Cost-effectiveness of iron supplementation and malaria chemoprophylaxis inthe prevention of anaemia and malaria among Tanzanian infants

Prerequisites for effective interventions against severe anaemia and malari a among infants are economic evaluations to aid the setting of priorities a nd the making of health policy. in the present study we analysed the cost a nd effectiveness of three control strategies hypothetically delivered throu gh the Expanded Programme on Immunization (EPI). For the prevention of seve re anaemia and from the perspective of the health provider, the cost-effect iveness ratios were, respectively, US$ 8, US$ 9, and US$ 21 per disability- adjusted life year (DALY) for malaria chemoprophylaxis with Deltaprim (a co mbination of 3.125 mg pyrimethamine and 25 mg dapsone) + iron, Deltaprim al one, or iron supplementation alone. For malaria prevention, Deltaprim + iro n cost US$ 9.7 per DALY and Deltaprim alone cost US$ 10.2 per DALY. From a sociocultural perspective the cost-effectiveness ratios ranged from US$ 9 t o US$ 26 for severe anaemia prevention and from US$ 11 to US$ 12 for the pr evention of clinical malaria. These ratios were highly cost-effective, as d efined by the World Bank's proposed threshold of less than US$ 25 per DALY for comparative assessments. Furthermore, all the preventive interventions were less costly than the current malaria and anaemia control strategies th at rely on clinical case management. This economic analysis supports the in clusion of both malaria chemoprophylaxis and iron supplementation delivered through EPI as part of the control strategies for these major killers of i nfants in parts of sub-Saharan Africa.