(P07-044-25) Cost-Effectiveness of Alternative Hypothetical Bouillon Fortification Programs: Modeled Evidence for Burkina Faso, Nigeria, and Senegal

Objectives: We estimated the cost-effectiveness of hypothetical bouillon fortification programs delivering different amounts of vitamin A, vitamin B12, folic acid, iron, and zinc in the contexts of Burkina Faso, Nigeria, and Senegal.

Methods: We combined household food consumption data with food composition information to estimate total daily apparent intake of energy and micronutrients (MN). Accounting for the contributions of MN provided by existing fortification programs, we compared the nutrient density of household diets (MN intake per 1,000 kcal) to the requirements of women of reproductive age (WRA) and children to assess the contributions of alternative bouillon fortification programs delivering different amounts of MN to reducing inadequacies. We used the Lives Saved Tool (LiST) to estimate child-lives saved attributable to bouillon fortification with vitamin A, zinc and/or folic acid. An ingredient- and activity-based approach was used to estimate the costs of planning, designing, launching, and operating bouillon fortification programs.

Results: Costs tended to linearly increase with the amounts of fortificants; the relationships between fortification levels and impacts on dietary adequacy and lives saved differed by country and by MN, and were generally nonlinear. In Burkina Faso, the cost per WRA achieving folate adequacy at 20 µg folic acid/g was $0.27, $0.17 at 60 µg/g, and $0.18 at 120 µg/g; for the same folic acid concentrations in Nigeria, cost per WRA achieving adequacy rose steadily from $0.16 (20 µg/g) to $0.50 (120 µg/g). In Senegal, the cost per child-life saved by a multi-fortified bouillon cube containing 10% of Codex NRV of vitamin A, folic acid, and zinc in 2.5g was $1,655 (Nigeria $613 and Burkina Faso $4,325); cost per child-life saved by cube delivering 83% of Codex NRV of the same MN was $3,766 (Nigeria $2,330 and Burkina Faso $1,219).

Conclusions: Measures of cost-effectiveness of bouillon fortification programs depend on dietary intake patterns and policy choices regarding the numbers and amounts of fortificants included in premixes. Knowing levels of fortification at which marginal impacts become small could help inform program design. Program efficiency should be considered alongside program objectives, affordability, and sustainability, and technical and commercial viability.

Funding Sources: Bill & Melinda Gates Fdn via HKI