Estimated unit costs of anaemia interventions for women of reproductive age in 193 UN member states: a costing study.

BACKGROUND

Anaemia affects an estimated 1·92 billion people worldwide. The UN Sustainable Development Goals set targets for reducing anaemia prevalence by 50% in women of reproductive age, for whom the risks and consequences of anaemia are the greatest. Prioritisation of cost-effective anaemia reduction strategies relies on robust estimates of the costs of interventions. We aimed to develop country-specific unit cost estimates for WHO-recommended anaemia interventions for women of reproductive age.

METHODS

A micro-costing approach was used to estimate unit costs (per recipient per year) for six anaemia prevention and treatment interventions in 193 UN member states using data from secondary sources. The interventions included were oral iron supplementation for pregnant and non-pregnant women, fortification of staple foods, multiple micronutrient supplementation for pregnant women, intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine, presumptive deworming treatment for pregnant and non-pregnant women, and insecticide-treated bednets. A health-care sector perspective and 1-year timeframe were adopted. Cost categories included commodity, supply chain, service delivery, and administrative programme costs. Parameter uncertainty was explored in deterministic sensitivity analyses. Costs are presented as population-weighted means and SDs in 2023 US dollars.

FINDINGS

In most countries, staple food fortification and deworming were the lowest cost interventions, with population-weighted average costs of less than US$1 per person per year in settings with the highest burden of anaemia (ranging from $0·27 [SD 0·25] for staple fortification in low-income-countries to $0·84 [0·21] for deworming in non-pregnant women in lower-middle-income countries). Multiple micronutrient supplements had the highest average unit costs in most countries, with unit costs ranging from $9·57 (SD 0·58) in low-income countries to $135·56 (SD 25·95) in high-income countries. Commodity and service delivery costs were the largest cost drivers, although this varied across interventions and settings.

INTERPRETATION

Our standardised methodology and dataset estimate country-level unit costs and describe cost drivers for WHO-recommended anaemia interventions. These findings can facilitate cost-effectiveness analyses of anaemia interventions for women of reproductive age and strengthen priority-setting processes.

FUNDING

Gates Foundation.