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Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh

Thursday, 10th of May 2018

PLoS One. 2018 Feb 15;13(2):e0191260. doi: 10.1371/journal.pone.0191260. eCollection 2018.

Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh

Svefors P¹, Selling KE¹, Shaheen R¹, Khan AI², Persson LÅ^1,3, Lindholm L⁴.

Author information

1 International Maternal and Child Health, Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden.

2 International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

3 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.

4 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Abstract

INTRODUCTION:

Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was associated with an increased risk of stunted growth in infancy and early childhood. This unfavourable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favourable (decreased under-five-years mortality) and unfavourable (increased stunting) outcomes.

METHOD:

Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation to be given food supplementation and daily doses of 30 mg, or 60 mg iron with 400 μg of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 μg of folic acid. E reduced stunting at 4.5 years compared with U, MMS increased stunting at 4.5 years compared with Fe60, while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALYs), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies.

RESULTS:

By incrementing UFe60 (standard practice) to EMMS, one DALY could be averted at a cost of US$24.

CONCLUSION:

When both favourable and unfavourable outcomes were included in the analysis, early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.