Abstract
BackgroundAbsence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries. We analyzed if the effect of invitation to food supplementation early in pregnancy combined with multiple micronutrient supplements (MMS) on infant survival represented value for money compared to invitation to food supplementation at usual time in pregnancy combined with iron-folic acid.MethodsOutcome data, infant mortality (IM) rates, came from MINIMat trial (Maternal and Infant Nutrition Interventions, Matlab, ISRCTN16581394). In MINIMat, women were randomized to early (E around 9 weeks of pregnancy) or usual invitation (U around 20 weeks) to food supplementation and daily doses of 30 mg, or 60 mg iron with 400 μgm of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 μgm of folic acid. In MINIMat, EMMS significantly reduced IM compared to UFe60F (U plus 60 mg iron 400 μgm Folic acid). We present incremental CE ratios for incrementing UFe60F to EMMS. Costing data came mainly from a published study.ResultsBy incrementing UFe60F to EMMS, one extra IM could be averted at a cost of US$907 and US$797 for NGO run and government run CNCs, respectively, and at US$1024 for a hypothetical scenario of highest cost. These comparisons generated one extra life year (LY) saved at US$30, US$27, and US$34, respectively.ConclusionsIncrementing UFe60F to EMMS in pregnancy seems worthwhile from health economic and public health standpoints.Trial registrationMaternal and Infant Nutrition Interventions, Matlab; ISRCTN16581394; Date of registration: Feb 16, 2009.
Highlights
Absence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries
In a randomized trial with the acronym Maternal and infant nutrition interventions (MINIMat) (Maternal and Infant Nutrition Interventions, Matlab) we have shown a substantial reduction in infant mortality (IM) with early invitation to prenatal food supplementation (E around week 9 pregnancy) combined with multiple micronutrients (MMS) (EMMS) compared to invitation to food supplementation at usual time (U- around week 20) in pregnancy and 60 mg iron 400 μgm folic acid (UFe60F) [15]
We present incremental cost-effectiveness ratios (ICERs) for incrementing usual invitation to food supplementation combined with ironfolic acid to invitation to food supplementation early in pregnancy combined with multiple micronutrients for women in rural Bangladesh
Summary
Absence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries. The Bangladesh Integrated Nutrition Project (BINP) and its successor National Nutrition Program (NNP) implemented food supplementation programs for malnourished pregnant and lactating women and undernourished children less than two years of age [1, 2]. It has been debated whether to move from the routine iron-folic acid supplementation in pregnancy to multiple micronutrients (MMS) in low- and middleincome settings [7]. This motivated UNICEF/WHO/ United Nations University to manufacture MMS for testing purposes under the assumption that populations in these countries are deficient in several micronutrients [7]. A meta-analysis concluded that MMS supplementation in pregnancy does not result in reduction of stillbirths or neonatal deaths, compared to ironfolic acid supplementation [12]
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