BMJ, doi: 10.1136/bmj.38652.550278.7C, (Published 10 November 2005)

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Cost effectiveness analysis of strategies for child health in developing countries

Tessa Tan-Torres Edejer ^1*, Moses Aikins ², Robert Black ³, Lara Wolfson ⁴, Raymond Hutubessy ⁴, David B Evans ⁵

¹ Costs, Effectiveness, Expenditure and Priority Setting, Health Systems Financing, World Health Organization, Geneva, Switzerland
² JSA Consultants, Accra, Ghana
³ Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
⁴ Initiative for Vaccine Research, World Health Organization
⁵ Health Systems Financing, Evidence and Information for Policy, World Health Organization

^* Correspondence to: tantorrest{at}who.int.

Objective To determine the costs and effectiveness of selected child health interventions--namely, case management of pneumonia, oral rehydration therapy, supplementation or fortification of staple foods with vitamin A or zinc, provision of supplementary food with counselling on nutrition, and immunisation against measles.

Design Cost effectiveness analysis.

Data sources Efficacy data came from published systematic reviews and before and after evaluations of programmes. For resource inputs, quantities came from literature and expert opinion, and prices from the World Health Organization Choosing Interventions that are Cost Effective (WHO-CHOICE) database

Results Cost effectiveness ratios clustered in three groups, with fortification with zinc or vitamin A as the most cost effective intervention, and provision of supplementary food and counselling on nutrition as the least cost effective. Between these were oral rehydration therapy, case management of pneumonia, vitamin A or zinc supplementation, and measles immunisation.

Conclusions On the grounds of cost effectiveness, micronutrients and measles immunisation should be provided routinely to all children, in addition to oral rehydration therapy and case management of pneumonia for those who are sick. The challenge of malnutrition is not well addressed by existing interventions.

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(Accepted 12 October 2005)
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