HarvestPlus

Cost-effectiveness analysis of iron, vitamin A, and zinc biofortification in selected low- and middle-income countries: A modelling study

Background Crop biofortification is an important tool to improve micronutrient deficiency, but the evidence of its cost-effectiveness remains limited. Objectives This study aims to estimate the cost-effectiveness of biofortified crops to address iron, zinc, and vitamin A deficiency in 13 countries. Methods We used the burden of disease (BoD) measured in disability-adjusted life years (DALYs) compiled by the Institute for Health Metrics and Evaluation (IHME), supplemented by a literature review, to quantify DALYs resulting from micronutrient deficiencies. Data and assumptions from the Food and Agriculture Organization of the United Nations (FAO) were used to estimate micronutrient intake and the potential impact of biofortification on micronutrient intake to calculate the efficacy of biofortification in reducing DALYs under conservative, moderate, and optimistic scenarios. The cost was estimated for 30 years (2024-2053) while the benefits were for 20 years (2034-2053). An incremental cost-effectiveness ratio (ICER), defined as additional cost per DALY averted, was estimated. Results The total cost of biofortification programs varied across countries, ranging from $4.28 million in Guatemala to $34.04 million in Nigeria over 30 years. The ICERs of biofortification varied by type of crop and country; regardless, all are cost-effective using GDP-based cut-offs, except for biofortified cassava and sweet potatoes in Zimbabwe. For example, for iron biofortification of beans under the conservative scenario, ICER was as low as $58.04 per DALY averted in Kenya and as high as $535.52 per DALY averted in Zimbabwe, demonstrating the range of cost-effectiveness of the intervention among the countries selected for the study. A similar pattern was found for iron biofortification of pearl millet; vitamin A biofortification of cassava, maize, and sweet potatoes; and zinc biofortification of rice, wheat, and maize in most countries. Conclusion Biofortification of staple crops by selective plant breeding is potentially cost-effective to address iron, zinc, and vitamin A deficiencies.

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