# Cost‐Efficiency and Cost‐Effectiveness of Alternative Bouillon Fortification Programs: Evidence for Burkina Faso, Nigeria, and Senegal

## TL;DR

This paper evaluates the cost and effectiveness of adding vitamins and minerals to bouillon in three African countries to improve child health.

## Contribution

The study introduces a modeling approach to assess how different fortification levels affect cost and health outcomes in specific dietary contexts.

## Key findings

- Cost-efficiency for vitamin A fortification ranged from $0.05 in Burkina Faso to $0.12 in Nigeria.
- Scenario 1 of bouillon fortification saved the most child-lives but was not the most cost-effective.
- Cost per child-life saved varied from $1272 in Burkina Faso to $3234 in Senegal for co-fortified bouillon.

## Abstract

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.

Achieving dietary adequacy in vitamin A, zinc, and/or folate can save child‐lives. Different amounts and combinations of micronutrients have different costs and different effects on child mortality. This study presents ten bouillon fortification options for Nigeria. Scenarios 7 and 8 are the most cost‐effective, but save relatively few child‐lives. Scenario 9 is the least cost‐effective. Scenarios 1, 3, 6, and 10 are similarly cost‐effective; Scenario 1 saves the most child‐lives. This information is relevant for policy discussions.