Resetting global health goals: modelling cost-effective targets for anaemia reduction

BackgroundAnaemia causes widespread health and economic harms. 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 country. This suggests that current targets were grounded in aspiration rather than a systematic assessment of what is achievable given current recommended interventions and national healthcare priorities.MethodsWe develop a country-level health economic model to support feasible and ambitious target-setting for anaemia based on cost-effectiveness, applied to 191 countries. Our model integrates country-specific data on prevalence, intervention costs, effectiveness and coverage. Interventions are applied to maximise health gains subject to country-level cost-effectiveness thresholds at 1 × gross domestic product per capita. We assess parameter uncertainty through Monte Carlo simulations and scenarios that consider alternative thresholds, constraints on cost, and coverage.FindingsOur results indicate that an ambitious, achievable and cost-effective global target for anaemia reduction is 17% [95% uncertainty interval: 5% – 34%]. The maximum achievable target is a 22% [11% - 36%] reduction. No scenario approached the current 50% global reduction target, indicating that this goal is unachievable with existing recommended interventions. Targets for individual countries ranged from 0% to 29%, with substantial variation both between and within regions and income groups. InterpretationOur findings suggest that a value-based global target for anaemia reduction will be significantly lower than existing international commitments. Value-based targets using evidence about what is achievable given existing interventions and countries’ differing contexts can provide better incentives for progress and offer more realistic forecasts of human development.