Cost-effectiveness of zinc interventions in China: A cohort-based Markov model

Zinc acts as an important cofactor in the body and is essential for normal functions. Several zinc interventions have been implemented worldwide to improve the public's zinc status, but limited studies have assessed their cost-effectiveness. To help inform decision-making on zinc interventions to maximize benefits within a fixed budget, we took China as an example and evaluated the cost-effectiveness of three interventions, that is, supplementation, food fortification, and biofortification. As an essential group at high risk of zinc deficiency, children aged 5-14 years, who account for 10% of the Chinese population, were selected as the target group in this study. We constructed a decision-analytic Markov model to determine the cost-effectiveness of interventions in China under different scenarios. In our model, biofortification through conventional breeding was shown to be the most cost-effective approach in most scenarios. Compared with other interventions, zinc supplementation gained fewer quality-adjusted life years at a higher net cost, suggesting that this common approach may not be optimal for large-scale, long-term implementation at the national level. While the robustness of the results was further confirmed by the sensitivity analysis, more research is needed to assess the cost-effectiveness of addressing zinc deficiency with other interventions. Further clinical trials are also expected to evaluate the effectiveness of zinc interventions in reducing pneumonia cases.