Vitamin C Fortification of Food Aid Commodities Final Report (1997) / Chapter Skim
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3 Cost-Effectiveness Analysis
3 Cost-Effectiveness Analysis
Pages 23-36
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From page 23... ...
It is assumed that accomplishing these will achieve the congressionally mandated objective of improving the health of food aid recipients, thereby reducing the need for, and cost of, later medical interventions. The first objective, improving or maintaining the vitamin C intake of the target population, seems to consist of two subobjectives: (1)
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From page 24... ...
Many recipients of developmental food aid are iron deficient (OMNI, 1994; Toole, 1994; Beaton, 1995~. However, doubling the vitamin C content of fortified, blended foods to improve iron absorption may be much less costeffective than increasing the iron content of such foods above their present levels of fortification, or of increasing iron in the diet by other means.
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From page 25... ...
adopted the policy in 1994 of providing fortified, blended foods to populations wholly dependent on food aid. Other risk factors for scurvy include physiological status (pregnancy and lactation)
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From page 26... ...
The cost-effectiveness assessment would be affected if it were possible to fortify a small percentage of blended food and target this food specifically to refugee situations known to be at high risk of vitamin C deficiency over the long run. Cost-effectiveness would be improved because the additional fortification would be required only for the small percentage of blended food going to the high-risk population; however, there would be some additional management cost involved in keeping track of two separate supplies of blended food.
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From page 27... ...
The following analysis is based on the assumptions spelled out in the text and is in this sense a hypothetical "best guess." The conclusion is that using the most optimistic assumptions, the cost of using highly fortified CSB to avert a case of scurvy may range from $158 to $1,223, depending entirely on assumptions regarding coverage of the target population, while the cost to avert a case of scurvy by tripling the conventional ration may range from $7.45 to $74.50 based on the expectation that rations would be targeted by camp, but not by individual within a camp. Thus increasing the conventional ration to high-risk camps is at least 2.1 times more cost-effective than increasing the level of fortification and may be 16.4 times as cost-effective or more.
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From page 28... ...
For example, if 25 percent of East African refugee camps are at high risk of deficiency, the marginal cost of reaching a target camp by fortifying all blended food with high levels of vitamin C is $361 per MT that actually reaches the target population. These high costs result from the inability to target fortified food to the at-risk population.
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From page 29... ...
This number represents more than 200 times the estimated scurvy incidence of 10,000 cases, although there is no assurance that normal distribution would necessarily target those individuals. Assumptions Regarding Nutrient Losses The SUSTAIN pilot study estimated losses of vitamin C from conventional and highly fortified blends.
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From page 30... ...
However, we know that retention rates are higher when initial fortification levels are higher. If conventional CSB retains 30 percent of its fortificant and highly fortified CSB retains 60 percent, then providing 10 mg of vitamin C to an individual would cost 2.79 cents per day with conventional CSB and 0.63 cents per day with highly fortified CSB, suggesting that the highly fortified CSB may be as much as 4.4 times more cost effective as a vitamin C delivery mechanism Note, though, that the reduction in quantity of ration implicit in this calculation would have serious implications for other nutrients contained in the blended food.
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From page 31... ...
These foods are more often used as supplementary food in maternal and child health programs. When frank scurvy appears in refugee camps, distribution of blended foods is only one option considered; others include procurement of local foods containing vitamin C (a preferred strategy because such procurement can strengthen the local economy, the foods provide additional nutrients, and a quick response is possible)
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From page 32... ...
A ration of about 102 g of conventionally fortified blended food would provide 10 mg of vitamin C, based on the pessimistic assumption of 24.5 percent nutrient retention after cooking. Of the highly fortified food, 23 g would provide 10 mg of vitamin C under the optimistic assumption of 48 percent nutrient retention.
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From page 33... ...
, we may assume that at most only about 13 percent of scurvy cases could be averted using current allocations; if only 13 percent of the 10,000 cases per year could be averted through increased fortification, then the cost per case averted would be $1,223. At current prices, the cost of tripling the ration of conventionally fortified blended food from 30 to 90 g per person per day, an amount that would provide close to the 10 mg needed to prevent scurvy, would be an additional $7.45 per person per year, a total of $74,500 for 10,000 cases.
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From page 34... ...
Since extra fortification raises the cost of blended foods by 1.8 percent, tripling the conventional ration for 10,000 recipients, which would reduce the amount available by only 0.14 percent, clearly is over 12.8 times more cost effective. If the triple ration were targeted by camp rather than individual suffering from scurvy and a prevalence rate of 10 percent were assumed, tripling the conventional ration would reduce the total amount of blended food available by 1.4 percent, which is still less than the 1.8 percent cost of fortifying the entire supply of blended food.
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From page 35... ...
Thus, the net effect of improving iron absorption through the addition of vitamin C would be an additional cost of $5.52 per metric ton; obviously, adding vitamin C is not a cost-effective strategy for improving the absorption of iron from blended foods. Although there are many approaches that could be considered to improve iron intake, this substantial difference in cost-effectiveness and the uncertainty about the stability of vitamin C make it unlikely that further comparisons would alter this conclusion.
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