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Cost-effectiveness estimates
Evidence Action Equal Vitamin Access (EVA)
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Cost per DALY calculation
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Summary
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IndicatorsMild ModerateSevereTotalSource
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Marginal population reached 4,710,000 Monitoring data
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Number of cases averted 441,699 541,535 31,766 1,015,000 Monitoring data and DHS data
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DALY averted for morbidity 1,767 28,160 4,733 34,660 Estimated
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DALY averted for mortality without discounting3540Estimated
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Total DALYs averted without discounting 38,200 Estimated
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Total DALYs averted with discounting 36,120
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Total costs of the intervention for the year 2024$2,530,308Programme
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Costs per DALY averted without discounting 66.24 Estimated
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Costs per DALY averted with discounting 70.05 Estimated
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Monitoring data
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Comments
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Year2024
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Name of the country India
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Name of the programme Equal Vitamin Access (EVA)
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Brief description of the programmeEVA is a technical assistance program supporting the Indian government to deliver school- and anganwadi- based iron and folic acid (IFA) supplementation aimed at reducing the burden of anemia. IFA supplementation targeted to be delivered to all children 6 months – 19 years of age as part of Anemia Mukt Bharat (Anemia-free India).
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Objective of the programmeIncrease IFA coverage rates among school-aged children
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Outcome descriptionReduce anemia prevalence among school-aged children, reduce adverse birth outcomes among pregnant school-aged women
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Target group (age specific/description)School-aged children (SAC), children aged 6 months-19 years
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Total Target Population by age group/target group in number49,860,000
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Number of population reached for each group35,760,000
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Marginal population reached4,710,000
In other words, the additional number of school-aged children reached due to our programming.
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Gender distribution of the beneficiaries50% female, 50% male
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Programme start date2019
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Duration of the programme8+ yearsThe program is currently funded through 2027
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List of outcome indicators (prevention of morbidity / mortality)
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Indicator 1Anemia cases avertedIncludes mild, moderate, and severe anemia infection
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Indicator 2Deaths averted
Includes deaths due to iron deficiency in trimester 1 of pregnancy, namely neural tube defects (NTDs)
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Indicator 3DALYs averted
Disability-Adjusted Lived Year is the sum of Years of Lives Lost (from early death) plus the Years Lived with Disability
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Marginal Impact
We report on the marginal impact of our programming. To do so, we look at baseline disease burden, the increase in IFA supplementation due to our program, and the existing evidence on morbidity and mortality benefits of IFA supplementation to calculate the number of anemia cases, deaths, and subsequently, DALYs averted due to our program.
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Indicator 1 - Number of anemia cases averted1,015,00021.5%
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Indicator 2 - Number of deaths averted50
Deaths associated with iron-deficiency anemia resulting in fetus neural tube defects
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Indicator 3 - Number of DALYs averted44,000
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Total marginal cost of the program$2,530,308
This represents cost actuals billed to the program in 2024 (including salaries and all operational expenses).
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Additional costs incurred by government$0.00
Marginal government cost is based on approved state budgets (ROP) relative to 2020-2021 ROP baseline costs. Since there was no increase in government ROP expenditures the marginal government cost in 2024 was 0.
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Other statistics
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Age-standardized Life Expectancy 72WHO Life Tables
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Disability weight for mild anemia0.004GBD 2021, assuming 1 year duration, 4% discount rate
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Disability weight for moderate anemia0.052GBD 2021, assuming 1 year duration, 4% discount rate
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Disability weight for severe anemia0.149GBD 2021, assuming 1 year duration, 4% discount rate
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Disability weight for death1GBD 2021, 4% discount rate
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Life expectancy at 2.5 years of age70.8
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Discounted at 3%29.2
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Calculation
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Percentage of Anaemia case averted out of population reached21.55%
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Other
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MildModerateSevereTotalAssumptions Sources
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Anaemia prevalence under five29.235.82.167.1DHS 2021-22
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Anaemia prevalence among aged 10-19 yrs 22.28 27.32 1.60 51.2Pooled prevalence of anemia among school children (6–18 years)
Similar proportions
Prevalence of anemia in India: a systematic review, meta-analysis and geospatial analysis | BMC Public Health | Full Text
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Overall prevalence51.4863.123.70118.30
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Total estimated children by severity 43.5%53.4%3.1%100.0%
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Number of cases averted441,699541,53531,7661,015,000
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DALY YLD1,76728,1604,733
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YLL3540
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Total 38,200
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Cost per DALY averted 66.24
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