Cost-Efficiency and Cost-Effectiveness of Alternative Bouillon Fortification Programs: Evidence for Burkina Faso,...

Cost-efficiency and cost-effectiveness of fortification programs are not single, fixed numbers, but rather depend on dietary intake patterns and choices regarding the numbers and amounts of fortificants in premixes. We modeled the cost-efficiency and cost-effectiveness of alternative bouillon fortification formulations with vitamins A, B9, and B12, iron, and zinc in Burkina Faso, Nigeria, and Senegal. Cost per consumer reached varied by nutrient and context; for example, cost-efficiency for vitamin A (96 µg/g) ranged from ∼$0.05 (Burkina Faso) to ∼$0.12 (Nigeria). In Nigeria, the cost per woman effectively covered by vitamin A-fortified bouillon delivering 40-250 µg/g ranged from ∼$2.00 to ∼$6.50; in Burkina Faso, this metric fell from ∼$3.25 to ∼$1.25 for the same programs. Cost per child-life saved by bouillon co-fortified with vitamin A (96 µg/g), zinc (1.68 mg/g), and folic acid (28.8 µg/g) ranged from ∼$1272 (Burkina Faso) to ∼$3234 (Senegal). Cost functions tended to be linear in the amounts of fortificants in premixes; nutritional and child mortality benefit curves tended to be nonlinear, with context-specific shapes. Identifying fortification levels at which marginal benefits become small could help inform the design of efficient programs; design should also consider technical issues, program objectives, affordability, and sustainability.