Micronutrient program costs: sources of variations and noncomparabilities.

BACKGROUND: Micronutrient interventions are contributing to substantial reductions in global morbidity and mortality. As the diversity and coverage of these interventions expand, it is increasingly important to understand their distinct roles and contributions, and the resources they require. To date, comparing program resource use has been hampered by several noncomparabilities in cost studies relating to diverse intervention activities and service delivery pathways, along with differences in methodological approaches.
OBJECTIVE: To promote better understanding of the variations and noncomparabilities in costs and cost structures of micronutrient interventions.
METHODS: Cost studies on supplementation, fortification and biofortification programs from the published and gray literature were reviewed (n = 130).
RESULTS: Specific areas of noncomparability identified include intervention characteristics and country context, as well as differences in methodological considerations, including data sources and definition of cost centers. Moreover, analyses vary significantly in terms of types of costs included. Implications and practical recommendations for standardizing future costing studies are provided.
CONCLUSIONS: Methodological variations and non-comparabilities do much more than limit the ability to make direct comparisons of costing studies; they carry important implications for the adoption, design, and implementation of interventions in countries suffering from micronutrient deficiencies. This study synthesizes evidence on the level of support required (both financial and otherwise) for programs to achieve desirable levels of coverage and performance. Having comparable and accurate estimates of costs is a necessary first step in planning for and implementing interventions that are of adequate scale and adequately resourced.