Cost-effective targets for anaemia reduction in 191 countries: a modelling study.

Background: Anaemia causes widespread health and economic harm. Current international targets for reducing anaemia in women of reproductive age, including the Sustainable Development Goal of halving prevalence by 2030, are unlikely to be met by any signatory country. This outcome suggests that current targets were grounded in aspiration rather than a systematic assessment of what is achievable given current recommended interventions and national health-care priorities. We propose a novel method of target setting for global health goals, with reducing anaemia in women of reproductive age as an example.

Methods: In this modelling study, we developed a country-level health economic model to support feasible and ambitious target-setting for anaemia for women of reproductive age (aged 15-49 years) based on cost-effectiveness analysis and applied it to 191 signatory countries. Our model integrated country-specific data on the current prevalence of anaemia, the effectiveness and current and maximal coverage of recommended interventions available to each country, the local unit costs of these interventions, and country-specific cost-effectiveness threshold estimates, including Global Burden of Disease data and data from the Demographic and Health Survey Program. Interventions were applied to maximise health gains subject to country-level cost-effectiveness thresholds at 1 × gross domestic product per capita. We assessed parameter uncertainty through Monte Carlo simulations and scenarios that considered alternative thresholds, constraints on cost, and coverage.

Findings: Our results indicate that an ambitious, achievable, and cost-effective global target for anaemia reduction in women aged 15-49 years by 2030 is 17% (95% uncertainty interval [UI] 5-34). The maximum achievable target removing all cost constraints is a 22% (11-36) reduction. No scenario approached the current 50% global Sustainable Development Goal reduction target, indicating that this goal is unachievable with existing recommended interventions. Reduction targets for individual countries ranged from 0% to 29%, with substantial variation both between and within regions and income groups.

Interpretation: Our findings suggest that a value-based global target for anaemia reduction will be substantially lower than the existing international commitment. Value-based targets using evidence from available interventions and cost-effectiveness for what is achievable given countries' differing contexts can provide better incentives for progress and offer more realistic forecasts of human development.

Funding: Gates Foundation.