Cost-effectiveness of zinc supplementation for prevention of childhood diarrhoea in Tanzania

Abstract

Objective: To assess the cost-effectiveness of prophylactic zinc supplementation for preventing diarrhoea in young children in Tanzania. Design: Cost-effectiveness analysis using decision-analytic modelling. Cost-effectiveness ratios were calculated as the incremental cost (2019 USD) per disability-adjusted life year (DALY) averted, from a societal perspective, and with a 3% discount rate applied to future outcomes. Sensitivity analyses were performed to test the robustness of results to alternative assumptions. Setting: Tanzania. Participants: A hypothetical cohort of 10,000 children ages 6 weeks to 18 months. Results: The intervention costs of zinc supplementation were estimated as $109,800 (95% uncertainty interval: 61,716–171,507). Zinc supplementation was estimated to avert 2,200 (776–3,737) diarrhoeal episodes, 14,080 (4,692–25,839) sick days, 1,584 (522–2,927) outpatient visits, 561 (160–1,189) inpatient bed-days, 0.51 (0.15–1.03) deaths, and 19.3 (6.1–37.5) DALYs (discounted at 3% per year). Zinc supplementation reduced diarrhoea care costs by $12, 887 (4,089–25,058). The incremental cost per DALY averted was $4,950 (1,678–17,933). Incremental cost-effectiveness ratios (ICERs) estimated from a health system perspective were similar to the results from the societal perspective. ICERs were substantially lower (more favourable) when future outcomes were not discounted, but all ICERs were above contemporary thresholds for cost-effectiveness in this setting. Conclusion: Prophylactic zinc reduced diarrhoea incidence and associated healthcare utilization; however it did not appear to be cost-effective for prevention of childhood diarrhoea in the scenario examined in this study. Reducing intervention costs, or identifying high risk groups for intervention targeting, may be needed to improve cost-effectiveness in this setting.

Zinc Prophylaxis to Reduce Mortality and Morbidity in Under-5 Children: Clinical and Global Health Points of View

“…Zinc supplementation was estimated to cost approximately $11 per child in a recent study. 5 Based on decision-analytic modeling, the authors reported that prophylactic zinc for 18 months did not appear to be cost-effective for the prevention of diarrhea in their setting. It is prudent that future studies address the above critical questions that determine the cost-effectiveness of 4, 9, or 11 months of zinc supplementation.…”

Engineered baicalein-decorated zinc phosphates for synergistic alleviation of inflammatory bowel disease by repairing the mucosal barrier and relieving oxidative stress

“…21 Clinically, Zn deficiency affects various organs, particularly the gastrointestinal tract. 22 Reportedly, Zn supplementation can reduce the incidence of diarrheal episodes and diarrhea-induced morbidity, 23 and has a positive impact on maintaining the barrier function and homeostasis of intestinal epithelial cells. 24 Currently, there are 31 clinical trials of zinc supplements, alone or in combination with drugs, for the treatment of diseases involving diarrhoea, nutritional deficiencies, metabolic disorders, cancer, tuberculosis, etc.…”