Predicted Effects and Cost-Effectiveness of Wheat Flour Fortification for Reducing Micronutrient Deficiencies, Maternal Anemia, and Neural Tube Defects in Yaoundé and Douala, Cameroon

• Published in: Food and nutrition bulletin Vol. 42; no. 4; pp. 551 - 566
• Main Authors: Noshirvan, Arram, Wu, Brenda, Luo, Hanqi, Kagin, Justin, Vosti, Stephen A., Ndjebayi, Alex, Assiene, Jules Guintang, Teta, Ismael, Nankap, Martin, Engle-Stone, Reina
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-12-2021
• Subjects: Anemia; Cameroon - epidemiology; Child; Cost-Benefit Analysis; Disability-Adjusted Life Years; Flour; Folic Acid; Food, Fortified; Humans; Iron Deficiencies; Micronutrients; Neural Tube Defects - epidemiology; Neural Tube Defects - prevention & control; Triticum; Cameroon; cost-effectiveness; neural tube defect; Cameroon; micronutrient; folic acid; fortification; anemia
• ISSN: 0379-5721; 1564-8265
• DOI: 10.1177/03795721211020716

Background:
Policy makers aiming to reduce micronutrient deficiencies (MNDs) and their health effects must choose among alternative definitions of impact when evaluating cost-effectiveness.
Objective:
Estimate the cost-effectiveness of a mandatory wheat flour fortification program for reducing cases of MNDs (iron, zinc, folate, vitamin B12), anemia and neural tube defects (NTDs) averted, and disability-adjusted life years (DALYs) averted in urban Cameroon.
Methods:
A 13-year predictive model was developed, including a 3-year start-up period and 10 years of program activity. Costs were estimated using historical program budgets. Effects were calculated based on observed changes in prevalence of MND and anemia 1 year postfortification and predicted reductions in NTDs based on NTD burden and wheat flour intake. Total DALYs averted were estimated for anemia and NTDs.
Results:
The program cost ∼$2.4 million over 13 years and averted an estimated ∼95 000 cases of maternal anemia and ∼83 500 cases of iron deficiency among children after 1 year. Cost/case-year averted for MNDs ranged from $0.50 for low plasma folate to $3.30 for iron deficiency and was $2.20 for maternal anemia. The program was predicted to avert 1600 cases of NTDs over 10 years at ∼$1500 per case averted. Estimated cost/DALY averted was $50 for NTDs and $115 for anemia.
Conclusions:
In Cameroon, cost-effectiveness of wheat flour fortification varied by the measure of impact employed, but was classified as “very cost-effective” for all outcomes using World Health Organization criteria. Policy makers and their advisors must determine how best to use information on program costs and benefits to inform their decisions.