 5

Programs and program packages most frequently deemed economically optimal, considering stochastic program costs and the number of children effectively covered. Cube 30%, fortified bouillon at 30% of Codex NRV for an adult in 2.5 g/day; oil improved, edible oils fortified with 17.5 mg/kg of VA; cube 15%, fortified bouillon at 15% of Codex NRV for an adult in 2.5 g/day; VAS, vitamin A supplementation; E, East macro‐region; O, Ouagadougou macro‐region; W, West macro‐region; N, North macro‐region; VAS without macro‐regional designations represents a national VAS program. Labels A–K represent different economically optimal programs and program packages, as identified in Table 3.

FIGURE 6

Top two programs or program packages most frequently deemed economically optimal, considering stochastic program costs and benefits. Cube 30%: fortified bouillon at 30% of Codex NRV for an adult in 2.5 g/day; oil improved: edible oils fortified with 17.5 mg/kg of VA; cube 15%, fortified bouillon at 15% of Codex NRV for an adult in 2.5 g/day; VAS: vitamin A supplementation; E: East macro‐region; O: Ouagadougou macro‐region; W: West macro‐region; N: North macro‐region; VAS without macro‐regional designations represents a national VAS program. See Table 3 for descriptions of scenario labels.